scholarly journals Interictal SEEG resting-state connectivity localizes seizure onset zone and predicts seizure outcome

2022 ◽  
Author(s):  
Haiteng Jiang ◽  
Vasileios Kokkinos ◽  
Shuai Ye ◽  
Alexandra Urban ◽  
Anto Bagic ◽  
...  
Keyword(s):  
Information Flow ◽  
Resting State ◽  
Inhibitory Input ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Drug Resistant Epilepsy ◽  
Resting State Connectivity

Stereotactic-electroencephalography (SEEG) is a common neurosurgical method to localize epileptogenic zone in drug resistant epilepsy patients and inform treatment recommendations. In the current clinical practice, localization of epileptogenic zone typically requires prolonged recordings to capture seizure, which may take days to weeks. Although epilepsy surgery has been proven to be effective in general, the percentage of unsatisfactory seizure outcomes is still concerning. We developed a method to identify the seizure onset zone (SOZ) and predict seizure outcome using short-time resting-state SEEG data. In a cohort of 43 drug resistant epilepsy patients, we estimated the information flow via directional connectivity and inferred the excitation-inhibition ratio from the 1/f power slope. We hypothesized that the antagonism of information flow at multiple frequencies between SOZ and non-SOZ underlying the relatively stable epilepsy resting state could be related to the disrupted excitation-inhibition balance. We found higher excitability in non-SOZ regions compared to the SOZ, with dominant information flow from non-SOZ to SOZ regions, probably reflecting inhibitory input from non-SOZ to prevent seizure initiation. Greater differences in information flow between SOZ and non-SOZ regions were associated with favorable seizure outcome. By integrating a balanced random forest model with resting-state connectivity, our method localized the SOZ with an accuracy of 85% and predicted the seizure outcome with an accuracy of 77% using clinically determined SOZ. Overall, our study suggests that brief resting-state SEEG data can significantly facilitate the identification of SOZ and may eventually predict seizure outcomes without requiring long-term ictal recordings.

Seizures Outcome After Stereoelectroencephalography-Guided Thermocoagulations in Malformations of Cortical Development Poorly Accessible to Surgical Resection

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Hélène Catenoix ◽  
François Mauguière ◽  
Alexandra Montavont ◽  
Philippe Ryvlin ◽  
Marc Guénot ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Low Voltage ◽  
Cortical Development ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Implanted Electrodes ◽  
Spontaneous Seizures ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND: Radiofrequency thermocoagulation (RFTC) guided by stereoelectroencephalography (SEEG) has proved to be a safe palliative method to reduce seizure frequency in patients with drug-resistant partial epilepsy. In malformation of cortical development (MCD), increasing the number of implanted electrodes over that needed for mapping of the epileptogenic zone could help to maximize RFTC efficiency. OBJECTIVE: To evaluate the benefit of SEEG-guided RFTC in 14 patients suffering from drug-resistant epilepsy related to MCD located in functional cortical areas or in regions poorly accessible to surgery. METHODS: Ten men and 4 women were treated by RFTC. Thermolesions were produced by applying a 50-V, 120-mA current for 10 to 30 seconds within the epileptogenic zone as identified by the SEEG investigation. RESULTS: An average of 25.8 ± 17.5 thermolesions were made per procedure. The median follow-up after the procedure was 41.7 months. Sixty-four percent of the patients experienced a long-term decrease in seizure frequency of >50%, of whom 6 (43%) presented long-lasting freedom from seizure. When a focal low-voltage fast activity was present at seizure onset on SEEG recordings, 87.5% of patients were responders or seizure free. All of the patients in whom electric stimulation reproduced spontaneous seizures were responders. CONCLUSION: Our results show the good benefit-risk ratio of the SEEG-guided procedure for patients suffering from MCD in whom surgery is risky. This study identifies 2 factors, focal low-voltage, high-frequency activity at seizure onset and lowered epileptogenic threshold in the coagulated area, that could be predictive of a favorable seizure outcome after RFTC.

scholarly journals The proportion of seizure onset zone contacts resected is not associated with outcome following SEEG-guided resective epilepsy surgery in children

2021 ◽  
Author(s):  
Mehdi Khan ◽  
Aswin Chari ◽  
Kiran Seunarine ◽  
Christin Eltze ◽  
Friederike Moeller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Imaging Data ◽  
Seizure Onset ◽  
Binary Logistic Regression Model ◽  
Primary Analysis ◽  
Seizure Onset Zone

AbstractPurposeChildren undergoing stereoelectroencephalography (SEEG)-guided epilepsy surgery represent a complex cohort. We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing SEEG-guided resective epilepsy surgery.MethodsPatients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Seizure outcomes were classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.ResultsOf 94 patients undergoing SEEG, 29 underwent subsequent focal resection of whom 22 had sufficient imaging data to be included in the primary analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF and 7 (31.8%) NSF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p<0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p=0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome, although the interpretation was limited by pseudo-complete separation of the data.ConclusionHistopathology is a significant predictor of surgical outcomes in children undergoing SEEG-guided resective epilepsy surgery. The percentage of SOZ contacts resected was not associated with SF. Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.

