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Zegers CML, Swinnen A, Roumen C, Hoffmann AL, Troost EGC, van Asch CJJ, Brandts L, Compter I, Dieleman EMT, Dijkstra JB, Granzier M, Hendriks M, Hofman P, Houben RMA, Ramaekers B, Ronner HE, Rouhl RPW, van der Salm S, Santegoeds RGC, Verhoeff JJ, Wagner GL, Zwemmer J, Schijns O, Colon AJ, Eekers DBP. High-precision stereotactic irradiation for focal drug-resistant epilepsy versus standard treatment: a randomized waitlist-controlled trial (the PRECISION trial). Trials 2024; 25:334. [PMID: 38773643 PMCID: PMC11106873 DOI: 10.1186/s13063-024-08168-9] [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: 01/30/2024] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION The standard treatment for patients with focal drug-resistant epilepsy (DRE) who are not eligible for open brain surgery is the continuation of anti-seizure medication (ASM) and neuromodulation. This treatment does not cure epilepsy but only decreases severity. The PRECISION trial offers a non-invasive, possibly curative intervention for these patients, which consist of a single stereotactic radiotherapy (SRT) treatment. Previous studies have shown promising results of SRT in this patient population. Nevertheless, this intervention is not yet available and reimbursed in the Netherlands. We hypothesize that: SRT is a superior treatment option compared to palliative standard of care, for patients with focal DRE, not eligible for open surgery, resulting in a higher reduction of seizure frequency (with 50% of the patients reaching a 75% seizure frequency reduction at 2 years follow-up). METHODS In this waitlist-controlled phase 3 clinical trial, participants are randomly assigned in a 1:1 ratio to either receive SRT as the intervention, while the standard treatments consist of ASM continuation and neuromodulation. After 2-year follow-up, patients randomized for the standard treatment (waitlist-control group) are offered SRT. Patients aged ≥ 18 years with focal DRE and a pretreatment defined epileptogenic zone (EZ) not eligible for open surgery will be included. The intervention is a LINAC-based single fraction (24 Gy) SRT treatment. The target volume is defined as the epileptogenic zone (EZ) on all (non) invasive examinations. The seizure frequency will be monitored on a daily basis using an electronic diary and an automatic seizure detection system during the night. Potential side effects are evaluated using advanced MRI, cognitive evaluation, Common Toxicity Criteria, and patient-reported outcome questionnaires. In addition, the cost-effectiveness of the SRT treatment will be evaluated. DISCUSSION This is the first randomized trial comparing SRT with standard of care in patients with DRE, non-eligible for open surgery. The primary objective is to determine whether SRT significantly reduces the seizure frequency 2 years after treatment. The results of this trial can influence the current clinical practice and medical cost reimbursement in the Netherlands for patients with focal DRE who are not eligible for open surgery, providing a non-invasive curative treatment option. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05182437. Registered on September 27, 2021.
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Affiliation(s)
- C M L Zegers
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - A Swinnen
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - C Roumen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - A L Hoffmann
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - E G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - C J J van Asch
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, the Netherlands
| | - L Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - I Compter
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - E M T Dieleman
- Department of Radiotherapy, Amsterdam UMC (AMC), Amsterdam, the Netherlands
| | - J B Dijkstra
- Department of Medical Psychology, Maastricht University Medical Center+, MHeNs School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - M Granzier
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - M Hendriks
- Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Maastricht, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - P Hofman
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R M A Houben
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - B Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - H E Ronner
- Department of Clinical Neurophysiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - R P W Rouhl
- Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - S van der Salm
- University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - R G C Santegoeds
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J J Verhoeff
- Department of Radiotherapy, Amsterdam UMC (AMC), Amsterdam, the Netherlands
- Department of Radiation Oncology, UMC Utrecht, 3584 CX, Utrecht, the Netherlands
| | - G L Wagner
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Zwemmer
- Department of Clinical Neurophysiology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Oemg Schijns
- Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A J Colon
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Epileptology, CHU Martinique, Fort-de-France, France
| | - D B P Eekers
- Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
