scholarly journals Dysmorphic neuron density underlies intrinsic epileptogenicity of the centre of cortical tubers

2019 ◽  
Author(s):  
Sarah EM. Stephenson ◽  
Harley G. Owens ◽  
Kay L. Richards ◽  
Wei Shern Lee ◽  
Colleen D’Arcy ◽  
...  
Keyword(s):  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Epileptic Activity ◽  
Neurological Deficits ◽  
Unbiased Stereology ◽  
Neuron Density ◽  
Mri Studies ◽  
Cortical Tubers ◽  
Eloquent Cortex ◽  
Dysmorphic Neurons

AbstractCortical tubers are benign lesions that develop in patients with tuberous sclerosis complex (TSC), often resulting in drug-resistant epilepsy. Surgical resection may be required for seizure control, but the extent of the resection required is unclear. Many centres include resection of perituberal cortex, which may be associated with neurological deficits. Also, patients with tubers in eloquent cortex may be excluded from epilepsy surgery.Our electrophysiological and MRI studies indicate that the tuber centre is the source of seizures, suggesting that smaller resections may be sufficient for seizure control. Here we report five epilepsy surgeries in four children with TSC and focal motor seizures from solitary epileptogenic tubers in the sensorimotor cortex in whom the resection was limited to the tuber centre, leaving the tuber rim and surrounding perituberal cortex intact. Seizures were eliminated in all cases, and no functional deficits were observed. On routine histopathology we observed an apparent increase in density of dysmorphic neurons at the tuber centre, which we confirmed using unbiased stereology which demonstrated a significantly greater density of dysmorphic neurons within the resected tuber centre (1951 ± 215 cells/mm3) compared to the biopsied tuber rim (531 ± 189 cells/mm3, n = 4, p = 0.008).Taken together with our previous electrophysiological and MRI studies implicating the tuber centre as the focus of epileptic activity, and other electrophysiological studies of dysmorphic neurons in focal cortical dysplasia, this study supports the hypothesis that dysmorphic neurons concentrated at the tuber centre are the seizure generators in TSC. Furthermore, our results support limiting resection to the tuber centre, decreasing the risk of neurological deficits when tubers are located within eloquent cortex.

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.

Awake Craniotomy for Resection of Left Temporal Cavernoma: 3-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E102-E102
Author(s):  
Krunal Patel ◽  
Leonardo Desessards Olijnyk ◽  
Karol P Budohoski ◽  
Thomas Santarius ◽  
Ramez W Kirollos ◽  
...  
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Seizure Control ◽  
Surgical Excision ◽  
Neurological Deficits ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
3 Dimensional ◽  
Bipolar Stimulation ◽  
Eloquent Cortex

Abstract Cavernomas presenting with seizures refractory to medical treatment may require surgical excision for seizure control. If superficial, they can be surgically accessible but can pose additional risks when located in or near eloquent cortex. In this 3D operative video we illustrate the technique for the resection of a left temporal cavernoma located near eloquent cortex for speech with awake surgery and cortical mapping to avoid a speech deficit postoperatively. Informed consent was obtained for this procedure. Navigation is used to localize the cavernoma following which a large craniotomy is performed exposing the temporal lobe, frontal lobe, and sylvian vein. Bipolar stimulation is used to localize speech with the patient awake until speech arrest occurs. The cavernoma is situated immediately inferior to the sulcus over which speech arrest occurs. The sulcus immediately above the cavernoma is opened and adjacent arteries are carefully preserved. The glial plane around the cavernoma is used to dissect the cavernoma from the surrounding cortex. Care is taken to remove the haemosiderin as this can act as a precipitant for ongoing seizures. In this case the patient had no neurological deficits following surgery and was seizure free.

scholarly journals Exacerbation of Pre-existing Epilepsy by Mild Head Injury: a Five Patient Series

2004 ◽  
Vol 31 (3) ◽  
pp. 394-397 ◽  
Author(s):  
P.C. Tai ◽  
D.W. Gross
Keyword(s):  
Head Injury ◽  
Temporal Relationship ◽  
Seizure Control ◽  
Head Injuries ◽  
Neurological Deficits ◽  
Mild Head Injury ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
One Year ◽  
Patients With Epilepsy

Objective:While the risk of developing seizures following a mild head injury has been reported and is thought to be low, the effect of mild head injury on patients with a pre-existing seizure disorder has not been reported. We present a series of cases where a strong temporal relationship between mild head injury and worsening of seizure frequency was observed.Methods:Five cases were identified and reviewed in detail. Information was derived from clinic and hospital charts with attention to the degree of injury, pre- and postinjury seizure patterns and frequency.Results:One patient has primary generalized epilepsy and four have localization related epilepsy. Prior to the head injury, three of the patients were seizure free (range: two to 24 years). The patients suffered from mild head injuries with no or transient loss of consciousness and no focal neurological deficits. In all cases, the patients experienced a worsening of seizure control within days of the injury. In one case, the patient's seizure pattern returned to baseline one year after the accident, while in the remaining four cases, the patients continue to have medically refractory seizures.Conclusion:A close temporal relationship between mild head injury and a worsening of seizure control was observed in five patients with epilepsy. Although further study is required, this observation suggests that a head injury that would be considered benign in the general population can have serious consequences such as recurrence of seizures and medical intractability in patients with epilepsy.

