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Reecher HM, Bearden DJ, Koop JI, Berl MM, Patrick KE, Ailion AS. The changing landscape of electrical stimulation language mapping with subdural electrodes and stereoelectroencephalography for pediatric epilepsy: A literature review and commentary. Epilepsia 2024; 65:1879-1898. [PMID: 38787551 DOI: 10.1111/epi.18009] [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: 01/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Electrical stimulation mapping (ESM) is used to locate the brain areas supporting language directly within the human cortex to minimize the risk of functional decline following epilepsy surgery. ESM is completed by utilizing subdural grid or depth electrodes (stereo-electroencephalography [sEEG]) in combination with behavioral evaluation of language. Despite technological advances, there is no standardized method of assessing language during pediatric ESM. To identify current clinical practices for pediatric ESM of language, we surveyed neuropsychologists in the Pediatric Epilepsy Research Consortium. Results indicated that sEEG is used for functional mapping at >80% of participating epilepsy surgery centers (n = 13/16) in the United States. However, >65% of sites did not report a standardized protocol to map language. Survey results indicated a clear need for practice recommendations regarding ESM of language. We then utilized PubMed/Medline and PsychInfo to identify 42 articles that reported on ESM of language, of which 18 met inclusion criteria, which included use of ESM/signal recording to localize language regions in children (<21 years) and a detailed account of the procedure and language measures used, and region-specific language localization outcomes. Articles were grouped based on the language domain assessed, language measures used, and the brain regions involved. Our review revealed the need for evidence-based clinical guidelines for pediatric language paradigms during ESM and a standardized language mapping protocol as well as standardized reporting of brain regions in research. Relevant limitations and future directions are discussed with a focus on considerations for pediatric language mapping.
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Affiliation(s)
- Hope M Reecher
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald J Bearden
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer I Koop
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Department of Neuropsychology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Madison M Berl
- Department of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Kristina E Patrick
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Neuroscience, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alyssa S Ailion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Osawa SI, Suzuki K, Ukishiro K, Kakinuma K, Ishida M, Niizuma K, Shimoda Y, Kikuchi H, Kochi R, Jin K, Matsumoto Y, Uematsu M, Nakasato N, Endo H, Tominaga T. Super-selective injection of propofol into the intracranial arteries enables Patient's self-evaluation of expected neurological deficit. Cortex 2024; 176:209-220. [PMID: 38805783 DOI: 10.1016/j.cortex.2024.04.016] [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: 01/22/2024] [Revised: 03/23/2024] [Accepted: 04/19/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION It is hard to realize the extent of the expected postoperative neurological deficit for patients themselves. The provision of appropriate information can contribute not only to examining surgical indications but also to filling the gap between patient and expert expectations. We hypothesized that propofol infusion into the intracranial arteries (ssWada) could induce focal neurological symptoms with preserved wakefulness, enabling the patients to evaluate the postsurgical risk subjectively. METHODS Presurgical evaluation using ssWada was performed in 28 patients with drug-resistant epilepsy. Based on anatomical knowledge, propofol was super-selectively infused into the intracranial arteries including the M1, M2, and M3 segments of the middle cerebral artery (MCA), A2 segment of the anterior cerebral artery, and P2 segment of the posterior cerebral artery to evaluate the neurological and cognitive symptoms. We retrospectively analyzed a total of 107 infusion trials, including their target vessels, and elicited symptoms of motor weakness, sensory disturbance, language, unilateral hemispatial neglect (UHN), and hemianopsia. We evaluated preserved wakefulness which enabled subjective evaluations of the symptoms and comparison of the subjective experience to the objective findings, besides adverse effects during the procedure. RESULTS Preserved wakefulness was found in 97.2% of all trials. Changes in neurological symptoms were positively evaluated for motor weakness in 51.4%, sensory disturbance in 5.6%, language in 48.6%, UHN in 22.4%, and hemianopsia in 32.7%. Six trials elicited seizures. Multivariate analysis showed significant correlations between symptom and infusion site of language and left side, language and MCA branches, motor weakness and A2 or M2 superior division, and hemianopsia and P2. Transient adverse effect was observed in 8 cases with 12 infusion trials (11.2 %). CONCLUSION The ssWada could elicit focal neurological symptoms with preserved wakefulness. The methodology enables specific evaluation of risk for cortical resection and subjective evaluation of the expected outcome by the patients.