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van Lanen RHGJ, Wiggins CJ, Colon AJ, Backes WH, Jansen JFA, Uher D, Drenthen GS, Roebroeck A, Ivanov D, Poser BA, Hoeberigs MC, van Kuijk SMJ, Hoogland G, Rijkers K, Wagner GL, Beckervordersandforth J, Delev D, Clusmann H, Wolking S, Klinkenberg S, Rouhl RPW, Hofman PAM, Schijns OEMG. Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study. Neuroradiology 2022; 64:753-764. [PMID: 34984522 PMCID: PMC8907090 DOI: 10.1007/s00234-021-02884-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). METHODS We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. RESULTS All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. CONCLUSION This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER www.trialregister.nl : NTR7536.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - C J Wiggins
- Scannexus, Ultra-High Field MRI Research Center, Maastricht, the Netherlands
| | - A J Colon
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - W H Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D Uher
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G S Drenthen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - M C Hoeberigs
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - G L Wagner
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | | | - D Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - S Wolking
- Department of Epileptology and Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - S Klinkenberg
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P A M Hofman
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
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van Lanen RHGJ, Colon AJ, Wiggins CJ, Hoeberigs MC, Hoogland G, Roebroeck A, Ivanov D, Poser BA, Rouhl RPW, Hofman PAM, Jansen JFA, Backes W, Rijkers K, Schijns OEMG. Ultra-high field magnetic resonance imaging in human epilepsy: A systematic review. Neuroimage Clin 2021; 30:102602. [PMID: 33652376 PMCID: PMC7921009 DOI: 10.1016/j.nicl.2021.102602] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Resective epilepsy surgery is an evidence-based curative treatment option for patients with drug-resistant focal epilepsy. The major preoperative predictor of a good surgical outcome is detection of an epileptogenic lesion by magnetic resonance imaging (MRI). Application of ultra-high field (UHF) MRI, i.e. field strengths ≥ 7 Tesla (T), may increase the sensitivity to detect such a lesion. METHODS A keyword search strategy was submitted to Pubmed, EMBASE, Cochrane Database and clinicaltrials.gov to select studies on UHF MRI in patients with epilepsy. Follow-up study selection and data extraction were performed following PRISMA guidelines. We focused on I) diagnostic gain of UHF- over conventional MRI, II) concordance of MRI-detected lesion, seizure onset zone and surgical decision-making, and III) postoperative histopathological diagnosis and seizure outcome. RESULTS Sixteen observational cohort studies, all using 7T MRI were included. Diagnostic gain of 7T over conventional MRI ranged from 8% to 67%, with a pooled gain of 31%. Novel techniques to visualize pathological processes in epilepsy and lesion detection are discussed. Seizure freedom was achieved in 73% of operated patients; no seizure outcome comparison was made between 7T MRI positive, 7T negative and 3T positive patients. 7T could influence surgical decision-making, with high concordance of lesion and seizure onset zone. Focal cortical dysplasia (54%), hippocampal sclerosis (12%) and gliosis (8.1%) were the most frequently diagnosed histopathological entities. SIGNIFICANCE UHF MRI increases, yet variably, the sensitivity to detect an epileptogenic lesion, showing potential for use in clinical practice. It remains to be established whether this results in improved seizure outcome after surgical treatment. Prospective studies with larger cohorts of epilepsy patients, uniform scan and sequence protocols, and innovative post-processing technology are equally important as further increasing field strengths. Besides technical ameliorations, improved correlation of imaging features with clinical semiology, histopathology and clinical outcome has to be established.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
| | - A J Colon
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - C J Wiggins
- Scannexus, Ultra High Field MRI Research Center, Maastricht, The Netherlands
| | - M C Hoeberigs
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A M Hofman
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
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Abstract
OBJECTIVE MEG and EEG after sleep deprivation (EEG-SD) are applied as diagnostic tools in the evaluation of patients with possible epilepsy. There is no gold standard to check whether the diagnosis based on these two modalities is correct. The best standard available is the long-term follow-up of patients. As follow-up of an earlier study in which the additional value of MEG vs EEG-SD diagnosis was evaluated, we investigated the long-term validity of MEG-based and EEG-SD-based diagnosis. MATERIALS AND METHODS Data collected from 46 patients were used in a comparative study of the last known diagnosis against the original one of 8 years ago. RESULTS Long-term (3-8 years) sensitivity of sharp phenomena (combining spikes and sharp waves) in routine MEG and in EEG-SD for the diagnosis epilepsy is 71% and 62%, respectively. When compared to the original study, this hardly changed. Over time, uncertainty on diagnosis diminishes. CONCLUSION MEG as well as EEG-SD are robust long-term predictors for epilepsy.
