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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 2024:10.1007/s00381-024-06420-w. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Cohen NT, Buraniqi E, Smith JD, Vezina LG, Gaillard WD. Ictal Arterial Spin Labeling-Magnetic Resonance Imaging Identifies Seizure Onset Zone in Epilepsia Partialis Continua. Ann Neurol 2024; 95:760-761. [PMID: 38110689 DOI: 10.1002/ana.26865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Nathan T Cohen
- Center for Neuroscience Research, Children's National, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Ersida Buraniqi
- Center for Neuroscience Research, Children's National, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Jacklyn D Smith
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - L Gilbert Vezina
- Center for Neuroscience Research, Children's National, George Washington University School of Medicine, Washington, DC, USA
- Department of Neuroradiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - William D Gaillard
- Center for Neuroscience Research, Children's National, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
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McGinley C, Teti S, Hofmann K, Schreiber JM, Cohen NT, Gaillard WD, Oluigbo CO. Seizure Control Outcomes following Resection of Cortical Dysplasia in Patients with DEPDC5 Variants: A Systematic Review and Individual Patient Data Analysis. Neuropediatrics 2024; 55:1-8. [PMID: 37984419 DOI: 10.1055/a-2213-8584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
There is insufficient evidence regarding the efficacy of epilepsy surgery in patients with pharmacoresistant focal epilepsy and coexistent DEPDC5 (dishevelled EGL-10 and pleckstrin domain-containing protein 5) pathogenic (P), likely pathogenic (LP), or variance of unknown significance (VUS) variants. To conduct a systematic review on the literature regarding the use and efficacy of epilepsy surgery as an intervention for patients with DEPDC5 variants who have pharmacoresistant epilepsy. A systematic review of the current literature published regarding the outcomes of epilepsy surgery for patients with DEPDC5 variants was conducted. Demographics and individual patient data were recorded and analyzed. Subsequent statistical analysis was performed to assess significance of the findings. A total of eight articles comprising 44 DEPDC5 patients with genetic variants undergoing surgery were included in this study. The articles primarily originated in high-income countries (5/8, 62.5%). The average age of the subjects was 10.06 ± 9.41 years old at the time of study. The most common form of epilepsy surgery was focal resection (38/44, 86.4%). Thirty-seven of the 40 patients (37/40, 92.5%) with reported seizure frequency results had improvement. Twenty-nine out of 38 patients (29/38, 78.4%) undergoing focal resection achieved Engel Score I postoperatively, and two out of four patients achieved International League Against Epilepsy I (50%). Epilepsy surgery is effective in patients with pharmacoresistant focal epilepsy and coexistent DEPDC5 P, LP, or VUS variants.
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Affiliation(s)
- Christopher McGinley
- College of Medicine, Howard University College of Medicine, Washington, District of Columbia, United States
| | - Saige Teti
- Division of Neurosurgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Katherine Hofmann
- Division of Neurosurgery, Children's National Hospital, Washington, District of Columbia, United States
| | - John M Schreiber
- Division of Neurology, Children's National Hospital, Washington, District of Columbia, United States
| | - Nathan T Cohen
- Division of Neurology, Children's National Hospital, Washington, District of Columbia, United States
| | - William D Gaillard
- Division of Neurosurgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Hospital, Washington, District of Columbia, United States
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Cohen NT, Xie H, Gholipour T, Gaillard WD. A scoping review of the functional magnetic resonance imaging-based functional connectivity of focal cortical dysplasia-related epilepsy. Epilepsia 2023; 64:3130-3142. [PMID: 37731142 DOI: 10.1111/epi.17775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/22/2023]
Abstract
Focal cortical dysplasia (FCD) is the most frequent etiology of operable pharmacoresistant epilepsy in children. There is burgeoning evidence that FCD-related epilepsy is a disorder that involves distributed brain networks. Functional magnetic resonance imaging (fMRI) is a tool that allows one to infer neuronal activity and to noninvasively map whole-brain functional networks. Despite its relatively widespread availability at most epilepsy centers, the clinical application of fMRI remains mostly task-based in epilepsy. Another approach is to map and characterize cortical functional networks of individuals using resting state fMRI (rsfMRI). The focus of this scoping review is to summarize the evidence to date of investigations of the network basis of FCD-related epilepsy, and to highlight numerous potential future applications of rsfMRI in the exploration of diagnostic and therapeutic strategies for FCD-related epilepsy. There are numerous studies demonstrating a global disruption of cortical functional networks in FCD-related epilepsy. The underlying pathological subtypes of FCD influence overall functional network patterns. There is evidence that cortical functional network mapping may help to predict postsurgical seizure outcomes, highlighting the translational potential of these findings. Additionally, several studies emphasize the important effect of FCD interaction with cortical networks and the expression of epilepsy and its comorbidities.