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

2013 ◽  
Vol 119 (2) ◽  
pp. 318-323 ◽  
Author(s):  
Philippe Schucht ◽  
Fadi Ghareeb ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
Return To Work ◽  
Seizure Control ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Neurological Deficits ◽  
Main Concern ◽  
Low Grade ◽  
Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

Electrocorticography

2017 ◽  
Author(s):  
Marc R. Nuwer ◽  
Stephan Schuele
Keyword(s):  
Cerebral Cortex ◽  
Functional Activity ◽  
Seizure Control ◽  
Epileptic Activity ◽  
Tumor Surgery ◽  
Anesthetic Agents ◽  
Electroencephalographic Signals ◽  
Interictal Discharges ◽  
Cortical Regions ◽  
Postoperative Seizure

Electrocorticography (ECoG) is the method of recording electroencephalographic signals directly from surgically exposed cerebral cortex. It detects intraoperatively the cortical regions with substantial epileptiform interictal discharges. Direct cortical stimulation during ECoG provides a method of identifying language, motor, and sensory regions during a craniotomy. Both techniques—the identification of cortex with epileptic activity and cortex with important eloquent functional activity—help determine limits for surgical cortical resection. These are used most commonly during epilepsy and tumor surgery. Anesthetic agents can adversely affect the recording, and ECoG restricts the types of anesthesia that can be used. The amount of spiking from diffuse or remote cortical regions on ECoG can predict the success of postoperative seizure control.

Similar PDK1–AKT–mTOR pathway activation in balloon cells and dysmorphic neurons of type II focal cortical dysplasia with refractory epilepsy

2015 ◽  
Vol 112 ◽  
pp. 137-149 ◽  
Author(s):  
Yuan-xiang Lin ◽  
Kun Lin ◽  
De-zhi Kang ◽  
Xin-xiu Liu ◽  
Xing-fu Wang ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Mtor Pathway ◽  
Type Ii ◽  
Balloon Cells ◽  
Pathway Activation ◽  
Dysmorphic Neurons

Surgical Treatment of Intractable Epilepsy Associated with Schizencephaly

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 421-429 ◽  
Author(s):  
Richard Leblanc ◽  
Donatella Tampieri ◽  
Yves Robitaille ◽  
William Feindel ◽  
Frederick Andermann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Intractable Epilepsy ◽  
Epileptic Activity ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Intractable Seizures ◽  
Generalized Seizures ◽  
Assessment And Treatment

Abstract With the advent of magnetic resonance imaging, there has been an increased recognition of schizencephaly during life, especially in epileptic patients. We report our experience with the assessment and treatment of three patients with medically intractable seizures associated with this condition. The three men were aged 24 to 37 years. Two had delayed developmental milestones and hemiparesis or hemiplegia. One had normal development and a normal neurological examination. Seizures began between the ages of 15 and 19 years and lasted for 5 to 22 years before surgery. All had partial simple or generalized seizures with predominant electroencephalographic and electrocorticographic epileptic activity localized to temporal and frontal lobes on the side of the lesion. Neuropsychological assessment indicated widespread dysfunction maximal at the areas of predominant electroencephalographic abnormality. Magnetic resonance imaging demonstrated anterior parasagittal, parietal, and Rolandic cerebral clefts, with ventricular diverticuli, gray matter heterotopia, polymicrogyria, and a true agenesis of the corpus callosum in individual patients. The patients underwent temporal (one patient) and frontotemporal (two patients) lobectomies without additional neurological deficits or neuropsychological deterioration. Postoperative follow-up showed reduction in seizure frequency. We conclude that the surgical treatment of epilepsy is well tolerated in such patients, and their seizures can be alleviated by resection of epileptogenic areas.

scholarly journals Abnormal maturation of non-dysmorphic neurons in focal cortical dysplasia: Immunohistochemical considerations

Seizure ◽  
2010 ◽  
Vol 19 (5) ◽  
pp. 274-279 ◽  
Author(s):  
Sae Hanai ◽  
Takashi Saito ◽  
Eiji Nakagawa ◽  
Asako Arai ◽  
Taisuke Otsuki ◽  
...  
Keyword(s):  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Dysmorphic Neurons

scholarly journals Doublecortin-like (DCL) expression in focal cortical dysplasia and cortical tubers

Epilepsia ◽  
2009 ◽  
Vol 50 (12) ◽  
pp. 2629-2637 ◽  
Author(s):  
Karin Boer ◽  
Paul J. Lucassen ◽  
Wim G. M. Spliet ◽  
Erno Vreugdenhil ◽  
Peter C. van Rijen ◽  
...  
Keyword(s):  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Cortical Tubers

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.

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