scholarly journals Comparison of Ictal Brain Perfusion SPECT With 99mTc-HMPAO Versus 99mTc-ECD for Identification of The Epileptic Seizure Onset Zone

2020 ◽  
Author(s):  
Mariam Jaber ◽  
Jila Taherpour ◽  
Berthold Voges ◽  
Ivayla Apostolova ◽  
Thomas Sauvigny ◽  
...  
Keyword(s):  
Brain Perfusion ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Tracer Injection ◽  
Brain Perfusion Spect ◽  
Temporal Epilepsy ◽  
Large Patient ◽  
Seizure Onset Zone ◽  
Perfusion Spect ◽  
Drug Resistant Epilepsy

Abstract Background: The chemical microspheres 99mTc-HMPAO and 99mTc-ECD are widely used as tracers in ictal brain perfusion SPECT for identification of the seizure onset zone (SOZ) in presurgical evaluation of patients with drug-resistant epilepsy and uncertainty of SOZ localization after standard diagnostic workup. For both tracers there are theoretical arguments to favor it over the other for this task. The aim of this study was to compare the performance of ictal brain perfusion SPECT between 99mTc-HMPAO and 99mTc-ECD in a rather large patient sample.Methods: The study retrospectively included 196 patients from clinical routine in whom ictal perfusion SPECT had been performed with stabilized 99mTc-HMPAO (n = 110) or 99mTc-ECD (n = 86). Lateralization and localization of the SOZ was obtained by the consensus of two independent readers who visually inspected the SPECT images retrospectively. Results: The 99mTc-HMPAO group and the 99mTc-ECD group were well matched with respect to age, sex, age at first seizure, duration of disease, seizure frequency, history of previous brain surgery, and findings of presurgical MRI. The tracer groups differed significantly with respect to the latency of tracer injection (median latency 4 s longer in the 99mTc-HMPAO group), duration of the seizure after tracer injection (25 s shorter in the 99mTc-HMPAO group), tracer dose (70 MBq higher in the 99mTc-HMPAO group), and delay of the SPECT acquisition after tracer injection (63 min longer in the 99mTc-HMPAO group). The fraction of lateralising ictal SPECT did not differ significantly between the 99mTc-HMPAO and the 99mTc-ECD group (65.5% versus 72.1%, p = 0.355). Sensitivity of ictal perfusion SPECT (independent of the tracer) for correct localization of the SOZ in 62 patients with temporal lobe epilepsy and at least worthwhile improvement (Engel scale ≤ III) 12 months after temporal epilepsy surgery was 63%.Conclusions: This study does not provide evidence to favor 99mTc-HMPAO or 99mTc-ECD for identification of the SOZ by ictal perfusion SPECT in patients with drug resistant epilepsy.

A probabilistic approach for lateralization of seizure onset zone in drug-resistant epilepsy with bilateral cerebral pathology

2016 ◽  
Vol 277 ◽  
pp. 136-140
Author(s):  
Ravindra Arya ◽  
Siva Sivaganesan ◽  
Katherine D. Holland ◽  
Hansel M. Greiner ◽  
Francesco T. Mangano ◽  
...  
Keyword(s):  
Probabilistic Approach ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Cerebral Pathology ◽  
Drug Resistant Epilepsy

scholarly journals Neural Fragility as an EEG Marker of the Seizure Onset Zone

2019 ◽  
Author(s):  
Adam Li ◽  
Chester Huynh ◽  
Zachary Fitzgerald ◽  
Iahn Cajigas ◽  
Damian Brusko ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Predictive Power ◽  
Biological Marker ◽  
Complete Removal ◽  
Drug Resistant ◽  
Success Rates ◽  
Seizure Onset ◽  
Intracranial Eeg ◽  
Seizure Onset Zone ◽  
Drug Resistant Epilepsy

AbstractOver 15 million epilepsy patients worldwide do not respond to drugs. Successful surgical treatment requires complete removal, or disconnection of the seizure onset zone (SOZ), brain region(s) where seizures originate. Unfortunately, surgical success rates vary between 30%-70% because no clinically validated biological marker of the SOZ exists. We develop and retrospectively validate a new EEG marker - neural fragility. We validate this new marker in a retrospective analysis of 91 patients by using neural fragility of the annotated SOZ as a metric to predict surgical outcomes. Fragility predicts 43/47 surgical failures with an overall prediction accuracy of 76%, compared to the accuracy of clinicians being 48% (successful outcomes). In failed outcomes, we identify fragile regions that were untreated. When compared to 20 EEG features proposed as SOZ markers, fragility outperformed in predictive power and interpretability suggesting neural fragility as an EEG fingerprint of the SOZ.One Sentence SummaryNeural fragility, an intracranial EEG biomarker for the seizure onset zone in drug-resistant epilepsy, predicts surgical outcomes with high accuracy.