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Affiliation(s)
- Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Kyoko Suzuki
- Department of Behavioral and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuo Kakinuma
- Department of Behavioral and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ishida
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hana Kikuchi
- Department of Behavioral and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryuzaburo Kochi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasushi Matsumoto
- Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Jensen MA, Fine A, Kerezoudis P, Wong Kisiel L, Alden E, Hermes D, Miller KJ. Functional Mapping of Movement and Speech Using Task-Based Electrophysiological Changes in Stereoelectroencephalography. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.29.582865. [PMID: 38496670 PMCID: PMC10942370 DOI: 10.1101/2024.02.29.582865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Stereoelectroencephalography (sEEG) has become the predominant method for intracranial seizure localization. When imaging, semiology, and scalp EEG are not in full agreement or definitively localizing, implanted sEEG recordings are used to test candidate seizure onset zones (SOZs). Discovered SOZs may then be targeted for resection, laser ablation, or neurostimulation. If a SOZ is eloquent, resection and ablation are both contraindicated, so identifying functional representation is crucial for therapeutic decision making. Objective We present a novel functional brain mapping technique that utilizes task-based electrophysiological changes in sEEG during behavioral tasks and test this in pediatric and adult patients. Methods sEEG was recorded in twenty patients with epilepsy, aged 6-39 (12 female, 18 of 20 patients < 21 years old), who underwent implanted monitoring to identify seizure onset. Each performed 1) visually cued simple repetitive movements of the hand, foot, or tongue while electromyography was recorded, and 2) simple picture naming or verb generation speech tasks while audio was recorded. Broadband changes in the power spectrum of the sEEG were compared between behavior and rest. Results Electrophysiological functional mapping of movement and/or speech areas was completed in all 20 patients. Eloquent representation was identified in both cortex and white matter, and generally corresponded to classically described functional anatomic organization as well as other clinical mapping results. Robust maps of brain activity were identified in healthy brain, regions of developmental or acquired structural abnormality, and SOZs. Conclusion Task based electrophysiological mapping using broadband changes in the sEEG signal reliably identifies movement and speech representation in pediatric and adult epilepsy patients.
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Otomo M, Osawa SI, Suzuki K, Kakinuma K, Ukishiro K, Suzuki H, Niizuma K, Narita N, Nakasato N, Tominaga T. Bilateral and asymmetrical localization of language function identified by the superselective infusion of propofol in an epilepsy patient with a mild malformation of cortical development: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23451. [PMID: 38145562 PMCID: PMC10751223 DOI: 10.3171/case23451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/16/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Atypical localization of language function can result in unexpected postsurgical deficits after cortical resection, but it is difficult to predict the risk in the presurgical evaluation. The authors experienced a rare case of the bilateral and independent existence of different components of language function identified by segmented evaluation of anatomical anterior and posterior language areas using the superselective infusion of propofol. OBSERVATIONS A 32-year-old right-handed female presented with drug-resistant epilepsy. Comprehensive epilepsy evaluation suggested that the epileptic foci involved the whole left frontal lobe but provided less evidence of structural abnormality. To estimate the extent of functional deterioration likely to be caused by an extended left frontal lobectomy, the authors evaluated segmented cortical function in the ipsi- and contralateral hemispheres by the superselective infusion of propofol into the branches of the intracranial artery. The results revealed bilateral and asymmetrical localization of language function because the patient presented with different components of aphasia in each hemisphere. Based on the authors' assessment of her functional tolerance, an extended left frontal lobectomy was performed and resulted in neurological deficits within the anticipated range. LESSONS An accurate understanding of the correlations between vascular and functional anatomy and the highly specific evaluation of language function provides more advanced presurgical assessment, allowing more tailored planning of cortical resection.
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Affiliation(s)
| | | | | | | | | | - Hiroyoshi Suzuki
- Department of Pathology, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Departments of Neurosurgery
- Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan; and
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
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Frauscher B, Bartolomei F, Baud MO, Smith RJ, Worrell G, Lundstrom BN. Stimulation to probe, excite, and inhibit the epileptic brain. Epilepsia 2023; 64 Suppl 3:S49-S61. [PMID: 37194746 PMCID: PMC10654261 DOI: 10.1111/epi.17640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Direct cortical stimulation has been applied in epilepsy for nearly a century and has experienced a renaissance, given unprecedented opportunities to probe, excite, and inhibit the human brain. Evidence suggests stimulation can increase diagnostic and therapeutic utility in patients with drug-resistant epilepsies. However, choosing appropriate stimulation parameters is not a trivial issue, and is further complicated by epilepsy being characterized by complex brain state dynamics. In this article derived from discussions at the ICTALS 2022 Conference (International Conference on Technology and Analysis for Seizures), we succinctly review the literature on cortical stimulation applied acutely and chronically to the epileptic brain for localization, monitoring, and therapeutic purposes. In particular, we discuss how stimulation is used to probe brain excitability, discuss evidence on the usefulness of stimulation to trigger and stop seizures, review therapeutic applications of stimulation, and finally discuss how stimulation parameters are impacted by brain dynamics. Although research has advanced considerably over the past decade, there are still significant hurdles to optimizing use of this technique. For example, it remains unclear to what extent short timescale diagnostic biomarkers can predict long-term outcomes and to what extent these biomarkers add information to already existing biomarkers from passive electroencephalographic recordings. Further questions include the extent to which closed loop stimulation offers advantages over open loop stimulation, what the optimal closed loop timescales may be, and whether biomarker-informed stimulation can lead to seizure freedom. The ultimate goal of bioelectronic medicine remains not just to stop seizures but rather to cure epilepsy and its comorbidities.