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Affiliation(s)
- Nathan T Cohen
- Center for Neuroscience Research, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Hua Xie
- Center for Neuroscience Research, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Taha Gholipour
- Center for Neuroscience Research, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Neurology, George Washington University Epilepsy Center, Washington, District of Columbia, USA
| | - William D Gaillard
- Center for Neuroscience Research, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
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Cohen NT, Chang P, Gholipour T, Oluigbo C, Vezina LG, Xie H, Zhang A, Gaillard WD. Limbic network co-localization predicts pharmacoresistance in dysplasia-related epilepsy. Ann Clin Transl Neurol 2023; 10:2161-2165. [PMID: 37700505 PMCID: PMC10646997 DOI: 10.1002/acn3.51892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
To evaluate the role of focal cortical dysplasia co-localization to cortical functional networks in the development of pharmacoresistance. One hundred thirty-six focal cortical dysplasia patients with 3.0 T or 1.5 T MRI were identified from clinical databases at Children's National Hospital. Clinico-radio-pathologic factors and network co-localization were determined. Using binomial logistic regression, limbic network co-localization (odds ratio 4.164 95% confidence interval 1.02-17.08, p = 0.048), and focal to bilateral tonic-clonic seizures (4.82, 1.30-18.03, p = 0.019) predicted pharmacoresistance. These findings provide clinicians with markers to identify patients with focal cortical dysplasia-related epilepsy at high risk of developing pharmacoresistance and should facilitate earlier epilepsy surgical evaluation.
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Affiliation(s)
- Nathan T. Cohen
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - Phat Chang
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - Taha Gholipour
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - Chima Oluigbo
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - L. Gilbert Vezina
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - Hua Xie
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
| | - Anqing Zhang
- Division of Biostatistics and Study MethodologyChildren's National Research InstituteWashingtonDCUSA
| | - William D. Gaillard
- Center for Neuroscience ResearchChildren's National Hospital, The George Washington University School of MedicineWashingtonDCUSA
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Chang P, Xie H, Illapani VSP, You X, Anwar T, Pasupuleti A, Vu TA, Vezina LG, Gholipour T, Oluigbo CO, Zhang A, Gaillard WD, Cohen NT. Focal to bilateral tonic-clonic seizures predict pharmacoresistance in focal cortical dysplasia-related epilepsy. Epilepsia 2023; 64:2434-2442. [PMID: 37349955 PMCID: PMC10529443 DOI: 10.1111/epi.17700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is the most common etiology of surgically-remediable epilepsy in children. Eighty-seven percent of patients with FCD develop epilepsy (75% is pharmacoresistant epilepsy [PRE]). Focal to bilateral tonic-clonic (FTBTC) seizures are associated with worse surgical outcomes. We hypothesized that children with FCD-related epilepsy with FTBTC seizures are more likely to develop PRE due to lesion interaction with restricted cortical neural networks. METHODS Patients were selected retrospectively from radiology and surgical databases from Children's National Hospital. INCLUSION CRITERIA 3T magnetic resonance imaging (MRI)-confirmed FCD from January 2011 to January 2020; ages 0 days to 22 years at MRI; and 18 months of documented follow-up. FCD dominant network (Yeo 7-network parcellation) was determined. Association of FTBTC seizures with epilepsy severity, surgical outcome, and dominant network was tested. Binomial regression was used to evaluate predictors (FTBTC seizures, age at seizure onset, pathology, hemisphere, lobe) of pharmacoresistance and Engel outcome. Regression was used to evaluate predictors (age at seizure onset, pathology, lobe, percentage default mode network [DMN] overlap) of FTBTC seizures. RESULTS One hundred seventeen patients had a median age at seizure onset of 3.00 years (interquartile range [IQR] .42-5.59 years). Eighty-three patients had PRE (71%); 34 had pharmacosensitive epilepsy (PSE) (29%). Twenty patients (17%) had FTBTC seizures. Seventy-three patients underwent epilepsy surgery. Multivariate regression showed that FTBTC seizures are associated with an increased risk of PRE (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.21-33.98, p = .02). FCD hemisphere/lobe was not associated with PRE. Percentage DMN overlap predicts FTBTC seizures. Seventy-two percent (n = 52) overall and 53% (n = 9) of patients with FTBTC seizures achieved Engel class I outcome. SIGNIFICANCE In a heterogeneous population of surgical and non-operated patients with FCD-related epilepsy, the presence of FTBTC seizures is associated with a tremendous risk of PRE. This finding is a recognizable marker to help neurologists identify those children with FCD-related epilepsy at high risk of PRE and can flag patients for earlier consideration of potentially curative surgery. The FCD-dominant network also contributes to FTBTC seizure clinical expression.
