scholarly journals P.103 Midline Spikes and Intractable Seizures in Pediatric Epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S49-S49
Author(s):  
K Luan ◽  
J Mailo ◽  
N Liu ◽  
J Kassiri ◽  
DB Sinclair
Keyword(s):  
Focal Cortical Dysplasia ◽  
Intractable Epilepsy ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Seizure Onset ◽  
Focal Seizures ◽  
Intractable Seizures ◽  
Epileptic Discharges ◽  
Common Etiology

Background: Epileptic discharges localized to the midline vertex are rare. However, they have been associated with intractable seizures and severe long-term consequences in the developing brain. Our study aimed to understand the etiology of pediatric midline seizures and define post-surgical seizure outcomes. Methods: We reviewed charts, electroencephalography (EEG), and neuroimaging studies of ten pediatric patients with epileptic discharges localized to the midline vertex in the Comprehensive Epilepsy Program. The seizures were classified according to the International League Against Epilepsy criteria, patient age, sex, neuroimaging results, seizure etiology and outcomes were obtained. Results: Age of seizure onset was within the first 10 years of life in 90% of patients, with focal seizures being the most prevalent. Focal cortical dysplasia (FCD) was the most common etiology present in 50% of patients. These children had normal neuroimaging studies and intractable epilepsy. However, seizure freedom was achieved following surgical resection of the epileptogenic zone. Conclusions: We demonstrated that patients with midline epileptic discharges are associated with intractable focal seizures and early seizure onset. Despite normal neuroimaging reports, FCD was the most common pathology. Thus our study suggests early localization and resection of the epileptogenic zone may be beneficial for achieving seizure freedom in children with this electroclinical syndrome.

scholarly journals Depth Electrodes in Pediatric Epilepsy Surgery

2013 ◽  
Vol 40 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Janani Kassiri ◽  
Jeff Pugh ◽  
Sharon Carline ◽  
Laura Jurasek ◽  
Thomas Snyder ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Surgical Removal ◽  
Seizure Freedom ◽  
Sufficient Information ◽  
Epileptogenic Zone ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Intractable Seizures ◽  
Clinical Scenarios

Abstract:Background:The surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. To date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. In addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery.Methods:We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone.Result:The ictal onset zone was successfully identified in all 18 patients. Treatment of all surgical patients resulted in successful seizure freedom (Engel class I) without neurological complications.Conclusion:Intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.

Surgery for Nontumoral Insular Epilepsy Explored by Stereoelectroencephalography

Neurosurgery ◽  
2016 ◽  
Vol 79 (4) ◽  
pp. 578-588 ◽  
Author(s):  
Guillaume Gras-Combe ◽  
Lorella Minotti ◽  
Dominique Hoffmann ◽  
Alexandre Krainik ◽  
Philippe Kahane ◽  
...  
Keyword(s):  
Focal Cortical Dysplasia ◽  
Intractable Epilepsy ◽  
Insular Cortex ◽  
Cavernous Angioma ◽  
Cortical Dysplasia ◽  
Electrode Placement ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Pharmacoresistant Epilepsy ◽  
The Right

Abstract BACKGROUND Hidden by the perisylvian operculi, insular cortex has long been underexplored in the context of epilepsy surgery. Recent studies advocated stereoelectroencephalography (SEEG) as a reliable tool to explore insular cortex and its involvement in intractable epilepsy and suggested that insular seizures could be an underestimated entity. However, the results of insular resection to treat pharmacoresistant epilepsy are rarely reported. OBJECTIVE We report 6 consecutive cases of right insular resection performed based on anatomoelectroclinical correlations provided by SEEG. METHODS Six right-handed patients (3 male, 3 female) with drug-resistant epilepsy underwent comprehensive presurgical evaluation. Based on video electroencephalographic recordings, they all underwent SEEG evaluation with bilateral (n = 4) or unilateral right (n = 2) insular depth electrode placement. All patients had both orthogonal and oblique (1 anterior, 1 posterior) insular electrodes (n = 4-6 electrodes). Preoperative magnetic resonance imaging findings were normal in 4 patients, 1 patient had right insular focal cortical dysplasia, and 1 patient had a right opercular postoperative scar (cavernous angioma). All patients underwent right partial insular corticectomy via the subpial transopercular approach. RESULTS Intracerebral recordings demonstrated an epileptogenic zone confined to the right insula in all patients. After selective insular resection, 5 of 6 patients were seizure free (Engel class I) with a mean follow-up of 36.2 months (range, 18-68 months). Histological findings revealed focal cortical dysplasia in 5 patients and a gliosis scar in 1 patient. All patients had minor transient neurological deficit (eg, facial paresis, dysarthria). CONCLUSION Insular resection based on SEEG findings can be performed safely with a significant chance of seizure freedom.