scholarly journals P.042 Safety and efficacy of stereoelectroencephalography in pediatric epilepsy surgery

2019 ◽  
Vol 46 (s1) ◽  
pp. S25
Author(s):  
CA Elliott ◽  
K Narvacan ◽  
J Kassiri ◽  
S Carline ◽  
B Wheatley ◽  
...  
Keyword(s):  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Neurogenic Pulmonary Edema ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Pediatric Drug ◽  
Safety And Efficacy ◽  
Drug Resistant Epilepsy

Background: There are few published reports on the safety and efficacy of stereoelectroencephalography (SEEG) in the presurgical evaluation of pediatric drug-resistant epilepsy. Our objective was to describe institutional experience with pediatric SEEG in terms of (1) insertional complications, (2) identification of the epileptogenic zone and (3) seizure outcome following SEEG-tailored resections. Methods: Retrospective review of 29 patients pediatric drug resistant epilepsy patients who underwent presurgical SEEG between 2005 – 2018. Results: 29 pediatric SEEG patients (15 male; 12.4 ± 4.6 years old) were included in this study with mean follow-up of 6.0 ± 4.1 years. SEEG-related complications occurred in 1/29 (3%)—neurogenic pulmonary edema. A total of 190 multi-contact electrodes (mean of 7.0 ± 2.5per patient) were implanted across 30 insertions which captured 437 electrographic seizures (mean 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal MRI with surface EEG that failed to identify the EZ (16/29; 55%). SEEG-tailored resections were performed in 24/29 (83%). Engel I outcome was achieved following resections in 19/24 cases (79%) with 5.9 ± 4.0 years of post-operative follow-up. Conclusions: Stereoelectroencephalography in presurgical evaluation of pediatric drug-resistant epilepsy is a safe and effective way to identify the epileptogenic zone permitting SEEG-tailored resection.

scholarly journals EEG source connectivity to localize the seizure onset zone in patients with drug resistant epilepsy

2017 ◽  
Vol 16 ◽  
pp. 689-698 ◽  
Author(s):  
Willeke Staljanssens ◽  
Gregor Strobbe ◽  
Roel Van Holen ◽  
Vincent Keereman ◽  
Stefanie Gadeyne ◽  
...  
Keyword(s):  
Drug Resistant ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Drug Resistant Epilepsy

scholarly journals P.099 Generator replacement with cardiac based VNS device in children with drug-resistant epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S47-S48
Author(s):  
A Hadjinicolaou ◽  
P Jain ◽  
I Yau ◽  
R Whitney ◽  
JT Rutka ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Seizure Outcome ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Study Population ◽  
The Mean ◽  
Drug Resistant Epilepsy ◽  
Generator Replacement

Background: We aimed to study the proportion of patients with DRE and pre-existing VNS device, who show improvement of at least one class in McHugh seizure outcome classification at last follow up after generator replacement with cardiac based VNS device. Methods: We retrospectively reviewed children with DRE with the older VNS model (102) who underwent battery replacement with the AspireSR®, model 106 since September 2016 at our institution. We assessed the seizure outcomes since the first VNS device insertion till the last follow up after AspireSR® (with cardiac-based seizure detection) using McHugh seizure outcome classification. Results: The study population was comprised of 15 patients. The mean age at seizure onset was 2.7 years old, with mean age of initial VNS1 placement being 10.1 years and mean age of replacement with VNS2 being 14.9 years of age. Three of the fifteen patients had reported status epilepticus prior to initial VNS insertion, and none reported episodes following insertion. Two patients showed at least one class improvement in McHugh seizure outcomes at last follow up after VNS2. Conclusions: Through our preliminary data at the present time, we note that the majority of our patients maintains their seizure control following replacement with VNS2 with a few showing improvement.

Overnight ictal magnetoencephalography

2020 ◽  
pp. 10.1212/CPJ.0000000000000937
Author(s):  
Jeremy T. Moreau ◽  
Elisabeth Simard-Tremblay ◽  
Steffen Albrecht ◽  
Bernard Rosenblatt ◽  
Sylvain Baillet ◽  
...  
Keyword(s):  
Epileptic Activity ◽  
Added Value ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Presurgical Evaluation ◽  
Seizure Onset Zone ◽  
Drug Resistant Epilepsy

The added value of magnetoencephalography (MEG) in the presurgical evaluation for drug-resistant epilepsy is well-recognised 1-4. However, MEG remains mostly limited to analysis of interictal epileptic activity 1,5. Seizures are uncommonly captured due to logistical considerations despite mounting evidence of the value of ictal MEG in localising the seizure onset zone 5-7. Here we report the recording and analysis of ictal MEG recordings in two drug-resistant epilepsy presurgical candidates that spent a night sleeping in the MEG.

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