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Affiliation(s)
- Phat Chang
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Hua Xie
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Venkata Sita Priyanka Illapani
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Xiaozhen You
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Tayyba Anwar
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Archana Pasupuleti
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Thuy-Anh Vu
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - L. Gilbert Vezina
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Taha Gholipour
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Chima O. Oluigbo
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Anqing Zhang
- Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, DC
| | - William Davis Gaillard
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
| | - Nathan T. Cohen
- Center for Neuroscience Research, Children’s National Hospital, The George Washington University School of Medicine, Washington, DC, USA
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Shlobin NA, Hofmann K, Cohen NT, Koubeissi MZ, Gaillard WD, Oluigbo CO. Deep Brain Stimulation of the Centromedian Nucleus of the Thalamus for Lennox-Gastaut Syndrome: A Systematic Review and Individual Patient Data Analysis. Neurosurgery 2023; 92:703-715. [PMID: 36700706 DOI: 10.1227/neu.0000000000002280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Lennox-Gastaut syndrome (LGS) is a severe childhood-onset pharmacoresistant epilepsy. Deep brain stimulation (DBS) of the centromedian nucleus of the thalamus (CMN) has been utilized. OBJECTIVE To conduct a systematic review and individual patient data (IPD) analysis to characterize outcomes of DBS of CMN in LGS. METHODS PubMed, Embase, and Scopus were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were screened by title/abstract then full text. Included articles were reviewed for bibliographic, demographic, and outcome data. IPD were extracted from studies providing IPD for all patients. RESULTS Of 72 resultant articles, 10 studies (114 patients) were included. Six of 7 studies reporting the outcome of ≥50% seizure reduction indicated that ≥50% of patients achieved this, with improved functional ability. Seizure freedom rate was generally <10%. Six studies with 47 patients provided IPD. The mean ages at epilepsy onset and CMN DBS were 3.9 ± 4.5 years and 17.4 ± 8.8 years, respectively. Nineteen of 41 (46.3%) patients had positive MRI findings. Seizure types included atypical absence in 39 (83.0%) patients, generalized tonic-clonic in 32 (68.1%), tonic in 22 (46.8%), and atonic in 20 (42.6%). Thirty-eight (80.9%) patients experienced ≥50% reduction in seizure frequency, and only 3 (6.4%) experienced seizure freedom. The mean seizure reduction was 62.9% ± 31.2% overall. Quality of life improved in 30/34 (88.2%) and was unchanged in the remainder (11.8%). The complication rate was 2/41 (4.9%). The mean length of follow-up was 19.8 ± 26.1 months (IQR: 4-18 months). CONCLUSION Limited data indicate that DBS of the CMN may be effective and safe for people with LGS.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine Hofmann
- Deparment of Neurosurgery, Children's National Hospital, Washington, District of Columbia, USA
| | - Nathan T Cohen
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Mohamad Z Koubeissi
- Department of Neurology, The George Washington University, Washington, District of Columbia, USA
| | - William D Gaillard
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Deparment of Neurosurgery, Children's National Hospital, Washington, District of Columbia, USA
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Spitzer H, Ripart M, Whitaker K, D’Arco F, Mankad K, Chen AA, Napolitano A, De Palma L, De Benedictis A, Foldes S, Humphreys Z, Zhang K, Hu W, Mo J, Likeman M, Davies S, Güttler C, Lenge M, Cohen NT, Tang Y, Wang S, Chari A, Tisdall M, Bargallo N, Conde-Blanco E, Pariente JC, Pascual-Diaz S, Delgado-Martínez I, Pérez-Enríquez C, Lagorio I, Abela E, Mullatti N, O’Muircheartaigh J, Vecchiato K, Liu Y, Caligiuri ME, Sinclair B, Vivash L, Willard A, Kandasamy J, McLellan A, Sokol D, Semmelroch M, Kloster AG, Opheim G, Ribeiro L, Yasuda C, Rossi-Espagnet C, Hamandi K, Tietze A, Barba C, Guerrini R, Gaillard WD, You X, Wang I, González-Ortiz S, Severino M, Striano P, Tortora D, Kälviäinen R, Gambardella A, Labate A, Desmond P, Lui E, O’Brien T, Shetty J, Jackson G, Duncan JS, Winston GP, Pinborg LH, Cendes F, Theis FJ, Shinohara RT, Cross JH, Baldeweg T, Adler S, Wagstyl K. Interpretable surface-based detection of focal cortical dysplasias: a Multi-centre Epilepsy Lesion Detection study. Brain 2022; 145:3859-3871. [PMID: 35953082 PMCID: PMC9679165 DOI: 10.1093/brain/awac224] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/22/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonized a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. On a restricted 'gold-standard' subcohort of seizure-free patients with FCD type IIB who had T1 and fluid-attenuated inversion recovery MRI data, the MELD FCD surface-based algorithm had a sensitivity of 85%. Across the entire withheld test cohort the sensitivity was 59% and specificity was 54%. After including a border zone around lesions, to account for uncertainty around the borders of manually delineated lesion masks, the sensitivity was 67%. This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions in individuals with epilepsy.