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Affiliation(s)
- A. J. Colon
- Department of Clinical Neurophysiology; ACE, location Kempenhaeghe; Heeze The Netherlands
- Department of R&D; ACE; Heeze The Netherlands
- Department of Neurology; Ghent University Hospital; Ghent Belgium
| | - H. E. Ronner
- Department of Clinical Neurophysiology; VUmc; Amsterdam The Netherlands
| | - P. Boon
- Department of R&D; ACE; Heeze The Netherlands
- Department of Neurology; Ghent University Hospital; Ghent Belgium
| | - P. Ossenblok
- Department of R&D; ACE; Heeze The Netherlands
- Department of Clinical Physics; ACE, location Kempenhaeghe; Heeze The Netherlands
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Colon AJ, van Osch MJP, Buijs M, Grond JVD, Boon P, van Buchem MA, Hofman PAM. Detection superiority of 7 T MRI protocol in patients with epilepsy and suspected focal cortical dysplasia. Acta Neurol Belg 2016; 116:259-69. [PMID: 27389578 PMCID: PMC4989014 DOI: 10.1007/s13760-016-0662-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022]
Abstract
In 11 adult patients with suspicion of Focal cortical dysplasia (FCD) on 1.5 T (n = 1) or 3 T (n = 10) magnetic resonance imaging (MRI), 7 T MRI was performed. Visibility, extent, morphological features and delineation were independently rated and subsequently discussed by three observers. Additionally, head-to-head comparisons with corresponding 3 T images were made in the eight patients with a previous 3 T MRI and sustained suspicion of FCD. Comparison with histopathology was done in the five patients that underwent surgery. All lesions, seen at 1.5 and 3 T, were also recognized on 7 T. At 7 T FLAIR highlighted the FCD-like lesions best, whereas T2 and T2* were deemed better suited to review structure and extent of the lesion. Image quality with the used 7 T MRI setup was higher than the quality with the used 3 T MRI setup. In 2 out of 11 patients diagnosis changed, in one after re-evaluation of the images, and in the other based on histopathology. With the used 7 T MRI setup, FCD-like lesions can be detected with more confidence and detail as compared to lower field strength. However, concordance between radiologic diagnosis and final diagnosis seems to be lower than expected.
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Fürbass F, Ossenblok P, Hartmann M, Perko H, Skupch AM, Lindinger G, Elezi L, Pataraia E, Colon AJ, Baumgartner C, Kluge T. Prospective multi-center study of an automatic online seizure detection system for epilepsy monitoring units. Clin Neurophysiol 2014; 126:1124-1131. [PMID: 25454341 DOI: 10.1016/j.clinph.2014.09.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 06/03/2014] [Revised: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE A method for automatic detection of epileptic seizures in long-term scalp-EEG recordings called EpiScan will be presented. EpiScan is used as alarm device to notify medical staff of epilepsy monitoring units (EMUs) in case of a seizure. METHODS A prospective multi-center study was performed in three EMUs including 205 patients. A comparison between EpiScan and the Persyst seizure detector on the prospective data will be presented. In addition, the detection results of EpiScan on retrospective EEG data of 310 patients and the public available CHB-MIT dataset will be shown. RESULTS A detection sensitivity of 81% was reached for unequivocal electrographic seizures with false alarm rate of only 7 per day. No statistical significant differences in the detection sensitivities could be found between the centers. The comparison to the Persyst seizure detector showed a lower false alarm rate of EpiScan but the difference was not of statistical significance. CONCLUSIONS The automatic seizure detection method EpiScan showed high sensitivity and low false alarm rate in a prospective multi-center study on a large number of patients. SIGNIFICANCE The application as seizure alarm device in EMUs becomes feasible and will raise the efficiency of video-EEG monitoring and the safety levels of patients.