Accuracy and Safety of Customized Stereotactic Fixtures for Stereoelectroencephalography in Pediatric Patients

2020 ◽  
pp. 1-8
Author(s):  
Constantin Pistol ◽  
Andrei Daneasa ◽  
Jean Ciurea ◽  
Alin Rasina ◽  
Andrei Barborica ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Perioperative Complications ◽  
Intractable Epilepsy ◽  
Target Point ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Localization Error ◽  
Temporal Area ◽  
Lateral Entry ◽  
Stereotactic Implantation

Stereoelectroencephalography (SEEG) in children with intractable epilepsy presents particular challenges. Their thin and partially ossified cranium, specifically in the temporal area, is prone to fracture while attaching stereotactic systems to the head or stabilizing the head in robot’s field of action. Postponing SEEG in this special population of patients can have serious consequences, reducing their chances of becoming seizure-free and impacting their social and cognitive development. This study demonstrates the safety and accuracy offered by a frameless personalized 3D printed stereotactic implantation system for SEEG investigations in children under 4 years of age. SEEG was carried out in a 3-year-old patient with drug-resistant focal epilepsy, based on a right temporal-perisylvian epileptogenic zone hypothesis. Fifteen intracerebral electrodes were placed using a StarFix patient-customized stereotactic fixture. The median lateral entry point localization error of the electrodes was 0.90 mm, median lateral target point localization error was 1.86 mm, median target depth error was 0.83 mm, and median target point localization error was 1.96 mm. There were no perioperative complications. SEEG data led to a tailored right temporal-insular-opercular resection, with resulting seizure freedom (Engel IA). In conclusion, patient-customized stereotactic fixtures are a safe and accurate option for SEEG exploration in young children.

scholarly journals Dual Pathology in Rasmussen’s Encephalitis: A Report of Coexistent Focal Cortical Dysplasia and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Richard A. Prayson
Keyword(s):  
Chronic Inflammation ◽  
Focal Cortical Dysplasia ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Cortical Atrophy ◽  
Review Of The Literature ◽  
Dual Pathology ◽  
Rasmussen’S Encephalitis ◽  
Intractable Seizures

Rasmussen’s encephalitis is a well-established, albeit rare cause of medically intractable epilepsy. In a small number of Rasmussen's cases, a second pathology is identified, which independently can cause medically intractable seizures (dual pathology). This paper documents a case of a 13-year-old male who presented with medically intractable epilepsy. The patient underwent a series of surgical resections, early on resulting in a diagnosis of focal cortical dysplasia and later yielding a diagnosis of coexistent Rasmussen’s encephalitis, marked by chronic inflammation, microglial nodules, and focal cortical atrophy, combined with focal cortical dysplasia (Palmini et al. type IIA, ILAE type IIA). The literature on dual pathology in the setting of Rasmussen’s encephalitis is reviewed.

scholarly journals Pediatric epilepsy surgery: could age be a predictor of outcomes?

2016 ◽  
Vol 18 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Benoit Jenny ◽  
Nicolas Smoll ◽  
Yassine El Hassani ◽  
Shahan Momjian ◽  
Claudio Pollo ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Pediatric Epilepsy ◽  
University Hospitals ◽  
Chi Square ◽  
Intractable Seizures ◽  
Antiepileptic Medication ◽  
Pediatric Epilepsy Surgery ◽  
Chi Square Test ◽  
Free Rate