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Affiliation(s)
- Hannah Spitzer
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
| | - Mathilde Ripart
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | | | - Felice D’Arco
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Kshitij Mankad
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Andrew A Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome 00165, Italy
| | - Luca De Palma
- Rare and Complex Epilepsies, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Stephen Foldes
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Zachary Humphreys
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Marcus Likeman
- Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Shirin Davies
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, UK
| | | | - Matteo Lenge
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Nathan T Cohen
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610093, China
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Shan Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Aswin Chari
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Martin Tisdall
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Nuria Bargallo
- Department of Neuroradiology, Hospital Clinic Barcelona and Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid 28029, Spain
| | | | | | - Saül Pascual-Diaz
- Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
| | | | | | | | - Eugenio Abela
- Center for Neuropsychiatry and Intellectual Disability, Psychiatrische Dienste Aargau AG, Windisch 5120, Switzerland
| | - Nandini Mullatti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Jonathan O’Muircheartaigh
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
| | - Maria Eugenia Caligiuri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | - Ben Sinclair
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Neurology, Monash University, Melbourne, VIC 3004, Australia
| | - Anna Willard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Jothy Kandasamy
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Ailsa McLellan
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Drahoslav Sokol
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Mira Semmelroch
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Ane G Kloster
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Giske Opheim
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Department of Neuroradiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Letícia Ribeiro
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Clarissa Yasuda
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | | | - Khalid Hamandi
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Anna Tietze
- Charité University Hospital, Berlin 10117, Germany
| | - Carmen Barba
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Renzo Guerrini
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | | | - Xiaozhen You
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sofía González-Ortiz
- Department of Neuroradiology, Hospital del Mar, Barcelona 08003, Spain
- Magnetic Resonance Imaging Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Reetta Kälviäinen
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Kuopio 70210, Finland
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Angelo Labate
- Neurology Unit, Department of BIOMORF, University of Messina, Messina 98168, Italy
| | - Patricia Desmond
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Elaine Lui
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Terence O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, 3052, Australia
| | - Jay Shetty
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, VIC 3071, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC 3084, Australia
| | - John S Duncan
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Gavin P Winston
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada K7L 3N6
| | - Lars H Pinborg
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital—Rigshopsitalet, Copenhagen 2100, Denmark
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Fabian J Theis
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
- Department of Mathematics, Technical University of Munich, Garching 85748, Germany
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Helen Cross
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Torsten Baldeweg
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Sophie Adler
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | - Konrad Wagstyl
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK
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9
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Cohen NT, Chang P, You X, Zhang A, Havens KA, Oluigbo CO, Whitehead MT, Gholipour T, Gaillard WD. Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy. Neurology 2022; 99:e2006-e2013. [PMID: 35985831 PMCID: PMC9651467 DOI: 10.1212/wnl.0000000000201033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Focal cortical dysplasia (FCD) is the most common cause of surgically remediable epilepsy in children. Little is known about the risk factors for the timing and development of pharmacoresistance in this population. This study sought to evaluate the prevalence and risk factors for pharmacoresistance in pediatric FCD-related epilepsy. METHODS In this retrospective single-center cohort design, patients were identified from search of centralized radiology report database and a central epilepsy surgical database. Inclusion criteria consisted of 3T MRI-confirmed FCD from January, 2011, to January, 2020; ages 0 days to 22 years at MRI; and at least 18 months of documented follow-up after MRI, unless had single seizure or incidentally discovered FCD. Records were excluded if there was dual pathology (except for mesial temporal sclerosis), hemimegalencephaly, or tuberous sclerosis complex present in imaging or history. RESULTS One hundred forty-three patients with confirmed FCD met the inclusion criteria. One hundred twenty-four children had epilepsy (87% of patients with FCD) with median age at seizure onset 2.7 years (IQR 0.75-6 years, range 0-17 years). Twelve children (8.5%) had a single lifetime seizure (provoked or unprovoked) or recurrent provoked seizures. Seven children (4.9%) had incidental FCD. Ninety-two patients (74%) of those with epilepsy met criteria for pharmacoresistance. Of children with epilepsy of all types, 93 children (75%) were seizure-free at the last visit; 82 patients underwent epilepsy surgery, of whom 59 (72%) achieved seizure freedom. Seven percent (9/124) achieved seizure freedom with a second ASM and 5.6% (7/124) with a third or more ASMs. Failure of only 1 antiseizure medication is associated with enormous increased incidence and earlier development of pharmacoresistance (OR 346; 95% CI 19.6-6,100); Cox regression showed FCD lobar location, pathologic subtype, and age at seizure onset are not. DISCUSSION Failure of 1 antiseizure medication is associated with substantial risk of pharmacoresistance. These data support an operational redefinition of pharmacoresistance, for surgical planning, in FCD-related epilepsy to the failure of 1 antiseizure medication and support early, potentially curative surgery to improve outcomes in this patient population.