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Affiliation(s)
- F Fürbass
- Department Safety & Security, AIT Austrian Institute of Technology GmbH, Vienna, Austria.
| | - P Ossenblok
- Clinical Physics, Academic Center of Epileptology, Heeze & Maastricht UMC+, The Netherlands
| | - M Hartmann
- Department Safety & Security, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - H Perko
- Department Safety & Security, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - A M Skupch
- Department Safety & Security, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - G Lindinger
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - L Elezi
- General Hospital Hietzing with Neurological Center Rosenhuegel, 2nd Neurological Department, Vienna, Austria
| | - E Pataraia
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - A J Colon
- Department of Clinical Neurophysiology, Academic Center of Epileptology, Heeze & Maastricht UMC+, PO Box 61, 5590 AB Heeze, The Netherlands
| | - C Baumgartner
- General Hospital Hietzing with Neurological Center Rosenhuegel, 2nd Neurological Department, Vienna, Austria
| | - T Kluge
- Department Safety & Security, AIT Austrian Institute of Technology GmbH, Vienna, Austria
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Wijnen BFM, de Kinderen RJA, Colon AJ, Dirksen CD, Essers BAB, Hiligsmann M, Leijten FSS, Ossenblok PPW, Evers SMAA. Eliciting patients' preferences for epilepsy diagnostics: a discrete choice experiment. Epilepsy Behav 2014; 31:102-9. [PMID: 24389020 DOI: 10.1016/j.yebeh.2013.11.029] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diagnosing epilepsy is a lengthy and burdensome process for patients and their family. Although the need for a more patient-centered approach in clinical practice is widely acknowledged, empirical evidence regarding patient preferences for diagnostic modalities in epilepsy is missing. The objectives of this study were 1) to identify to what extent important attributes of diagnostic procedures in epilepsy affect preferences for a procedure, 2) to determine the relative importance of these attributes, and 3) to calculate overall utility scores for routine electroencephalography (EEG) and magnetoencephalography (MEG) recordings. METHODS A discrete choice experiment was performed to determine patients' preferences, which involved presentation of pairwise choice tasks regarding hypothetical scenarios. Scenarios varied along six attributes: "way of measuring brain activity", "duration", "freedom of movement", "travel time", "type of additional examination", and "chance of additional examination". Choice tasks were constructed using a statistically efficient design, and the questionnaire contained 15 unique unlabeled choice tasks. Mixed multinomial logistic regression was used to estimate patients' preferences. RESULTS A total of 289 questionnaires were included in the analysis. McFadden's pseudo R(2) showed a model fit of 0.28, and all attributes were statistically significant. Heterogeneity in preferences was present for all attributes. "Freedom of movement" and "Chance of additional examination" were perceived as the most important attributes. Overall utility scores did not substantially differ between routine EEG and MEG. CONCLUSION This study suggests that the identified attributes are important in determining patients' preference for epilepsy diagnostics. It can be concluded that MEG is not necessarily more patient-friendly than a routine EEG in primary diagnostics and, regarding additional diagnostics, patients have a strong preference for long-term 24-h EEG over EEG after sleep deprivation. Furthermore, barring substantial heterogeneity within the parameters in mind, our study suggests that it is important to take individual preferences into account in medical decision-making.
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Affiliation(s)
- B F M Wijnen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - R J A de Kinderen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - A J Colon
- Department of Clinical Neurophysiology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - C D Dirksen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - B A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - M Hiligsmann
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - F S S Leijten
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre Utrecht, 3584 CG Utrecht, The Netherlands.
| | - P P W Ossenblok
- Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - S M A A Evers
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Colon AJ, Vredeveld JW, Blaauw G. Motor Evoked Potentials After Transcranial Magnetic Stimulation Support Hypothesis of Coexisting Central Mechanism in Obstetric Brachial Palsy. J Clin Neurophysiol 2007; 24:48-51. [PMID: 17277578 DOI: 10.1097/01.wnp.0000237075.85689.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Six infants with obstetric brachial palsy, ranging from 4 to 7 months of age, were investigated. One was suspected of having extensive brachial plexus lesions and five were suspected of having a unilateral lesion of both roots C5 and C6. All were referred to our center to investigate the possibility for reconstructive surgery. In all infants, even at this age, transcranial magnetic stimulation resulted in motor evoked potentials (MEP) in the biceps (in one, in the brachioradial) muscles. Averaging could not be done because of the intraindividual variation in latency. The MEP was easier to recognize if evoked when the infant had the arm bent. In all five infants suspected of upper brachial plexus lesion with avulsion of both roots C5 and C6 and/or complete rupture of the upper trunk, proven in four, an MEP on the lesioned side could be evoked. Combined with earlier investigations showing (almost) normal EMG and somatosensory evoked potentials in infants with upper plexus lesion, this leads us to the conclusion that the paralysis of these infants cannot only be attributed to the peripheral axonal damage alone but that central plasticity must also play an important role. As this is a slow process, some infants might not yet be able to use the paralytic muscles. Some theoretic issues are discussed.
