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Wong GM, McCray A, Hom K, Teti S, Cohen NT, Gaillard WD, Oluigbo CO. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst 2024; 40:2471-2482. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children. OBJECTIVE The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery. METHODS In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023. RESULTS Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months. CONCLUSION SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.
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Affiliation(s)
- Georgia M Wong
- Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Ashley McCray
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Kara Hom
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | - Saige Teti
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Nathan T Cohen
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
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Slavin KV. Systems Neuroscience's 2022 Top Papers: An Editorial Summary. Brain Sci 2024; 14:315. [PMID: 38671967 PMCID: PMC11048697 DOI: 10.3390/brainsci14040315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the seemingly endless-and sometimes overwhelming-flow of scientific information, there are always some articles that stand out from the crowd, either due to the depth of the covered topic, or due to their unique and unexpected findings [...].
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Affiliation(s)
- Konstantin V. Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Neurology Service, Jesse Brown Veterans Administration Hospital, Chicago, IL 60612, USA
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Filipescu C, Landré E, Turak B, Devaux B, Chassoux F. Towards a better identification of ictal semiology patterns in insular epilepsies: A stereo-EEG study. Clin Neurophysiol 2023; 155:32-43. [PMID: 37683325 DOI: 10.1016/j.clinph.2023.08.007] [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: 04/12/2023] [Revised: 07/26/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To describe pure insular ictal semiology and patterns of extra-insular spread demonstrated by stereoelectroencephalography (SEEG) according to a classification based on the insular cytoarchitecture. METHODS We investigated the ictal semiology in 17 patients undergoing SEEG for insular epilepsy. The insular cortex was divided into three regions roughly overlapping with the agranular, dysgranular and granular regions. Ictal semiology was described accordingly: anterior insula (AI, short anterior and middle gyri), middle insula (MI, short posterior and long anterior gyri) and posterior insula (PI, long posterior gyrus). RESULTS Awareness impairment occurred secondarily to extra-insular ictal spread. Subjective manifestations were constant. AI seizures (n = 3) presented with autonomic (increased heart rate [HR], respiratory changes), oropharyngeal (mainly throat sensations), emotional (fear, anguish) semiology and the "hand-to-throat" sign followed by frontal-like semiology. MI seizures (n = 8) presented with mainly non-painful paresthesia, some autonomic (respiratory, increased HR), oropharyngeal or thermic symptoms and early motor features with spread to the opercular cortex. PI seizures (n = 6) were characterized by somatosensory semiology, mainly paresthesia potentially painful, and cephalic sensations. CONCLUSIONS Cytoarchitectonic-based classification and the corresponding ictal features support the antero-posterior grading of insular seizures and highlight specific ictal symptoms. SIGNIFICANCE This refinement of insular semiology can help optimize the planning of SEEG for presumed insular epilepsy.
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Affiliation(s)
- Cristina Filipescu
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France; Neurophysiology and Epileptology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France.
| | - Elisabeth Landré
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France.
| | - Baris Turak
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France.
| | - Bertrand Devaux
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France; Paris-Cité University, Paris, France.
| | - Francine Chassoux
- Surgical Epileptology Unit, Neurosurgery Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, France.
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Cossette-Roberge H, Li J, Citherlet D, Nguyen DK. Localizing and lateralizing value of auditory phenomena in seizures. Epilepsy Behav 2023; 145:109327. [PMID: 37422934 DOI: 10.1016/j.yebeh.2023.109327] [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: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Auditory seizures (AS) are a rare type of focal seizures. AS are classically thought to involve a seizure onset zone (SOZ) in the temporal lobe, but there remain uncertainties about their localizing and lateralizing value. We conducted a narrative literature review with the aim of providing an up-to-date description of the lateralizing and localizing value of AS. METHODS The databases PubMed, Scopus, and Google Scholar were searched for literature on AS in December 2022. All cortical stimulation studies, case reports, and case series were analyzed to assess for auditory phenomena that were suggestive of AS and to evaluate if the lateralization and/or localization of the SOZ could be determined. We classified AS according to their semiology (e.g., simple hallucination versus complex hallucination) and the level of evidence with which the SOZ could be predicted. RESULTS A total of 174 cases comprising 200 AS were analyzed from 70 articles. Across all studies, the SOZ of AS were more often in the left (62%) than in the right (38%) hemisphere. AS heard bilaterally followed this trend. Unilaterally heard AS were more often due to a SOZ in the contralateral hemisphere (74%), although they could also be ipsilateral (26%). The SOZ for AS was not limited to the auditory cortex, nor to the temporal lobe. The areas more frequently involved in the temporal lobe were the superior temporal gyrus (STG) and mesiotemporal structures. Extratemporal locations included parietal, frontal, insular, and rarely occipital structures. CONCLUSION Our review highlighted the complexity of AS and their importance in the identification of the SOZ. Due to the limited data and heterogeneous presentation of AS in the literature, the patterns associated with different AS semiologies warrant further research.