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Affiliation(s)
- Nathan T Cohen
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C.
| | - Phat Chang
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Xiaozhen You
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Anqing Zhang
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Kathryn A Havens
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Chima O Oluigbo
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Matthew T Whitehead
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - Taha Gholipour
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
| | - William D Gaillard
- From the Departments of Neurology (N.T.C., K.A.H.,W.D.G.), Neurosurgery (C.O.O.), Neuroradiology (M.T.W.), and the Center for Neuroscience Research (N.T.C., P.C., X.Y., A.Z., K.A.H., C.O.O., M.T.W., T.G., W.D.G.), Department of Neurology (N.T.C., K.A.H.,W.D.G.) and Neurosurgery (C.O.O.), Children's National Hospital, The George Washington University School of Medicine, Washington, D.C
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10
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Cohen NT, You X, Krishnamurthy M, Sepeta LN, Zhang A, Oluigbo C, Whitehead MT, Gholipour T, Baldeweg T, Wagstyl K, Adler S, Gaillard WD. Networks Underlie Temporal Onset of Dysplasia-Related Epilepsy: A MELD Study. Ann Neurol 2022; 92:503-511. [PMID: 35726354 PMCID: PMC10410674 DOI: 10.1002/ana.26442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/22/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate if focal cortical dysplasia (FCD) co-localization to cortical functional networks is associated with the temporal distribution of epilepsy onset in FCD. METHODS International (20 center), retrospective cohort from the Multi-Centre Epilepsy Lesion Detection (MELD) project. Patients included if >3 years old, had 3D pre-operative T1 magnetic resonance imaging (MRI; 1.5 or 3 T) with radiologic or histopathologic FCD after surgery. Images processed using the MELD protocol, masked with 3D regions-of-interest (ROI), and co-registered to fsaverage_sym (symmetric template). FCDs were then co-localized to 1 of 7 distributed functional cortical networks. Negative binomial regression evaluated effect of FCD size, network, histology, and sulcal depth on age of epilepsy onset. From this model, predictive age of epilepsy onset was calculated for each network. RESULTS Three hundred eighty-eight patients had median age seizure onset 5 years (interquartile range [IQR] = 3-11 years), median age at pre-operative scan 18 years (IQR = 11-28 years). FCDs co-localized to the following networks: limbic (90), default mode (87), somatomotor (65), front parietal control (52), ventral attention (32), dorsal attention (31), and visual (31). Larger lesions were associated with younger age of onset (p = 0.01); age of epilepsy onset was associated with dominant network (p = 0.04) but not sulcal depth or histology. Sensorimotor networks had youngest onset; the limbic network had oldest age of onset (p values <0.05). INTERPRETATION FCD co-localization to distributed functional cortical networks is associated with age of epilepsy onset: sensory neural networks (somatomotor and visual) with earlier onset, and limbic latest onset. These variations may reflect developmental differences in synaptic/white matter maturation or network activation and may provide a biological basis for age-dependent epilepsy onset expression. ANN NEUROL 2022;92:503-511.
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Affiliation(s)
- Nathan T Cohen
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Xiaozhen You
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Manu Krishnamurthy
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Leigh N Sepeta
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Anqing Zhang
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
- Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, DC
| | - Chima Oluigbo
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
- Department of Neurosurgery, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Matthew T Whitehead
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
- Department of Neuroradiology, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
| | - Taha Gholipour
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
- George Washington University Epilepsy Center, The George Washington University School of Medicine, Washington, DC
| | - Torsten Baldeweg
- Great Ormond Street Institute for Child Health, University College of London, London, UK
| | | | - Sophie Adler
- Great Ormond Street Institute for Child Health, University College of London, London, UK
| | - William D Gaillard
- Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC
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11
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Cohen NT, Bahar B, Conry JA, Schreiber JM. Variability in Serum Concentrations and Clinical Response in Artisanal Versus Pharmaceutical Cannabidiol Treatment of Pediatric Pharmacoresistant Epilepsy. J Pediatr Pharmacol Ther 2022; 27:558-563. [DOI: 10.5863/1551-6776-27.6.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
We hypothesized that serum cannabidiol (CBD) concentrations would be higher in patients taking pharmaceutical- versus artisanal-CBD oil, and higher serum CBD concentrations would correlate with increased side effects and decreased seizure frequency.
METHODS
This was a retrospective chart review. We included patients with pharmacoresistant epilepsy, treated with artisanal-CBD or pharmaceutical-CBD (Epidiolex), and with quantitative serum CBD concentrations. We tracked epilepsy diagnosis, artisanal-CBD dosage, pharmaceutical-CBD dose, serum CBD concentration, clobazam concentration, N-desmethylclobazam concentration, seizure history (frequency of motor seizures), response to medication (percentage reduction in motor seizures), and side effects.