OBJECTIVE Like adults, many children suffering from intractable seizures benefit from surgical therapy. Although various reports indicate that early intervention may avoid severe developmental consequences often associated with intractable epilepsy, surgery is still considered a last option for many children. In this retrospective study, the authors aimed to determine whether pediatric epilepsy surgery, in particular during the first years of life, relates to measurable benefits. METHODS Data from 78 patients (age range 5 months to 17 years) who underwent epilepsy surgery at the Geneva and Lausanne University Hospitals between 1997 and 2012 were reviewed retrospectively. Patients were dichotomized into 2 groups: infants (≤ 3 years of age, n = 19), and children/adolescents (4–17 years of age, n = 59). Compared with children/adolescents, infants more often had a diagnosis of dysplasia (37% vs 10%, respectively; p < 0.05, chi-square test). RESULTS The overall seizure-free rate was 76.9%, with 89.5% in infants and 72.9% in the children/adolescents group. Infants were 2.76 times as likely to achieve seizure-free status as children/adolescents. Postoperative antiepileptic medication was reduced in 67.9% of patients. Only 11.4% of the patients were taking more than 2 antiepileptic drugs after surgery, compared with 43% before surgery (p < 0.0001). The overall complication rate was 15.1% (6.4% transient hemiparesis), and no major complications or deaths occurred. CONCLUSIONS The data show a high seizure-free rate in children ≤ 3 years of age, despite a higher occurrence of dysplastic, potentially ill-defined lesions. Pediatric patients undergoing epilepsy surgery can expect a significant reduction in their need for medication. Given the excellent results in the infant group, prospective studies are warranted to determine whether age ≤ 3 years is a predictor for excellent surgical outcome.

scholarly journals Repeat surgery for focal cortical dysplasias in children: indications and outcomes

2017 ◽  
Vol 19 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Matthew F. Sacino ◽  
Cheng-Ying Ho ◽  
Matthew T. Whitehead ◽  
Amy Kao ◽  
Dewi Depositario-Cabacar ◽  
...  
Keyword(s):  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Univariate Analysis ◽  
National Health System ◽  
Intractable Epilepsy ◽  
Complete Resection ◽  
Seizure Freedom ◽  
Mri Findings ◽  
Repeat Surgery ◽  
Quality Control Mechanism

OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy that often may be treated by surgery. Following resection, many patients continue to experience seizures, necessitating a decision for further surgery to achieve the desired seizure outcomes. Few studies exist on the efficacy of reoperation for intractable epilepsy due to FCD in pediatric cohorts, including the definition of prognostic factors correlated with clinical benefit from further resection. METHODS The authors retrospectively analyzed the medical records and MR images of 22 consecutive pediatric patients who underwent repeat FCD resection after unsuccessful first surgery at the Children's National Health System between March 2005 and April 2015. RESULTS Accounting for all reoperations, 13 (59%) of the 22 patients achieved complete seizure freedom and another 5 patients (23%) achieved significant improvement in seizure control. Univariate analysis demonstrated that concordance in electrocorticography (ECoG) and MRI localization (p = 0.005), and completeness of resection (p = 0.0001), were associated with seizure freedom after the first reoperation. Patients with discordant ECoG and MRI findings ultimately benefited from aggressive multilobe lobectomy or hemispherectomy. Repeat lesionectomies utilizing intraoperative MRI (iMRI; n = 9) achieved complete resection and seizure freedom in all cases. CONCLUSIONS Reoperation may be clinically beneficial in patients with intractable epilepsy due to FCD. Patients with concordant intraoperative ECoG and MRI localization may benefit from extended resection of residual dysplasia at the margins of the previous lesional cavity, and iMRI may offer benefits as a quality control mechanism to ensure that a complete resection has been accomplished. Patients with discordant findings may benefit from more aggressive resections at earlier stages to achieve better seizure control and ensure functional plasticity.

scholarly journals Validating EEG, MEG and combined MEG and EEG beamforming for an estimation of the epileptogenic zone in focal cortical dysplasia

2021 ◽  
Author(s):  
Frank Neugebauer ◽  
Marios Antonakakis ◽  
Kanjana Unnwongse ◽  
Yaroslav Parpaley ◽  
Jörg Wellmer ◽  
...  
Keyword(s):  
Regularization Parameter ◽  
Focal Cortical Dysplasia ◽  
Estimation Method ◽  
Cortical Dysplasia ◽  
Source Analysis ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Scanning Method ◽  
Eeg Source Analysis ◽  
Skull Conductivity