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Affiliation(s)
- Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France. AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, Marseille, France
| | - Maxime O. Baud
- Sleep-Wake-Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern
| | - Rachel J. Smith
- University of Alabama at Birmingham, Electrical and Computer Engineering Department, Birmingham, Alabama, US. University of Alabama at Birmingham, Neuroengineering Program, Birmingham, Alabama, US
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, US
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Volfart A, Rossion B, Yan X, Angelini L, Maillard L, Colnat-Coulbois S, Jonas J. Intracerebral electrical stimulation of the face-selective right lateral fusiform gyrus transiently impairs face identity recognition. Neuropsychologia 2023; 190:108705. [PMID: 37839512 DOI: 10.1016/j.neuropsychologia.2023.108705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Neuroimaging and intracranial electrophysiological studies have consistently shown the largest and most consistent face-selective neural activity in the middle portion of the human right lateral fusiform gyrus ('fusiform face area(s)', FFA). Yet, direct evidence for the critical role of this region in face identity recognition (FIR) is still lacking. Here we report the first evidence of transient behavioral impairment of FIR during focal electrical stimulation of the right FFA. Upon stimulation of an electrode contact within this region, subject CJ, who shows typical FIR ability outside of stimulation, was transiently unable to point to pictures of famous faces among strangers and to match pictures of famous or unfamiliar faces presented simultaneously for their identity. Her performance at comparable tasks with other visual materials (written names, pictures of buildings) remained unaffected by stimulation at the same location. During right FFA stimulation, CJ consistently reported that simultaneously presented faces appeared as being the same identity, with little or no distortion of the spatial face configuration. Independent electrophysiological recordings showed the largest neural face-selective and face identity activity at the critical electrode contacts. Altogether, this extensive multimodal case report supports the causal role of the right FFA in FIR.
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Affiliation(s)
- Angélique Volfart
- Université de Lorraine, CNRS, F-54000, Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348, Louvain-La-Neuve, Belgium; Queensland University of Technology, Faculty of Health, School of Psychology & Counselling, 4059, Brisbane, Australia
| | - Bruno Rossion
- Université de Lorraine, CNRS, F-54000, Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348, Louvain-La-Neuve, Belgium; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000, Nancy, France.
| | - Xiaoqian Yan
- Université de Lorraine, CNRS, F-54000, Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348, Louvain-La-Neuve, Belgium; Fudan University, Institute of Science and Technology for Brain-Inspired Intelligence, 200433, Shanghai, China
| | - Luna Angelini
- Université de Lorraine, CNRS, F-54000, Nancy, France
| | - Louis Maillard
- Université de Lorraine, CNRS, F-54000, Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000, Nancy, France
| | - Sophie Colnat-Coulbois
- Université de Lorraine, CNRS, F-54000, Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurochirurgie, F-54000, Nancy, France
| | - Jacques Jonas
- Université de Lorraine, CNRS, F-54000, Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000, Nancy, France
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Cockle E, Rayner G, Malpas C, Alpitsis R, Rheims S, O'Brien TJ, Neal A. An international survey of SEEG cortical stimulation practices. Epilepsia Open 2023; 8:1084-1095. [PMID: 37437189 PMCID: PMC10472359 DOI: 10.1002/epi4.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Cortical stimulation is an important component of stereoelectroencephalography (SEEG). Despite this, there is currently no standardized approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability. METHODS A 68-item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians. RESULTS Responses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years (M = 10.73, SD = 9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3 to 10 mA (M = 5.33, SD = 2.29) for 1 Hz and from 2 to 15 mA (M = 6.54, SD = 3.68) for 50 Hz stimulation. Charge density ranged from 8 to 200 μC/cm2 , with up to 43% of responders utilizing charge densities higher than recommended upper safety limits, i.e. 55 μC/cm2 . North American responders reported statistically significant higher maximum current (P < 0.001) for 1 Hz stimulation and lower pulse width for 1 and 50 Hz stimulation (P = 0.008, P < 0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation; in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites, and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localizing capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1 Hz stimulation considered the most localizing. SIGNIFICANCE SEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus-based clinical guidelines. In particular, an internationally standardized approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimizing outcomes for people with drug-resistant epilepsy.