RESULTS
Forty-two patients met inclusion criteria. Mean serum CBD concentration was 51.1 ng/mL (artisanal group) and 124 ng/mL (pharmaceutical group) (p = 0.022). Patients receiving artisanal-CBD had no change in median overall seizures (IQR, −50% to 50%); the pharmaceutical-CBD group had median 50% reduction (IQR, −90% to no change) (p = 0.199).
CONCLUSIONS
Pharmaceutical-CBD achieves higher serum CBD concentrations than artisanal-CBD in pediatric patients with refractory epilepsy. These higher CBD concentrations are associated with increased reported adverse effects, but no detectable difference in seizure frequency.
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Affiliation(s)
- Nathan T. Cohen
- Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Burak Bahar
- Division of Pathology & Laboratory Medicine (BB), Children's National Hospital, Washington, DC
| | - Joan A. Conry
- Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John M. Schreiber
- Comprehensive Pediatric Epilepsy Program (NTC, JAC, JMS), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
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12
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Wagstyl K, Whitaker K, Raznahan A, Seidlitz J, Vértes PE, Foldes S, Humphreys Z, Hu W, Mo J, Likeman M, Davies S, Lenge M, Cohen NT, Tang Y, Wang S, Ripart M, Chari A, Tisdall M, Bargallo N, Conde‐Blanco E, Pariente JC, Pascual‐Diaz S, Delgado‐Martínez I, Pérez‐Enríquez C, Lagorio I, Abela E, Mullatti N, O'Muircheartaigh J, Vecchiato K, Liu Y, Caligiuri M, Sinclair B, Vivash L, Willard A, Kandasamy J, McLellan A, Sokol D, Semmelroch M, Kloster A, Opheim G, Yasuda C, Zhang K, Hamandi K, Barba C, Guerrini R, Gaillard WD, You X, Wang I, González‐Ortiz S, Severino M, Striano P, Tortora D, Kalviainen R, Gambardella A, Labate A, Desmond P, Lui E, O'Brien T, Shetty J, Jackson G, Duncan JS, Winston GP, Pinborg L, Cendes F, Cross JH, Baldeweg T, Adler S. Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study. Epilepsia 2022; 63:61-74. [PMID: 34845719 PMCID: PMC8916105 DOI: 10.1111/epi.17130] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Drug-resistant focal epilepsy is often caused by focal cortical dysplasias (FCDs). The distribution of these lesions across the cerebral cortex and the impact of lesion location on clinical presentation and surgical outcome are largely unknown. We created a neuroimaging cohort of patients with individually mapped FCDs to determine factors associated with lesion location and predictors of postsurgical outcome. METHODS The MELD (Multi-centre Epilepsy Lesion Detection) project collated a retrospective cohort of 580 patients with epilepsy attributed to FCD from 20 epilepsy centers worldwide. Magnetic resonance imaging-based maps of individual FCDs with accompanying demographic, clinical, and surgical information were collected. We mapped the distribution of FCDs, examined for associations between clinical factors and lesion location, and developed a predictive model of postsurgical seizure freedom. RESULTS FCDs were nonuniformly distributed, concentrating in the superior frontal sulcus, frontal pole, and temporal pole. Epilepsy onset was typically before the age of 10 years. Earlier epilepsy onset was associated with lesions in primary sensory areas, whereas later epilepsy onset was associated with lesions in association cortices. Lesions in temporal and occipital lobes tended to be larger than frontal lobe lesions. Seizure freedom rates varied with FCD location, from around 30% in visual, motor, and premotor areas to 75% in superior temporal and frontal gyri. The predictive model of postsurgical seizure freedom had a positive predictive value of 70% and negative predictive value of 61%. SIGNIFICANCE FCD location is an important determinant of its size, the age at epilepsy onset, and the likelihood of seizure freedom postsurgery. Our atlas of lesion locations can be used to guide the radiological search for subtle lesions in individual patients. Our atlas of regional seizure freedom rates and associated predictive model can be used to estimate individual likelihoods of postsurgical seizure freedom. Data-driven atlases and predictive models are essential for evidence-based, precision medicine and risk counseling in epilepsy.
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Cohen NT, Cross JH, Arzimanoglou A, Berkovic SF, Kerrigan JF, Miller IP, Webster E, Soeby L, Cukiert A, Hesdorffer DK, Kroner BL, Saper CB, Schulze-Bonhage A, Gaillard WD. Hypothalamic Hamartomas: Evolving Understanding and Management. Neurology 2021; 97:864-873. [PMID: 34607926 PMCID: PMC8610628 DOI: 10.1212/wnl.0000000000012773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022] Open
Abstract
Hypothalamic hamartomas (HH) are rare, basilar developmental lesions with widespread comorbidities often associated with refractory epilepsy and encephalopathy. Imaging advances allow for early, even prenatal, detection. Genetic studies suggest mutations in GLI3 and other patterning genes are involved in HH pathogenesis. About 50%-80% of children with HH have severe rage and aggression and a majority of patients exhibit externalizing disorders. Behavioral disruption and intellectual disability may predate epilepsy. Neuropsychological, sleep, and endocrine disorders are typical. The purpose of this article is to provide a summary of the current understanding of HH and to highlight opportunities for future research.
