Certain clinical features are associated with seizure frequency after epilepsy surgery

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.

Download Full-text

The Role of Epilepsy Surgery in the Treatment of Childhood Epileptic Encephalopathy

Epilepsy Research and Treatment ◽

10.1155/2013/983049 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Husam R. Kayyali ◽

Ahmed Abdelmoity ◽

Saleh Baeesa

Keyword(s):

Clinical Features ◽

Developmental Disability ◽

Epilepsy Surgery ◽

Surgical Approach ◽

Brain Function ◽

Brain Lesion ◽

Epileptic Encephalopathy ◽

Intractable Seizures ◽

Electroencephalogram Eeg

Children with epileptic encephalopathy often have global impairment of brain function and frequent intractable seizures, which contribute further to their developmental disability. Many of these children have identifiable brain lesion on neurological imaging. In such cases, epilepsy surgery may be considered as a treatment option despite the lack of localized epileptic pattern on electroencephalogram (EEG). In this paper, we summarize the clinical features of epileptic encephalopathy syndromes and review the reported literature on the surgical approach to some of these disorders.

Download Full-text

Mesial Extratemporal Lobe Epilepsy: Clinical Features and Surgical Strategies

Neurosurgery ◽

10.1227/neu.0000000000001230 ◽

2017 ◽

Vol 80 (2) ◽

pp. 269-278

Author(s):

Tom Theys ◽

Lorella Minotti ◽

Laura Tassi ◽

Giorgio Lo Russo ◽

Alim-Louis Benabid ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Features ◽

Epilepsy Surgery ◽

Epileptogenic Zone ◽

Imaging Findings ◽

Surgical Strategies ◽

Therapeutic Challenge ◽

Scalp Eeg

AbstractBACKGROUND: Extratemporal lobe epilepsy surgery remains a diagnostic and therapeutic challenge. Scalp electroencephalography (EEG) correlates, clinical semiology, and imaging findings are often ambiguous or difficult to interpret, necessitating the need for invasive recordings. This is particularly true for those extratemporal lobe epilepsy cases in which seizures develop from the midline.OBJECTIVE: The aim of this study was to examine the clinical features and surgical strategies in mesial extratemporal lobe epilepsy.METHODS: A retrospective study reviewing clinical and surgical characteristics was conducted in 30 patients who underwent epilepsy surgery in mesial extratemporal areas at our institution between 1991 and 2011.RESULTS: Although the location of the epileptogenic zone was associated with specific seizure types, semiology proved to be heterogeneous. Although scalp EEG was of good lateralizing value, it was poor for localizing the epileptogenic zone, necessitating a frequent need for invasive electroencephalographic recordings.CONCLUSION: Surgical resections in mesial extratemporal regions were found to be safe and resulted in satisfactory seizure outcomes.

Download Full-text

Screening symptoms of depression and suicidal ideation in people with epilepsy using the Beck depression inventory

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492012000300004 ◽

2012 ◽

Vol 18 (3) ◽

pp. 85-91 ◽

Cited By ~ 5

Author(s):

Priscila Camile Barioni Salgado ◽

Mateus Henrique Nogueira ◽

Clarissa Lin Yasuda ◽

Fernando Cendes

Keyword(s):

Suicidal Ideation ◽

Beck Depression Inventory ◽

Seizure Frequency ◽

Epilepsy Surgery ◽

Female Gender ◽

Seizure Type ◽

Depression Symptoms ◽

Related Factors ◽

Symptoms Of Depression ◽

Before And After

OBJECTIVE: To measure the severity of symptoms of depression and suicidal ideation in people with epilepsy (PWE) before and after epilepsy surgery using the Beck Depression Inventory (BDI). We aimed to determine the factors associated to depression in PWE. METHODS: PWE, regardless of epilepsy type, seizure type, duration or frequency of seizures, and AEDs were investigated. The sample (n=468) was divided into two groups: pre-operatory (n=346) and pos-operatory (n=122). RESULTS: Before epilepsy surgery female gender, unemployment and high seizure frequency were associated factors for the occurrence of symptoms of depression. After epilepsy surgery, the only factor associated to high level of depression symptoms was the lack of seizure remission. Suicidal ideation was associated to seizure frequency before and after epilepsy surgery. CONCLUSION: Our results confirm the generally held view that depression is common in PWE and provide further insight to the association of depression with certain socio-demographic and seizure-related factors before and after epilepsy surgery.