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Affiliation(s)
- Emily Cockle
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Genevieve Rayner
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Charles Malpas
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Rubina Alpitsis
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Sylvain Rheims
- Lyon Neurosciences Research Center (Inserm U1028, CNRS UMR5292, Lyon 1 University)LyonFrance
- Department of Functional Neurology and EpileptologyHospices Civils de Lyon and Lyon 1 UniversityLyonFrance
- Epilepsy Institute and member of the ERN EpiCARELyonFrance
| | - Terence J O'Brien
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Andrew Neal
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
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Aungaroon G, Vedala K, Byars AW, Ervin B, Rozhkov L, Horn PS, Ihnen S, Holland KD, Tenney JR, Kremer K, Fong SL, Lin N, Liu W, Arthur TM, Fujiwara H, Skoch J, Leach JL, Mangano FT, Greiner HM, Arya R. Comparing electrical stimulation functional mapping with subdural electrodes and stereoelectroencephalography. Epilepsia 2023; 64:1527-1540. [PMID: 36872854 PMCID: PMC10239361 DOI: 10.1111/epi.17575] [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: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Electrical stimulation mapping (ESM) is the clinical standard for functional localization with subdural electrodes (SDE). As stereoelectroencephalography (SEEG) has emerged as an alternative option, we compared functional responses, afterdischarges (ADs), and unwanted ESM-induced seizures (EISs) between the two electrode types. METHODS Incidence and current thresholds for functional responses (sensory, motor, speech/language), ADs, and EISs were compared between SDE and SEEG using mixed models incorporating relevant covariates. RESULTS We identified 67 SEEG ESM and 106 SDE ESM patients (7207 and 4980 stimulated contacts, respectively). We found similar incidence of language and motor responses between electrode types; however, more SEEG patients reported sensory responses. ADs and EISs occurred less commonly with SEEG than SDE. Current thresholds for language, face motor, and upper extremity (UE) motor responses and EIS significantly decreased with age. However, they were not affected by electrode type, premedication, or dominant hemispheric stimulation. AD thresholds were higher with SEEG than with SDE. For SEEG ESM, language thresholds remained below AD thresholds up to 26 years of age, whereas this relationship was inverse for SDE. Also, face and UE motor thresholds fell below AD thresholds at earlier ages for SEEG than SDE. AD and EIS thresholds were not affected by premedication. SIGNIFICANCE SEEG and SDE have clinically relevant differences for functional brain mapping with electrical stimulation. Although evaluation of language and motor regions is comparable between SEEG and SDE, SEEG offers a higher likelihood of identifying sensory areas. A lower incidence of ADs and EISs, and a favorable relationship between functional and AD thresholds suggest superior safety and neurophysiologic validity for SEEG ESM than SDE ESM.
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Affiliation(s)
- Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kishore Vedala
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Anna W. Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Paul S. Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - S.K.Z. Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katherine D. Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susan L. Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Todd M. Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Hisako Fujiwara
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - James L. Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neuroradiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Francesco T. Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Hansel M. Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
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Bernabei JM, Li A, Revell AY, Smith RJ, Gunnarsdottir KM, Ong IZ, Davis KA, Sinha N, Sarma S, Litt B. Quantitative approaches to guide epilepsy surgery from intracranial EEG. Brain 2023; 146:2248-2258. [PMID: 36623936 PMCID: PMC10232272 DOI: 10.1093/brain/awad007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Over the past 10 years, the drive to improve outcomes from epilepsy surgery has stimulated widespread interest in methods to quantitatively guide epilepsy surgery from intracranial EEG (iEEG). Many patients fail to achieve seizure freedom, in part due to the challenges in subjective iEEG interpretation. To address this clinical need, quantitative iEEG analytics have been developed using a variety of approaches, spanning studies of seizures, interictal periods, and their transitions, and encompass a range of techniques including electrographic signal analysis, dynamical systems modeling, machine learning and graph theory. Unfortunately, many methods fail to generalize to new data and are sensitive to differences in pathology and electrode placement. Here, we critically review selected literature on computational methods of identifying the epileptogenic zone from iEEG. We highlight shared methodological challenges common to many studies in this field and propose ways that they can be addressed. One fundamental common pitfall is a lack of open-source, high-quality data, which we specifically address by sharing a centralized high-quality, well-annotated, multicentre dataset consisting of >100 patients to support larger and more rigorous studies. Ultimately, we provide a road map to help these tools reach clinical trials and hope to improve the lives of future patients.
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Affiliation(s)
- John M Bernabei
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adam Li
- Department of Computer Science, Columbia University, New York, NY 10027, USA
| | - Andrew Y Revell
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Neuroengineering Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kristin M Gunnarsdottir
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ian Z Ong
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathryn A Davis
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nishant Sinha
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sridevi Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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10
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Miller KJ, Fine AL. Decision-making in stereotactic epilepsy surgery. Epilepsia 2022; 63:2782-2801. [PMID: 35908245 PMCID: PMC9669234 DOI: 10.1111/epi.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Surgery can cure or significantly improve both the frequency and the intensity of seizures in patients with medication-refractory epilepsy. The set of diagnostic and therapeutic interventions involved in the path from initial consultation to definitive surgery is complex and includes a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, and neuropsychologists, supported by a very large epilepsy-dedicated clinical architecture. In recent years, new practices and technologies have emerged that dramatically expand the scope of interventions performed. Stereoelectroencephalography has become widely adopted for seizure localization; stereotactic laser ablation has enabled more focal, less invasive, and less destructive interventions; and new brain stimulation devices have unlocked treatment of eloquent foci and multifocal onset etiologies. This article articulates and illustrates the full framework for how epilepsy patients are considered for surgical intervention, with particular attention given to stereotactic approaches.
