scholarly journals 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

2022 ◽  
Author(s):  
R. H. G. J. van Lanen ◽  
C. J. Wiggins ◽  
A. J. Colon ◽  
W. H. Backes ◽  
J. F. A. Jansen ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
High Field ◽  
Focal Epilepsy ◽  
Good Clinical Practice ◽  
Lesion Detection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Ultra High Field ◽  
Prospective Longitudinal

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.

scholarly journals Outcome of lesional epilepsy surgery

2019 ◽  
Vol 9 (4) ◽  
pp. 286-295 ◽  
Author(s):  
Jafar Mehvari Habibabadi ◽  
Houshang Moein ◽  
Reza Basiratnia ◽  
Shervin Badihian ◽  
Bagher Zaki ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Postoperative Outcome ◽  
Resource Poor Setting ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Prospective Longitudinal Study ◽  
Mortality And Morbidity ◽  
Prospective Longitudinal

BackgroundWe investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting.MethodsThis prospective longitudinal study was conducted during 2007–2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome.ResultsA total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods.ConclusionsWe found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy.

Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors

2017 ◽  
Vol 127 (5) ◽  
pp. 1147-1152 ◽  
Author(s):  
Veronica Pelliccia ◽  
Francesco Deleo ◽  
Francesca Gozzo ◽  
Ivana Sartori ◽  
Roberto Mai ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Large Population ◽  
Complete Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Determinant Factors ◽  
Associated Tumors

OBJECTIVEEpilepsy surgery is an effective means of treating focal epilepsy associated with long-term epilepsy-associated tumors. This study evaluated a large population of surgically treated patients with childhood onset of epilepsy and a histologically confirmed diagnosis of long-term epilepsy-associated tumors. The authors analyzed long-term seizure outcomes to establish whether the time of surgery and patients' ages were determinant factors.METHODSThe authors separately investigated several presurgical, surgical, and postsurgical variables in patients operated on before (pediatric group) and at or after (adult group) the age of 18 years. Patients with < 24 months of postsurgical follow-up were excluded from the analysis.RESULTSThe patients who underwent surgery before 18 years of age showed better seizure outcomes than those after 18 years of age (80% vs 53.3% Engel Class Ia outcome, respectively; p < 0.001). Multivariate analysis showed that the only variables significantly associated with seizure freedom were complete resection of the lesion, a shorter duration of epilepsy, and temporal lobe resection.CONCLUSIONSThe findings of this study indicate that pediatric patients are more responsive to epilepsy surgery and that a shorter duration of epilepsy, complete resection, and a temporal lobe localization are determinant factors for a positive seizure outcome.

scholarly journals Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Nicolo’ Bruschi ◽  
Giacomo Boffa ◽  
Matilde Inglese
Keyword(s):  
Multiple Sclerosis ◽  
High Field ◽  
Neurological Diseases ◽  
Lesion Detection ◽  
Demyelinating Diseases ◽  
Metabolic Imaging ◽  
Central Vein ◽  
Ultra High Field ◽  
Functional Features

Abstract Magnetic resonance imaging (MRI) is essential for the early diagnosis of multiple sclerosis (MS), for investigating the disease pathophysiology, and for discriminating MS from other neurological diseases. Ultra-high-field strength (7-T) MRI provides a new tool for studying MS and other demyelinating diseases both in research and in clinical settings. We present an overview of 7-T MRI application in MS focusing on increased sensitivity and specificity for lesion detection and characterisation in the brain and spinal cord, central vein sign identification, and leptomeningeal enhancement detection. We also discuss the role of 7-T MRI in improving our understanding of MS pathophysiology with the aid of metabolic imaging. In addition, we present 7-T MRI applications in other demyelinating diseases. 7-T MRI allows better detection of the anatomical, pathological, and functional features of MS, thus improving our understanding of MS pathology in vivo. 7-T MRI also represents a potential tool for earlier and more accurate diagnosis.

scholarly journals The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

2015 ◽  
Vol 15 (6) ◽  
pp. 644-650 ◽  
Author(s):  
Chima O. Oluigbo ◽  
Jichuan Wang ◽  
Matthew T. Whitehead ◽  
Suresh Magge ◽  
John S. Myseros ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Brain Mri ◽  
Age At Onset ◽  
Cortical Dysplasia ◽  
Complete Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Lesion Volume ◽  
Resection Volume

OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

European trends in epilepsy surgery

Neurology ◽  
2018 ◽  
Vol 91 (2) ◽  
pp. e96-e106 ◽  
Author(s):  
Maxime O. Baud ◽  
Thomas Perneger ◽  
Attila Rácz ◽  
Max C. Pensel ◽  
Christian Elger ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Disease Duration ◽  
Focal Epilepsy ◽  
Seizure Freedom ◽  
Early Referral ◽  
Temporal Epilepsy ◽  
Included Patient ◽  
Class 1 ◽  
Postsurgical Outcomes ◽  
Over Time

ObjectiveResective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart.MethodsSixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.ResultsOver time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period (p = 0.02). Mean disease duration at surgery decreased by 5.2 years (p < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted p = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02–1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%–5.3%, p = 0.7).ConclusionImprovements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.

scholarly journals The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

Epilepsia ◽  
2019 ◽  
Vol 60 (8) ◽  
Author(s):  
Francesca Conte ◽  
Wim Van Paesschen ◽  
Benjamin Legros ◽  
Chantal Depondt
Keyword(s):  
Epilepsy Surgery ◽  
Scale Validation ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Independent Population ◽  
Grading Scale

scholarly journals High-frequency oscillations in scalp EEG mirror seizure frequency in pediatric focal epilepsy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ece Boran ◽  
Johannes Sarnthein ◽  
Niklaus Krayenbühl ◽  
Georgia Ramantani ◽  
Tommaso Fedele
Keyword(s):  
Seizure Frequency ◽  
Epilepsy Surgery ◽  
High Frequency ◽  
Focal Epilepsy ◽  
Low Noise ◽  
Drug Resistant ◽  
Scalp Eeg ◽  
High Frequency Oscillations ◽  
Custom Made ◽  
Active Epilepsy

Abstract High-frequency oscillations (HFO) are promising EEG biomarkers of epileptogenicity. While the evidence supporting their significance derives mainly from invasive recordings, recent studies have extended these observations to HFO recorded in the widely accessible scalp EEG. Here, we investigated whether scalp HFO in drug-resistant focal epilepsy correspond to epilepsy severity and how they are affected by surgical therapy. In eleven children with drug-resistant focal epilepsy that underwent epilepsy surgery, we prospectively recorded pre- and postsurgical scalp EEG with a custom-made low-noise amplifier (LNA). In four of these children, we also recorded intraoperative electrocorticography (ECoG). To detect clinically relevant HFO, we applied a previously validated automated detector. Scalp HFO rates showed a significant positive correlation with seizure frequency (R2 = 0.80, p < 0.001). Overall, scalp HFO rates were higher in patients with active epilepsy (19 recordings, p = 0.0066, PPV = 86%, NPV = 80%, accuracy = 84% CI [62% 94%]) and decreased following successful epilepsy surgery. The location of the highest HFO rates in scalp EEG matched the location of the highest HFO rates in ECoG. This study is the first step towards using non-invasively recorded scalp HFO to monitor disease severity in patients affected by epilepsy.

Epilepsy Surgery of the Cingulate Gyrus and the Frontomesial Cortex

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 900-910 ◽  
Author(s):  
Marec von Lehe ◽  
Jan Wagner ◽  
Joerg Wellmer ◽  
Hans Clusmann ◽  
Thomas Kral
Keyword(s):  
Epilepsy Surgery ◽  
Supplementary Motor Area ◽  
Focal Epilepsy ◽  
Case Reports ◽  
Motor Area ◽  
Seizure Outcome ◽  
Cingulate Gyrus ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND: Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. OBJECTIVE: To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment. METHODS: Twenty-two patients (mean age, 36; range, 12–63) with a mean seizure history of 23 years (range, 2–52) were retrospectively analyzed. We report presurgical diagnostics, surgical strategy, and postoperative follow-up concerning functional morbidity and seizures (mean follow-up, 86 months; range, 25–174). RESULTS: Nineteen patients showed potential epileptogenic lesions on preoperative magnetic resonance imaging (MRI). All patients had noninvasive presurgical workup; 15 (68%) underwent invasive Video-electroencephalogram (EEG)-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG results was done in 6 patients. In 4 patients, the resection was incomplete because of the involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, 3 in the posterior cingulate gyrus) and 14 extended supracingular frontal resections were performed. Nine patients experienced temporary postoperative supplementary motor area syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Postoperatively, 62% of patients were seizure-free (International League Against Epilepsy [ILAE] 1), and 76% had a satisfactory seizure outcome (ILAE 1–3). CONCLUSION: Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.

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