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Affiliation(s)
- Hélène Cossette-Roberge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
| | - Jimmy Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Daphné Citherlet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Al-Bakri AF, Martinek R, Pelc M, Zygarlicki J, Kawala-Sterniuk A. Implementation of a Morphological Filter for Removing Spikes from the Epileptic Brain Signals to Improve Identification Ripples. SENSORS (BASEL, SWITZERLAND) 2022; 22:7522. [PMID: 36236621 PMCID: PMC9571066 DOI: 10.3390/s22197522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Epilepsy is a very common disease affecting at least 1% of the population, comprising a number of over 50 million people. As many patients suffer from the drug-resistant version, the number of potential treatment methods is very small. However, since not only the treatment of epilepsy, but also its proper diagnosis or observation of brain signals from recordings are important research areas, in this paper, we address this very problem by developing a reliable technique for removing spikes and sharp transients from the baseline of the brain signal using a morphological filter. This allows much more precise identification of the so-called epileptic zone, which can then be resected, which is one of the methods of epilepsy treatment. We used eight patients with 5 KHz data set and depended upon the Staba 2002 algorithm as a reference to detect the ripples. We found that the average sensitivity and false detection rate of our technique are significant, and they are ∼94% and ∼14%, respectively.
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Affiliation(s)
- Amir F. Al-Bakri
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah 51001, Iraq
| | - Radek Martinek
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University Ostrava—FEECS, 708 00 Ostrava–Poruba, Czech Republic
| | - Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- School of Computing and Mathematical Sciences, University of Greenwich, Park Row, London SE10 9LS, UK
| | - Jarosław Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
| | - Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
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Zhang X, Zhang G, Yu T, Xu C, Zhu J, Yan X, Ma K, Gao R. Temporal-insular spreading time in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Medicine (Baltimore) 2022; 101:e30114. [PMID: 35984139 PMCID: PMC9387976 DOI: 10.1097/md.0000000000030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Insular involvement in temporal lobe epilepsy (TLE) has gradually been recognized since the widespread use of stereoelectroencephalography (SEEG). However, the correlation between insular involvement and failed temporal lobe surgery remains unclear. In this study, we analyzed the surgical outcomes of TLE patients who underwent temporal and insular SEEG recordings and explored the predictors of failed anterior temporal lobectomy (ATL) in these patients with temporal seizures. Forty-one patients who underwent ATL for drug-resistant TLE were examined using temporal and insular SEEG recordings. The clinical characteristics, SEEG data, and postoperative seizure outcomes of these patients were analyzed, and multivariate analysis was used to identify the predictors of surgical outcome. In this series, the ictal temporal discharges invaded the insula in 39 (95.1%) patients. Twenty-three (56.1%) patients were seizure-free (Engel class I) after ATL with at least 1 year follow-up. Only temporal-insular spreading time (TIST) was an independent predictor of postoperative seizure-free outcomes (P = .035). By creating receiver operating characteristic curves for TIST, 400 milliseconds was identified as the cutoff for classification. All patients were classified into 2 groups (TIST ≤ 400 milliseconds and TIST > 400 milliseconds) based on the cutoff value; the difference in seizure-free rates between the 2 groups was significant (P = .001). The very early insular involvement in TLE may be associated with poorer seizure outcomes after ATL. Our findings may be helpful for estimating the appropriate operative procedures and will be valuable for evaluating the prognosis of TLE patients with temporal-insular SEEG recordings and temporal lobectomy.
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Affiliation(s)
- Xi Zhang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xi Zhang, Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China (e-mail: )
| | - Guojun Zhang
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Zhu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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