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Affiliation(s)
- Kai J. Miller
- Neurosurgery, Mayo Clinic, 200 First St., Rochester, MN, 55902
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11
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Holloway T, Leach JL, Tenney JR, Byars AW, Horn PS, Greiner HM, Mangano FT, Holland KD, Arya R. Functional MRI and electrical stimulation mapping for language localization: A comparative meta-analysis. Clin Neurol Neurosurg 2022; 222:107417. [DOI: 10.1016/j.clineuro.2022.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
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12
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Samanta D. Recent developments in stereo electroencephalography monitoring for epilepsy surgery. Epilepsy Behav 2022; 135:108914. [PMID: 36116362 DOI: 10.1016/j.yebeh.2022.108914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
Recently the utilization of the stereo electroencephalography (SEEG) method has exploded globally. It is now the preferred method of intracranial monitoring for epilepsy. Since its inception, the basic tenet of the SEEG method remains the same: strategic implantation of intracerebral electrodes based on a hypothesis grounded on anatomo-electroclinical correlation, interpretation of interictal and ictal abnormalities, and formation of a surgical plan based on these data. However, there are recent advancements in all these domains-electrodes implantations, data interpretation, and therapeutic strategy- that can make the SEEG a more accessible and effective approach. In this narrative review, these newer developments are discussed and summarized. Regarding implantation, efficient commercial robotic systems are now increasingly available, which are also more accurate in implanting electrodes. In terms of ictal and interictal abnormalities, newer studies focused on correlating these abnormalities with pathological substrates and surgical outcomes and analyzing high-frequency oscillations and cortical-subcortical connectivity. These abnormalities can now be further quantified using advanced tools (spectrum, spatiotemporal, connectivity analysis, and machine learning algorithms) for objective and efficient interpretation. Another aspect of recent development is renewed interest in SEEG-based electrical stimulation mapping (ESM). The SEEG-ESM has been used in defining epileptogenic networks, mapping eloquent cortex (primarily language), and analyzing cortico-cortical evoked potential. Regarding SEEG-guided direct therapeutic strategy, several clinical studies evaluated the use of radiofrequency thermocoagulation. As the emerging SEEG-based diagnosis and therapeutics are better evolved, treatments aimed at specific epileptogenic networks without compromising the eloquent cortex will become more easily accessible to improve the lives of individuals with drug-resistant epilepsy (DRE).
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
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13
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Li H, Ren Y, Meng Q, Liu Y, Wu H, Dong S, Liu X, Zhang H. Stimulation induced aura during subdural recording: A useful predictor of postoperative outcome in refractory epilepsy. Seizure 2022; 101:149-155. [PMID: 36027686 DOI: 10.1016/j.seizure.2022.08.004] [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: 05/12/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electrical cortical stimulation (ECS) is a routine procedure commonly conducted in intracranial EEG (iEEG) monitoring in refractory epilepsy and associated with postoperative outcome in stereoelectroencephalography (SEEG) exploration. To better understand this effective method, this study aimed to examine the role of ECS in subdural recording. METHODS The ECS results of 144 consecutive patients who were monitored via subdural electrodes and received epilepsy surgery were retrospectively collected. The occurrence of stimulation induced aura (SIA) and seizure (SIS) and their distributions as well as their associations with postoperative outcomes were analyzed. RESULTS Among all 144 patients, 47.2% (68/144) achieved Engel class I recovery with a mean follow-up of 6.6±2.2 years (2.0-9.8 years). The percentages of patients who showed SIA and SIS were 16.0% (23/144) and 43.8% (63/144), respectively. Our data indicated that 30.4% (42/138) of SIS occurred in frontal lobe, which was significantly higher than the 7.7% (10/130) occurred in temporal lobe and the 8.5% (11/129) in parieto-occipital region (p<0.001). Meanwhile, no such distribution difference was discovered in SIA (p=0.229). Univariate and multifactorial analyses showed that SIA was the only independent predictor for postoperative outcome and patients with SIA were 4.8 times more likely to achieve seizure-free (95% CI 1.557-14.789, p = 0.006). CONCLUSIONS Our study demonstrated that SIS sites are more likely to be located in the frontal lobe and SIA independently predicts optimal postoperative outcome in subdural recording.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Yutao Ren
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Qiang Meng
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Yong Liu
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Hao Wu
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Shan Dong
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Xiaofang Liu
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China.
