scholarly journals P.022 Neuroimaging findings and seizure type as risk factors for adult focal drug resistant epilepsy

2016 ◽  
Vol 43 (S2) ◽  
pp. S27-S27
Author(s):  
L Hernandez-Ronquillo ◽  
P Lebony-Roy ◽  
S Buckley ◽  
J Tellez Zenteno
Keyword(s):  
Risk Factors ◽  
Focal Epilepsy ◽  
Cortical Dysplasia ◽  
Age At Diagnosis ◽  
Control Group ◽  
Drug Resistant ◽  
Inclusion Criteria ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Drug Resistant Epilepsy

Background: About 35% of patients with epilepsy may develop drug-resistant epilepsy (DRE). Identifying risk factors associated with DRE will allow us to identify earlier patients in the course of the disease. Methods: This is a case-control study nested within a cohort. Chart reviews of subjects who full fill inclusion criteria were completed. Inclusion criteria included age>18 years, focal epilepsy determined by clinical correlation and EEG. DRE was determined by ILAE criteria. Results: 149 subjects were included. Seventy had DRE (cases), and seventy-nine did not have DRE (controls). DRE group had a mean age of 41 years (SD+14.8) compared to the control group (49+17.5) (p=0.003). DRE group had a mean age at diagnosis of epilepsy of 19+15.3 compared to the control group with a mean of 33.6+21. (p=<0.001). The main risk factors identified in this study were; cortical dysplasia OR 8.67 (CI 1.04-72.3, p=0.026); mesial temporal sclerosis (MTS) (OR 2.69; CI 1.12-6.47; p=0.024); and presence of complex partial seizures (OR 2.04. Conclusions: Young age at diagnosis of focal epilepsy, diagnosis of cortical dysplasia, MTS, and presence of complex partial seizures are risk factors for DRE

How to Inject Ictal SPECT? From Manual to Automated Injection

2021 ◽  
Author(s):  
Xavier Setoain ◽  
Francisco Campos ◽  
Antonio Donaire ◽  
Maria Mayoral ◽  
Andres Perissinotti ◽  
...  
Keyword(s):  
Injection System ◽  
Control Group ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Injection Time ◽  
Tracer Injection ◽  
Ictal Spect ◽  
Seizure Focus ◽  
Drug Resistant Epilepsy ◽  
Automated Injection

Abstract BackgroundSuccessful surgery depends on the accurate localization of epileptogenic zone before surgery. Ictal SPECT is the only imaging modality that allows identification of the ictal onset zone by measuring the regional cerebral blood flow at the time of injection. The main limitations of ictal SPECT in epilepsy are the complex methodology of the tracer injection during a seizure. To overcome these limitations, we present the main features of the first automated injector for ictal SPECT (epijet, LemerPax; La Chapelle -sur-Erdre; France). In this study we compared traditional manual injection with automated injection for ictal SPECT in122 patients with drug-resistant epilepsy. MethodsThe study included 55 consecutive prospective patients with drug-resistant epilepsy undergoing injection with the automated injector. The control group was our retrospective database of a historic pool of 67 patients, injected manually from 2014-2016. Calculated annual exposure/radioactive dose for operators was measured. Injection time, seizure focus localization with ictal SPECT, as well as repeated hospitalizations related to fails injections were compared in these two groups of patients. ResultsThere were no differences in the average injection time with epijet (13 s) compared with the traditional manual injection (14s). The seizure focus was successfully localized with ictal SPECT with epijet in 44/55 (80%) patients and with manual injection in 46/67 (68%) patients (p=0.694). Repeated studies were required in 16/67 (23%) patients in the manual injection group compared to 4 patients (7%) in the epijet group (p=0.022). Calculated annual exposure/dose for operators of 0.39 mSv/year and administered dose error inferior to 5% are other advantages of epijet. ConclusionThe first results using epijet are promising in adjustment of the injection dose, reducing the rate of radiation exposure for patients and nurses, maintaining the same injection time and allowing high SPECT accuracy. These preliminary results support the use of an automated injection system to inject radioactive ictal SPECT doses in epilepsy units.

scholarly journals Chronic subthreshold cortical stimulation for adult drug-resistant focal epilepsy: safety, feasibility, and technique

2018 ◽  
Vol 129 (2) ◽  
pp. 533-543 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Sanjeet S. Grewal ◽  
Matthew Stead ◽  
Brian Nils Lundstrom ◽  
Jeffrey W. Britton ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Cortical Stimulation ◽  
Adult Patients ◽  
Therapeutic Trial ◽  
Drug Resistant ◽  
Surgical Safety ◽  
Institutional Experience ◽  
Eloquent Cortex ◽  
Drug Resistant Epilepsy ◽  
Seizure Foci

OBJECTIVEEpilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection.METHODSAdult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted.RESULTSTen patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients.CONCLUSIONSThe authors’ institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.

scholarly journals Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood: Clinical and etiologic risk factors