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Affiliation(s)
- A J Colon
- Department of Neurophysiology, Kempenhaeghe, Heeze, The Netherlands.
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Colon AJ, Vredeveld JW, Blaauw G, Zandvoort JA. Spontaneous muscle fiber activity appears early in cases of obstetric brachial plexopathy. Muscle Nerve 2003; 28:515-6. [PMID: 14506727 DOI: 10.1002/mus.10449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
In the pre-operative screening of infants with obstetric brachial palsy (OBP), the results of routine electromyography are often overly optimistic when compared to the peri-operative findings. This prompted us to include investigation of the sensory innervation of these infants using the N20 (the first cortical response to a peripheral stimulation) of the somatosensory evoked potentials (SSEP). Three to seven months after birth, SSEP were recorded at the skull after stimulation of the thumb and middle finger in infants with obstetric rupture of the upper trunk or avulsion of roots C5, C6, or C7, and in whom no clinical improvement of motor function was observed in the biceps brachii and deltoid muscles. In most infants, a normal N20 could be evoked, indicating the existence of peripheral sensory pathways. From the thumb, these sensory pathways would necessarily bypass the upper trunk and dorsal roots of spinal nerves C5 and C6, and from the middle finger bypass the middle trunk and dorsal root C7, before extending into the dorsal column and projecting toward the thalamus and cerebral cortex. These data suggest that in infancy the segmental sensory innervation of the hand is more diverse than is described in most textbooks.
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Affiliation(s)
- A J Colon
- Department of Neurology, Atrium, Medical Center, Heerlen, The Netherlands.
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Colon AJ. MR findings of the brain stem in arterial hypertension. AJNR Am J Neuroradiol 2000; 21:1767. [PMID: 11039363 PMCID: PMC8174864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Voets AJ, Colon AJ, van den Berg JW. Mediastinal neurofibroma as a cause of unilateral diaphragm paralysis in von Recklinghausen's disease. Intensive Care Med 1999; 25:1336-7. [PMID: 10654226 DOI: 10.1007/s001340051073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
We retrospectively evaluated the significance of making a chest X-ray in the acute stage of a stroke. Forty percent of the chest X-rays were of suboptimal quality. Abnormal chest X-rays were, in part, the reason for consultation of chest specialists in 5%. A chest X-ray in patients with acute stroke should only be performed if there is clinical suspicion of pulmonary or cardiac pathology, not as a routine.
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Affiliation(s)
- A J Colon
- Department of Neurology, Atrium Medisch Centrum, Heerlen, The Netherlands
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Colon AJ. [Thoughts on hypertensive encephalopathy after an atypical case]. Rev Med Suisse Romande 1998; 118:505-7. [PMID: 9673499] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nowadays hypertensive encephalopathy is rare. A patient of 49 with neurological symptoms that are not classical for this syndrome is presented. While treating the hypertension the neurological symptoms disappeared. The necessary condition for the development of this syndrome is a fast rise of arterial pressure that is followed by intra-cranial edema. The edema is incited by vasodilatation that appears at tensions above the limits of cerebral autoregulation. It is recommended to treat the patients in an intensive care unit. Without treatment the patient will die.
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Affiliation(s)
- A J Colon
- Service de neurologie, Ziekenhuis De Wever, Heerlen
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Colon AJ, Koehler PJ. [Cerebral infarct and cancer: etiological relationship or incidental finding?]. Ned Tijdschr Geneeskd 1995; 139:1265-8. [PMID: 7609799] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A J Colon
- Ziekenhuis De Wever & Gregorius, afd. Neurologie, Heerlen
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