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Volfart A, Yan X, Maillard L, Colnat-Coulbois S, Hossu G, Rossion B, Jonas J. Intracerebral electrical stimulation of the right anterior fusiform gyrus impairs human face identity recognition. Neuroimage 2022; 250:118932. [PMID: 35085763 DOI: 10.1016/j.neuroimage.2022.118932] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 01/23/2023] Open
Abstract
Brain regions located between the right fusiform face area (FFA) in the middle fusiform gyrus and the temporal pole may play a critical role in human face identity recognition but their investigation is limited by a large signal drop-out in functional magnetic resonance imaging (fMRI). Here we report an original case who is suddenly unable to recognize the identity of faces when electrically stimulated on a focal location inside this intermediate region of the right anterior fusiform gyrus. The reliable transient identity recognition deficit occurs without any change of percept, even during nonverbal face tasks (i.e., pointing out the famous face picture among three options; matching pictures of unfamiliar or familiar faces for their identities), and without difficulty at recognizing visual objects or famous written names. The effective contact is associated with the largest frequency-tagged electrophysiological signals of face-selectivity and of familiar and unfamiliar face identity recognition. This extensive multimodal investigation points to the right anterior fusiform gyrus as a critical hub of the human cortical face network, between posterior ventral occipito-temporal face-selective regions directly connected to low-level visual cortex, the medial temporal lobe involved in generic memory encoding, and ventral anterior temporal lobe regions holding semantic associations to people's identity.
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Affiliation(s)
- Angélique Volfart
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348 Louvain-La-Neuve, Belgium
| | - Xiaoqian Yan
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348 Louvain-La-Neuve, Belgium; Stanford University, Department of Psychology, CA 94305 Stanford, USA
| | - Louis Maillard
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000 Nancy, France
| | - Sophie Colnat-Coulbois
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurochirurgie, F-54000 Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, CHRU-Nancy, CIC-IT, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France
| | - Bruno Rossion
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; University of Louvain, Psychological Sciences Research Institute, B-1348 Louvain-La-Neuve, Belgium; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000 Nancy, France
| | - Jacques Jonas
- Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, F-54000 Nancy, France.
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15
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Minkin K, Gabrovski K, Karazapryanov P, Milenova Y, Sirakov S, Dimova P. Theoretical stereoelectroencephalography density on the brain convexity. Epilepsy Res 2022; 179:106845. [PMID: 34968894 DOI: 10.1016/j.eplepsyres.2021.106845] [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: 09/28/2021] [Revised: 12/05/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Invasive electroencephalography (EEG) remains the "gold standard" for diagnosing the epileptogenic zone in patients with drug-resistant epilepsy and discrepancies between seizure semiology, video-EEG and magnetic resonance imaging (MRI) findings. However, the possibilities of stereoelectroencephalography (SEEG) to explore the brain surface remain a matter of debate and subdural EEG (SDEEG) is still preferred in some centers for cases when the supposed epileptogenic zone is on the brain convexity. The aim of our study was to evaluate the theoretical safe SEEG coverage on the brain convexity and to compare the theoretical SEEG cortical density with the usual SDEEG density. MATERIALS AND METHODS Our material included 10 hemispheres in 5 patients, who had been already investigated with SEEG for drug-resistant epilepsy. We translated our previously described technique in a theoretical model in an attempt to calculate the maximal number of avascular windows for each cerebral hemisphere. The distance between every entry point and the other entry points for each hemisphere was calculated using a mathematical formula. Subsequently, the theoretical SEEG coverage on the brain convexity was described using the maximal, minimal and average distances between each entry point and the closest 4 neighboring points. This type of measurement allows a direct comparison between SEEG and SDEEG in their ability to explore the brain convexity. RESULTS Ten hemispheres had 1328 safe entry points with a safety margin of 2.5 mm and a minimal distance of 2.5 mm between 2 entry points (average number of entry points: 132.8 (SD ± 5). The number of entry points in the explored 10 hemispheres varied from 104 to 156. The average distance between each entry point and its 4 neighbors was 11.47 mm. The maximal distance between two entry points in these 10 hemispheres was ranging from 20.28 to 27.23 mm (average: 24.67 mm). The closest entry points for the explored hemispheres were at an average distance of 4.67 mm (range: 2.82 - 5.96 mm). The average convexity surface was 223.68 cm2 (range: 204.63-238.77 cm2). The safe electrode density without electrode collision on the cortical surface was ranging from 0.46 to 0.69 electrodes per cm2 (average: 0.59 electrodes per cm2) (SD ± 0.023). CONCLUSION The theoretical SEEG cortical density is comparable with the usual SDEEG density. These findings, combined with the better safety profile of SEEG and the possibilities to explore deep cortical structures, explain the progressive shift from SDEEG to SEEG during the last years.