Epilepsia ◽  
2015 ◽  
Vol 57 (1) ◽  
pp. e7-e11 ◽  
Author(s):  
Sekhar C. Pillai ◽  
Shekeeb S. Mohammad ◽  
Yael Hacohen ◽  
Esther Tantsis ◽  
Kristina Prelog ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

scholarly journals Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Alyssa Denton ◽  
Lilian Thorpe ◽  
Alexandra Carter ◽  
Adriana Angarita-Fonseca ◽  
Karen Waterhouse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Drug Resistant ◽  
Age Group ◽  
Drug Resistant Epilepsy ◽  
New Diagnosis

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

scholarly journals Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

2018 ◽  
Vol 10 (1S) ◽  
pp. 81-88
Author(s):  
E. A. Narodova ◽  
A. A. Narodov ◽  
N. A. Shnayder ◽  
D. V. Dmitrenko ◽  
I. G. Strotskaya
Keyword(s):  
Focal Epilepsy ◽  
Rapid Development ◽  
Adult Population ◽  
Infectious Complications ◽  
High Rate ◽  
Drug Resistant ◽  
Postoperative Rehabilitation ◽  
Foreign Countries ◽  
Neurosurgical Treatment ◽  
Drug Resistant Epilepsy

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period  2010–2017 was sought in Russian and foreign databases. This  review included 58 only full-text publications. The search results  have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the  problem of this disease has not yet been fully resolved today. This is  evidenced by fairly high global prevalence rates in patients with  postoperative epilepsy resistant to antiepileptic therapy. The  literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according  to the type of an epileptogenic structural lesion and its location in  the brain. However, despite the rapid development of epilepsy  surgery, currently there is still a low surgical activity in the treatment  of patients with drugresistant epilepsy. Of importance is  also the presence of postoperative complications, including various  infectious complications and neurological deficit. Taking into account  the high rate of postoperative epilepsy, it is concluded that it is  appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

scholarly journals Drug-resistant focal epilepsy in children is associated with increased modal controllability of the whole brain and epileptogenic regions

2021 ◽  
Author(s):  
Kiran Seunarine ◽  
Xiaosong He ◽  
Martin Tisdall ◽  
Christopher Clark ◽  
Danielle S Bassett ◽  
...  
Keyword(s):  
Diffusion Mri ◽  
Focal Epilepsy ◽  
Brain Network ◽  
Structure And Function ◽  
Network Control ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
And Function ◽  
The Brain ◽  
Disease Understanding

Network control theory provides a framework by which neurophysiological dynamics of the brain can be modelled as a function of the structural connectome constructed from diffusion MRI. Average controllability describes the ability of a region to drive the brain to easy-to-reach neurophysiological states whilst modal controllability describes the ability of a region to drive the brain to difficult-to-reach states. In this study, we identify increases in mean average and modal controllability in children with drug-resistant epilepsy compared to healthy controls. Using simulations, we purport that these changes may be a result of increased thalamocortical connectivity. At the node level, we demonstrate decreased modal controllability in the thalamus and posterior cingulate regions. In those undergoing resective surgery, we also demonstrate increased modal controllability of the resected parcels, a finding specific to patients who were rendered seizure free following surgery. Changes in controllability are a manifestation of brain network dysfunction in epilepsy and may be a useful construct to understand the pathophysiology of this archetypical network disease. Understanding the mechanisms underlying these controllability changes may also facilitate the design of network-focussed interventions that seek to normalise network structure and function.

Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia: A Systematic Review and Meta-analysis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013066
Author(s):  
Anna Willard ◽  
Ana Antonic-Baker ◽  
Zhibin Chen ◽  
Terence John O'Brien ◽  
Patrick Kwan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Focal Cortical Dysplasia ◽  
Meta Analysis ◽  
Cortical Dysplasia ◽  
Favorable Outcome ◽  
Seizure Outcome ◽  
Drug Resistant ◽  
Resective Surgery ◽  
Post Surgery ◽  
Drug Resistant Epilepsy

Objective:Focal cortical dysplasia (FCD) has been associated with poorer post-surgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histological diagnosis, including patients with abnormal as well as normal pre-operative MRI. However, in clinical workflow, patient selection for surgery is based on pre-operative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.Methods:We devised our study protocol in accordance with PRISMA guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel Class I, ILAE Classes 1-2, or “seizure-free” status. Meta-regression was performed to investigate sources of heterogeneity.Results:Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed patients for ≥24 months post-surgery. The overall post-surgical favorable outcome rate was 70% (95% CI: 64-75). There was high inter-study heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion [risk ratio, RR=2.42 (95% CI: 1.55-3.76), p<0.001] and location of the FCD lesion in the temporal lobe [RR=1.38 (95% CI: 1.07-1.79), p=0013], but not lesion extent, intracranial EEG use, or FCD histological type. The number of FCD histological types included in the same study accounted for 7.6% of the observed heterogeneity.Conclusions:70% of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome following resective surgery. Our findings can be incorporated in routine pre-operative counselling and reinforce the importance of resecting completely the MRI-detected FCD where this is safe and feasible.

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