A game theory based analysis of network connectivity reveals that state transition is crucial for epilepsy surgery outcome prediction

Seizures recur in half of patients who undergo epilepsy surgery. Presurgical workup mainly focuses on seizures, but only partially helps predicting outcomes, even after invasive electroencephalography. We conceived a generalizable model to detect epileptogenic networks through connectivity changes and identified the crucial role of the transition from pre-seizure to seizure, achieving the highest outcome prediction (93%) to date in a chronological cohort of 21 patients with 3-year follow-up or more.

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The crucial role of primary care providers in the long-term follow-up of adult survivors of childhood cancer

Cancer Management and Research ◽

10.2147/cmar.s197644 ◽

2019 ◽

Vol Volume 11 ◽

pp. 3411-3418

Author(s):

Justin Jain ◽

Bessi Qorri ◽

Myron R Szewczuk

Keyword(s):

Primary Care ◽

Crucial Role ◽

Adult Survivors ◽

Primary Care Providers ◽

Care Providers ◽

Long Term Follow Up ◽

Survivors Of Childhood Cancer

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The role of preoperative diffusion tensor imaging in predicting and improving functional outcome in pediatric patients undergoing epilepsy surgery: a systematic review

BJR|Open ◽

10.1259/bjro.20200002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20200002

Author(s):

Jose Leon-Rojas ◽

Isabel Cornell ◽

Antonio Rojas-Garcia ◽

Felice D’Arco ◽

Jasmina Panovska-Griffiths ◽

...

Keyword(s):

Systematic Review ◽

Diffusion Tensor Imaging ◽

Functional Outcome ◽

Epilepsy Surgery ◽

Outcome Prediction ◽

Pediatric Patients ◽

Diffusion Tensor ◽

Pediatric Epilepsy ◽

Motor Outcome

Objective: Diffusion tensor imaging (DTI) is a useful neuroimaging technique for surgical planning in adult patients. However, no systematic review has been conducted to determine its utility for pre-operative analysis and planning of Pediatric Epilepsy surgery. We sought to determine the benefit of pre-operative DTI in predicting and improving neurological functional outcome after epilepsy surgery in children with intractable epilepsy. Methods: A systematic review of articles in English using PubMed, EMBASE and Scopus databases, from inception to January 10, 2020 was conducted. All studies that used DTI as either predictor or direct influencer of functional neurological outcome (motor, sensory, language and/or visual) in pediatric epilepsy surgical candidates were included. Data extraction was performed by two blinded reviewers. Risk of bias of each study was determined using the QUADAS 2 Scoring System. Results: 13 studies were included (6 case reports/series, 5 retrospective cohorts, and 2 prospective cohorts) with a total of 229 patients. Seven studies reported motor outcome; three reported motor outcome prediction with a sensitivity and specificity ranging from 80 to 85.7 and 69.6 to 100%, respectively; four studies reported visual outcome. In general, the use of DTI was associated with a high degree of favorable neurological outcomes after epilepsy surgery. Conclusion: Multiple studies show that DTI helps to create a tailored plan that results in improved functional outcome. However, more studies are required in order to fully assess its utility in pediatric patients. This is a desirable field of study because DTI offers a non-invasive technique more suitable for children. Advances in knowledge: This systematic review analyses, exclusively, studies of pediatric patients with drug-resistant epilepsy and provides an update of the evidence regarding the role of DTI, as part of the pre-operative armamentarium, in improving post-surgical neurological sequels and its potential for outcome prediction.

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Auras and the risk of seizures with impaired consciousness following epilepsy surgery: implications for driving

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316578 ◽

2017 ◽

Vol 89 (6) ◽

pp. 599-602 ◽

Cited By ~ 2

Author(s):

Sam Fairclough ◽

Aidan G O’Keeffe ◽

Jane de Tisi ◽

John S Duncan

Keyword(s):

Epilepsy Surgery ◽

Focal Epilepsy ◽

Prior History ◽

Surgery Outcome ◽

History Of ◽

Impaired Awareness ◽

The Uk ◽

International League

ObjectiveTo calculate the chance of a seizure in the next year (COSY) for seizures with impaired awareness in those experiencing auras only, those with no seizures and those with continuing seizures. Epilepsy surgery is an effective treatment for refractory focal epilepsy. Driving is an important factor affecting quality of life. In the UK, driving is not permitted if focal seizures with no impairment of awareness (auras, simple partial seizures) continue, if there is a prior history of seizures with impaired awareness, as will invariably be the case in those having epilepsy surgery. Current UK driving regulations allow driving if COSY is less than 20%.MethodWe calculated COSY in 819 epilepsy surgery patients with up to 25 years follow-up. Each patient year was graded on the The International League against Epilepsy surgery outcome scale.ResultsPatients who were entirely seizure-free for 1, 2 and 3 years had COSY of 4.9%, 3.5% and 2.4% respectively. Patients with only auras within the last 1, 2 or 3 years had a COSY of 11.3%, 9.2% and 7.8% respectively.ConclusionsIndividuals with auras only after epilepsy surgery had a higher COSY than those who were seizure-free. If a COSY of below 20% is regarded as an acceptable risk, it may be suggested that those with auras only in a given year be allowed to drive. The relative risk of these patients causing accidents is lower than population groups such as those aged <25 or >75 years, who are permitted to drive.

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The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

Neurosurgical FOCUS ◽

10.3171/2016.1.focus15538 ◽

2016 ◽

Vol 40 (3) ◽

pp. E16 ◽

Cited By ~ 11

Author(s):

Matthew F. Sacino ◽

Cheng-Ying Ho ◽

Jonathan Murnick ◽

Robert F. Keating ◽

William D. Gaillard ◽

...

Keyword(s):

Epilepsy Surgery ◽

Neurological Deficit ◽

Pediatric Patients ◽

Neurological Deficits ◽

Seizure Freedom ◽

Resection Group ◽

Eloquent Cortex ◽

Postoperative Seizure

OBJECTIVE Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale. RESULTS At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02). CONCLUSIONS These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.

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CRUCIAL ROLE OF POST-REPERFUSION ALLOGRAFT BIOPSY IN EVALUATION OF FOLLOW-UP BIOPSIES AFTER LIVER TRANSPLANTATION

Transplantation Journal ◽

10.1097/00007890-201007272-00581 ◽

2010 ◽

Vol 90 ◽

pp. 307

Author(s):

M. Raoufi ◽

M. El Atrache ◽

K. Brown ◽

D. Moonka ◽

A. Yoshida ◽

...

Keyword(s):

Liver Transplantation ◽

Crucial Role ◽

Allograft Biopsy

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The role of interictal epileptiform discharges in epilepsy surgery outcome

International Journal of Preventive Medicine ◽

10.4103/ijpvm.ijpvm_237_18 ◽

2019 ◽

Vol 10 (1) ◽

pp. 101 ◽

Cited By ~ 1

Author(s):

Nasim Tabrizi ◽

JafarMehvari Habibabadi ◽

Mohamad Zare

Keyword(s):

Epilepsy Surgery ◽

Surgery Outcome ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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