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Affiliation(s)
- Krasimir Minkin
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Petar Karazapryanov
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Yoana Milenova
- Department of Neurology, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Stanimir Sirakov
- Department of Interventional Radiology, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Petia Dimova
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
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Li H, Dong S, Meng Q, Liu Y, Du C, Li K, Liu X, Wu H, Zhang H. Disparate properties of afterdischarges elicited by electric cortical stimulation in MRI lesional epilepsy patients with different surgical outcomes. Clin Neurol Neurosurg 2021; 212:107034. [PMID: 34863054 DOI: 10.1016/j.clineuro.2021.107034] [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: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to demonstrate the prognostic value of afterdischarges(ADs) on surgical outcome by comparing the disparate properties in epilepsy patients with different surgical outcomes METHODS: 27 lesional epilepsy patients were retrospectively analyzed. The brain region covered by subdural electrodes in each patient was dichotomized into the area of the brain lobe(s) where the MRI lesion is located (region ML) and other brain areas (region nML). The occurrence of ADs and ADs evolving into clinical seizure, ADs threshold and ADs duration in region ML and nML were compared between seizure-free (SF) and non-seizure-free (nSF) patients. RESULTS A total of 2535 contacts were analyzed, and the total occurrence of ADs was 18.6% (471/2535). The overall occurrence of ADs in region ML (24.8%) was significantly higher than that in region nML (10.3%) (P < 0.001). In region ML, compared with SF patients, nSF patients had a lower occurrence of ADs (19.2% vs. 31.2%, P < 0.001), a higher occurrence of ADs evolves into clinical seizure (8.7% vs. 2.4%, P = 0.006), a higher ADs threshold (12.8 ± 4.1 mA vs. 11.0 ± 3.7 mA, P < 0.001) and a shorter ADs duration (15.3 ± 14.2 s vs. 20.6 ± 17.0 s, P < 0.001). However, in region nML, there was no significant difference in properties of ADs between SF and nSF patients. CONCLUSION Higher occurrence of ADs in region ML might predict a good outcome, whereas higher occurrence of ADs evolving into clinical seizure, higher ADs threshold and shorter ADs duration might predict an unfavorable surgical outcome. ADs might help predict surgical outcomes in epilepsy patients.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Shan Dong
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Qiang Meng
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Yong Liu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Changwang Du
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Kuo Li
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Xiaofang Liu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Hao Wu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710048, China.
| | - Hua Zhang
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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17
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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Makarov SN, Golestanirad L, Wartman WA, Nguyen BT, Noetscher GM, Ahveninen JP, Fujimoto K, Weise K, Nummenmaa AR. Boundary element fast multipole method for modeling electrical brain stimulation with voltage and current electrodes. J Neural Eng 2021; 18. [PMID: 34311449 DOI: 10.1088/1741-2552/ac17d7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023]
Abstract
Objective. To formulate, validate, and apply an alternative to the finite element method (FEM) high-resolution modeling technique for electrical brain stimulation-the boundary element fast multipole method (BEM-FMM). To include practical electrode models for both surface and embedded electrodes.Approach. Integral equations of the boundary element method in terms of surface charge density are combined with a general-purpose fast multipole method and are expanded for voltage, shunt, current, and floating electrodes. The solution of coupled and properly weighted/preconditioned integral equations is accompanied by enforcing global conservation laws: charge conservation law and Kirchhoff's current law.Main results.A sub-percent accuracy is reported as compared to the analytical solutions and simple validation geometries. Comparison to FEM considering realistic head models resulted in relative differences of the electric field magnitude in the range of 3%-6% or less. Quantities that contain higher order spatial derivatives, such as the activating function, are determined with a higher accuracy and a faster speed as compared to the FEM. The method can be easily combined with existing head modeling pipelines such as headreco or mri2mesh.Significance.The BEM-FMM does not rely on a volumetric mesh and is therefore particularly suitable for modeling some mesoscale problems with submillimeter (and possibly finer) resolution with high accuracy at moderate computational cost. Utilizing Helmholtz reciprocity principle makes it possible to expand the method to a solution of EEG forward problems with a very large number of cortical dipoles.