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Affiliation(s)
- Nathan T Cohen
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany.
| | - J Helen Cross
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Alexis Arzimanoglou
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Samuel F Berkovic
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - John F Kerrigan
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Ilene Penn Miller
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Erica Webster
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Lisa Soeby
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Arthur Cukiert
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Dale K Hesdorffer
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Barbara L Kroner
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Clifford B Saper
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
| | - William D Gaillard
- From the Center for Neuroscience Research (N.T.C., W.D.G.), Children's National Hospital, The George Washington University School of Medicine, Washington, DC; UCL NIHR BRC Great Ormond Street Institute of Child Health (J.H.C.), Member of ERN-EpiCARE, London; Great Ormond Street Hospital for Children (J.H.C.), NHS Trust, London; Young Epilepsy (J.H.C.), Lingfield, Surrey, UK; Department of Pediatric Clinical Epileptology (A.A.), Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE; HFME (A.A.), Hospices Civils de Lyon, France; Epilepsy Research Unit (A.A.), Barcelona's Children Hospital San Juan de Dios, Member of the ERN EpiCARE, Spain; Epilepsy Research Centre (S.F.B.), University of Melbourne, Australia; Division of Pediatric Neurology (J.F.K.), Barrow Neurological Institute at Phoenix Children's Hospital; Hope for Hypothalamic Hamartomas (I.P.M., E.W., L.S.), Phoenix, AZ; Epilepsy Surgery Program (A.C.), Clinica de Epilepsia de Sao Paulo, Brazil; Department of Epidemiology (D.K.H.), Columbia University Medical Center, New York, NY; RTI International (B.L.K.), Rockville, MD; Department of Neurology (C.B.S.), Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Epilepsy Center (A.S.-B.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany
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14
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Wiwattanadittakul N, Suwannachote S, You X, Cohen NT, Tran T, Phuackchantuck R, Tsuchida TN, Depositario-Cabacar DF, Zelleke T, Schreiber JM, Conry JA, Kao A, Bartolini L, Oluigbo C, Almira-Suarez MI, Havens K, Whitehead MT, Gaillard WD. Spatiotemporal distribution and age of seizure onset in a pediatric epilepsy surgery cohort with cortical dysplasia. Epilepsy Res 2021; 172:106598. [PMID: 33711709 DOI: 10.1016/j.eplepsyres.2021.106598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Focal Cortical Dysplasias (CD) are a common etiology of refractory pediatric epilepsy and are amenable to epilepsy surgery. We investigated the association of lesion volume and location to age of seizure onset among children with CD who underwent epilepsy surgery. METHODS A retrospective study of epilepsy surgery patients with pathologically-confirmed CD. Regions of interest (ROI) determined preoperative lesion volumes on 1.5 T and 3 T T2 and SPGR MRIs, and location in 7 distributed neural networks. Descriptive and inferential statistics were used. RESULTS Fifty-five patients were identified: 35 girls (56.5 %). Median age of seizure onset: 19.0 months (range 0.02 months - 16.0 years). Median age of surgery: 7.8 years (range 2.89 months - 24.45 years). CD were frontal (n = 21, 38 %); temporal (n = 15, 27 %); parietal (n = 10, 18 %); occipital (n = 3, 5%); multilobar (n = 6, 11 %). Frontal FCD had seizure onset < 1-year-old (P = 0.10); temporal lobe CD seizure onset was more likely > 5-years-old (P= 0.06). Median lesion volume for CD was 23.23 cm3 (range: 1.87-591.73 cm3). Larger CD lesions were associated with earlier epilepsy (P = 0.01, r = -0.16). We did not find that lesions proximal to early maturing cortical regions were associated with earlier seizure onset. We found an association with CD location in the default mode network (DMN) and age onset < 5years old (P = 0.03). Age of seizure onset was negatively correlated with percent of CD overlapping motor cortex (P = 0.001, r =-0.794) but not with CD overlap of the visual cortex (P = 0.35). There was no effect of CD type on age of epilepsy onset. SIGNIFICANCE Larger CD lesions are associated with earlier onset epilepsy. CD most commonly occurs within the DMN and Limbic network, and DMN is associated with seizure onset before 5-years-old. Percent of CD overlapping motor cortex correlates with earlier seizure onset. These observations may reflect patterns of brain maturation or regional differences in clinical expression of seizures.