AbstractMEG and EEG source analysis is frequently used for the presurgical evaluation of pharma-coresistant epilepsy patients. The source localization of the epileptogenic zone depends, among other aspects, on the selected inverse and forward approaches and their respective parameter choices. In this validation study, we compare for the inverse problem the standard dipole scanning method with two beamformer approaches and we investigate the influence of the covariance estimation method and the strength of regularization on the localization performance for EEG, MEG and combined EEG and MEG. For forward modeling, we investigate the difference between calibrated six-compartment and standard three-compartment head modeling. In a retrospective study of two patients with focal epilepsy due to focal cortical dysplasia type IIb and seizure-freedom following lesionectomy or radiofrequency-guided thermocoagulation, we used the distance of the localization of interictal epileptic spikes to the resection cavity resp. rediofrequency lesion as reference for good localization. We found that beamformer localization can be sensitive to the choice of the regularization parameter, which has to be individually optimized. Estimation of the covariance matrix with averaged spike data yielded more robust results across the modalities. MEG was the dominant modality and provided a good localization in one case, while it was EEG for the other. When combining the modalities, the good results of the dominant modality were mostly not spoiled by the weaker modality. For appropriate regularization parameter choices, the beamformer localized better than the standard dipole scan. Compared to the importance of an appropriate regularization, the sensitivity of the localization to the head modeling was smaller, due to similar skull conductivity modeling and the fixed source space without orientation constraint.

Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 174-182
Author(s):  
Evangelos Kogias ◽  
Thomas Bast ◽  
Susanne Schubert-Bast ◽  
Gert Wiegand ◽  
Armin Brandt ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Benign Tumors ◽  
Seizure Freedom ◽  
Childhood And Adolescence ◽  
Epileptogenic Zone ◽  
Seizure Recurrence ◽  
Eloquent Cortex

Abstract BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones–and lesions–localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

scholarly journals Resective Epilepsy Surgery for Tuberous Sclerosis in Children

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 517-524 ◽  
Author(s):  
Aria Fallah ◽  
Shaun D. Rodgers ◽  
Alexander G. Weil ◽  
Sumeet Vadera ◽  
Alireza Mansouri ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Medical Center ◽  
Cleveland Clinic ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract BACKGROUND: There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). OBJECTIVE: We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. METHODS: A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The “event” was defined as seizures after resective epilepsy surgery. RESULTS: Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and 2-year follow-up, respectively. On univariate analyses, younger age at seizure onset (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.03-4.00, P = .04), larger size of predominant tuber (HR: 1.03, 95% CI: 0.99-1.06, P = .12), and resection larger than a tuberectomy (HR: 1.86, 95% CI: 0.92-3.74, P = .084) were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy (HR: 2.90, 95% CI: 1.17-7.18, P = .022) was independently associated with a longer duration of seizure freedom. CONCLUSION: In this large consecutive cohort of children with TSC and medically intractable epilepsy, a greater extent of resection (more than just the tuber) is associated with a greater probability of seizure freedom. This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber.

Pediatric Epilepsy Surgery in Focal and Generalized Epilepsy: Current Trends and Recent Advancements

2021 ◽  
Author(s):  
William B. Harris ◽  
H. Westley Phillips ◽  
Aria Fallah ◽  
Gary W. Mathern
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Surgical Interventions ◽  
Current Trends ◽  
Pediatric Epilepsy Surgery ◽  
Generalized Epilepsy ◽  
Epileptogenic Foci

AbstractFor a subset of children with medically intractable epilepsy, surgery may provide the best chances of seizure freedom. Whereas the indications for epilepsy surgery are commonly thought to be limited to patients with focal epileptogenic foci, modern imaging and surgical interventions frequently permit successful surgical treatment of generalized epilepsy. Resection continues to be the only potentially curative intervention; however, the advent of various neuromodulation interventions provides an effective palliative strategy for generalized or persistent seizures. Although the risks and benefits vary greatly by type and extent of intervention, the seizure outcomes appear to be uniformly favorable. Advances in both resective and nonresective surgical interventions provide promise for improved seizure freedom, function, and quality of life. This review summarizes the current trends and recent advancements in pediatric epilepsy surgery from diagnostic workup and indications through surgical interventions and postoperative outcomes.

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