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Affiliation(s)
- Sergey N Makarov
- Electrical & Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609, United States of America.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Laleh Golestanirad
- Biomedical Engineering and Radiology Depts., Northwestern University, Chicago, IL 60611, United States of America
| | - William A Wartman
- Electrical & Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609, United States of America
| | - Bach Thanh Nguyen
- Biomedical Engineering and Radiology Depts., Northwestern University, Chicago, IL 60611, United States of America
| | - Gregory M Noetscher
- Electrical & Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609, United States of America
| | - Jyrki P Ahveninen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Kyoko Fujimoto
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD 20993, United States of America
| | - Konstantin Weise
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany
| | - Aapo R Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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Trébuchon A, Alario FX, Liégeois-Chauvel C. Functional Topography of Auditory Areas Derived From the Combination of Electrophysiological Recordings and Cortical Electrical Stimulation. Front Hum Neurosci 2021; 15:702773. [PMID: 34489664 PMCID: PMC8418073 DOI: 10.3389/fnhum.2021.702773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
The posterior part of the superior temporal gyrus (STG) has long been known to be a crucial hub for auditory and language processing, at the crossroad of the functionally defined ventral and dorsal pathways. Anatomical studies have shown that this "auditory cortex" is composed of several cytoarchitectonic areas whose limits do not consistently match macro-anatomic landmarks like gyral and sulcal borders. The only method to record and accurately distinguish neuronal activity from the different auditory sub-fields of primary auditory cortex, located in the tip of Heschl and deeply buried in the Sylvian fissure, is to use stereotaxically implanted depth electrodes (Stereo-EEG) for pre-surgical evaluation of patients with epilepsy. In this prospective, we focused on how anatomo-functional delineation in Heschl's gyrus (HG), Planum Temporale (PT), the posterior part of the STG anterior to HG, the posterior superior temporal sulcus (STS), and the region at the parietal-temporal boundary commonly labeled "SPT" can be achieved using data from electrical cortical stimulation combined with electrophysiological recordings during listening to pure tones and syllables. We show the differences in functional roles between the primary and non-primary auditory areas, in the left and the right hemispheres. We discuss how these findings help understanding the auditory semiology of certain epileptic seizures and, more generally, the neural substrate of hemispheric specialization for language.
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Affiliation(s)
- Agnès Trébuchon
- INSERM, Institute of Systems Neuroscience, Aix-Marseille University, Marseille, France
| | - F.-Xavier Alario
- CNRS, LPC, Aix-Marseille University, Marseille, France
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Catherine Liégeois-Chauvel
- INSERM, Institute of Systems Neuroscience, Aix-Marseille University, Marseille, France
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Samanta D, Ostendorf AP, Willis E, Singh R, Gedela S, Arya R, Scott Perry M. Underutilization of epilepsy surgery: Part I: A scoping review of barriers. Epilepsy Behav 2021; 117:107837. [PMID: 33610461 PMCID: PMC8035287 DOI: 10.1016/j.yebeh.2021.107837] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
One-third of persons with epilepsy have seizures despite appropriate medical therapy. Drug resistant epilepsy (DRE) is associated with neurocognitive and psychological decline, poor quality of life, increased risk of premature death, and greater economic burden. Epilepsy surgery is an effective and safe treatment for a subset of people with DRE but remains one of the most underutilized evidence-based treatments in modern medicine. The reasons for this quality gap are insufficiently understood. In this comprehensive review, we compile known significant barriers to epilepsy surgery, originating from both patient/family-related factors and physician/health system components. Important patient-related factors include individual and epilepsy characteristics which bias towards continued preferential use of poorly effective medications, as well as patient perspectives and misconceptions of surgical risks and benefits. Health system and physician-related barriers include demonstrable knowledge gaps among physicians, inadequate access to comprehensive epilepsy centers, complex presurgical evaluations, insufficient research, and socioeconomic bias when choosing appropriate surgical candidates.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Willis
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, USA
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Swanson LC, Hsu D, Ahmed R, Brucker J, Knox AT. Unexpected pain with electrocortical stimulation in a teenager with temporal encephalocele. Epilepsy Behav Rep 2021; 16:100444. [PMID: 33889835 PMCID: PMC8050858 DOI: 10.1016/j.ebr.2021.100444] [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: 02/05/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Temporal encephalocele is a treatable cause of drug-resistant epilepsy. Stereo-EEG can better localize seizure onset and identify potential post-op deficits. We present a neurophysiologic illustration of an important anatomic relationship.
Temporal lobe encephalocele has emerged as a potentially unrecognized cause of drug-resistant temporal lobe epilepsy (TLE) that can be effectively treated with epilepsy surgery. Here we present a case in which a 17-year-old male with drug-resistant epilepsy and left temporal encephalocele underwent workup for epilepsy surgery, and experienced unexpected pain with electrocortical stimulation. Stimulation of stereo-EEG electrodes in the left temporal pole resulted in severe, unilateral left-sided facial pain due to inadvertent stimulation of the trigeminal nerve. Stereo-EEG showed seizure onset adjacent to encephalocele with no involvement of mesial temporal structures. A temporal pole resection sparing the mesial temporal structures and repair of the sphenoid bone defect was performed. The patient experienced post-operative seizure freedom, with no loss of language function or sensory deficits in the distribution of the trigeminal nerve. This case highlights temporal encephalocele as a potentially overlooked cause of TLE and underscores the anatomical proximity of the trigeminal nerve to the temporal pole, an important consideration for surgical planning.
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Affiliation(s)
- Laura C Swanson
- Medical Scientist Training Program, University of Wisconsin-Madison School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, United States
| | - David Hsu
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705, United States
| | - Raheel Ahmed
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue Madison, WI 53792, United States
| | - Justin Brucker
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue Madison, WI 53792, United States
| | - Andrew T Knox
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705, United States
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