Download Full-text

Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study

Neurosurgery ◽

10.1093/neuros/nyz488 ◽

2019 ◽

Vol 87 (4) ◽

pp. 704-711 ◽

Cited By ~ 3

Author(s):

Johan Bjellvi ◽

Anna Edelvik Tranberg ◽

Bertil Rydenhag ◽

Kristina Malmgren

Keyword(s):

Risk Factors ◽

Intellectual Disability ◽

Seizure Frequency ◽

Epilepsy Surgery ◽

Neurological Deficit ◽

Age Of Onset ◽

Multivariable Analysis ◽

Seizure Outcome ◽

Age At Surgery ◽

New Onset

Abstract BACKGROUND Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE To analyze potential risk factors for these outcomes in a large cohort. METHODS We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.

Download Full-text

Predicting seizure frequency after epilepsy surgery

Epilepsy Research ◽

10.1016/j.eplepsyres.2005.09.005 ◽

2005 ◽

Vol 67 (3) ◽

pp. 89-99 ◽

Cited By ~ 10

Author(s):

John S. Khoury ◽

Ronald S. Winokur ◽

Joseph I. Tracy ◽

Michael R. Sperling

Keyword(s):

Seizure Frequency ◽

Epilepsy Surgery

Download Full-text

Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06943-x ◽

2021 ◽

Author(s):

S. Grasl ◽

S. Janik ◽

A. Dressler ◽

R. Diehm ◽

G. Gröppel ◽

...

Keyword(s):

Vagus Nerve ◽

Children And Adolescents ◽

Seizure Frequency ◽

Epilepsy Surgery ◽

Emotional Health ◽

Nerve Stimulator ◽

Pharmacoresistant Epilepsy ◽

Device Implantation ◽

Vagus Nerve Stimulator

Abstract Objective Vagus nerve stimulator (VNS) implantation is an established therapy for pharmacoresistant epilepsy that is not amenable to curative epilepsy surgery. Historically, VNS implantation has been performed by neurosurgeons, but otolaryngologist involvement is increasingly common. In this retrospective study, we aimed to evaluate the efficacy and safety of VNS implantation in children and adolescents from the otolaryngologists’ perspective. Methods This study included children and adolescents who had undergone VNS implantation at the study center between 2014 and 2018. Patient files were analyzed with regards to the durations of device implantation and hospitalization, postoperative complications, and clinical outcome, including seizure frequency, clinical global impression of improvement (CGI-I) score, and quality of life (QoL). Results A total of 73 children underwent VNS surgery. The median age at implantation was 9.3 ± 4.6 years, and median epilepsy duration before VNS surgery was 6 ± 4 years. Lennox–Gastaut syndrome was the most common syndrome diagnosis (62.3%), and structural abnormalities (49.3%) the most frequent etiology. Operation times ranged from 30 to 200 min, and median postoperative hospitalization length was 2 ± 0.9 days. No complications occurred, except for four revisions and two explantations due to local infections (2.7%). Among our patients, 76.7% were responders (≥ 50% reduction in seizure frequency), 72.1% showed improved CGI-I scores, and 18.6–60.5% exhibited considerable improvements in the QoL categories energy, emotional health, and cognitive functions. Conclusion Our results indicate that VNS implantation is a highly effective and safe treatment option for children and adolescents with AED-refractory epilepsies who are not candidates for curative epilepsy surgery.

Download Full-text