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Affiliation(s)
- Natrujee Wiwattanadittakul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Sirorat Suwannachote
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA; Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rungsit University, Bangkok, Thailand
| | - Xiaozhen You
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Nathan T Cohen
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA.
| | - Tan Tran
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Rochana Phuackchantuck
- Research Administration Section, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tammy N Tsuchida
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Tesfaye Zelleke
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - John M Schreiber
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Joan A Conry
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Amy Kao
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Luca Bartolini
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA; Department of Pediatrics, Brown University, Rhode Island, USA
| | - Chima Oluigbo
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - M Isabel Almira-Suarez
- Department of Pathology, Children's National Hospital & George Washington University School of Medicine, Washington DC, USA
| | - Kathryn Havens
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - Matthew T Whitehead
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
| | - William Davis Gaillard
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA
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15
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Cohen NT, Ziobro JM, Depositario-Cabacar DF, Havens K, Kao A, Schreiber JM, Tsuchida TN, Zelleke TG, Oluigbo CO, Gaillard WD. Measure thrice, cut twice: On the benefit of reoperation for failed pediatric epilepsy surgery. Epilepsy Res 2020; 161:106289. [PMID: 32088518 DOI: 10.1016/j.eplepsyres.2020.106289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/19/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether clinical outcomes are improved after repeat surgery for medically refractory epilepsy in children. METHODS This is a single-center retrospective cohort analysis of all patients who received repeat resective surgery for ongoing seizures from 2000-2017. From a total of 251 consecutive individual epilepsy surgical patients for focal resection, 53 patients met study inclusion criteria and had adequate follow-up documented. RESULTS Median age of seizure-onset was 2.0-years-old (IQR 0.3-5.5 years). The median age at first epilepsy surgery was 6.3-years-old (IQR 2.9-9.2 years) and at second epilepsy surgery was 8.4-years-old (IQR 4.7-12.6 years). Overall, 53 % (n = 28) of this series achieved Engel Class I (seizure freedom); with improved seizure control (Engel Class I-II) in 83 % (n = 44) of the cohort. 64 % (n = 34) had one reoperation; 26 % (n = 14) had two; and 9% (n = 5) had three. Pathology: 58 % (n = 31) had focal cortical dysplasia; 13 % (n = 10) tumor; 9% (n = 5) encephalitis; 6% (n = 3) gliosis; 4% (n = 2) mesial temporal sclerosis; and 2% (n = 1) hemimegalencephaly. Tumor pathology was associated with increased chance (p = 0.01) for seizure freedom (90 % of tumor patients had Engel Class I outcome). MTS had worse outcome with both patients having ongoing seizures (Engel II-IV). There were 6 patients who developed post-operative hemiparesis; one was unplanned but resolved. SIGNIFICANCE Reoperation for pediatric epilepsy surgery can lead to seizure freedom in many cases and improved seizure control in most cases. Reoperation for brain tumor pathology is associated with a high rate of seizure freedom.
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Affiliation(s)
- Nathan T Cohen
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States.
| | - Julie M Ziobro
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
| | | | - Kathryn Havens
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
| | - Amy Kao
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
| | - John M Schreiber
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
| | - Tammy N Tsuchida
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
| | - Tesfaye G Zelleke
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Hospital, Washington, DC, United States
| | - William D Gaillard
- Division of Child Neurology, Children's National Hospital, Washington, DC, United States
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16
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Cohen NT, Harrar DB, Diab YA, Pearl MS, Murnick JG. Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion. Pediatr Radiol 2020; 50:137-141. [PMID: 31511914 DOI: 10.1007/s00247-019-04515-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
We describe a 2-year-old girl with bow hunter syndrome complicated by vertebral artery dissection and multiple ischemic infarcts. Pediatric bow hunter syndrome is a rare and likely under-recognized disorder. Interestingly, our patient had atlanto-occipital ligament calcification on CT scan, an imaging finding that has not been reported in association with bow hunter syndrome and one that might help increase recognition of this dynamic disorder of the posterior circulation.
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Affiliation(s)
- Nathan T Cohen
- Division of Neurology, Children's National Health System, 111 Michigan Ave. NW, W4-800, Washington, DC, 20010, USA.
| | - Dana B Harrar
- Division of Neurology, Children's National Health System, 111 Michigan Ave. NW, W4-800, Washington, DC, 20010, USA.,Departments of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yaser A Diab
- Division of Hematology/Oncology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Monica S Pearl
- Division of Interventional Neuroradiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | - Jonathan G Murnick
- Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA.,Department of Radiology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Cohen NT, Chamberlain JM, Gaillard WD. Timing and selection of first antiseizure medication in patients with pediatric status epilepticus. Epilepsy Res 2019; 149:21-25. [DOI: 10.1016/j.eplepsyres.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/17/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
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