The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

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.

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Faculty Opinions recommendation of Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug-resistant focal epilepsy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727480100.793565897 ◽

2019 ◽

Author(s):

Christoph Baumgartner

Keyword(s):

Focal Epilepsy ◽

Adult Patients ◽

Preliminary Evaluation ◽

Drug Resistant ◽

Initial Validation ◽

Grading Scale

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Drug-resistant focal epilepsy in women of childbearing age: Reproduction and the effect of epilepsy surgery

Epilepsy & Behavior ◽

10.1016/j.yebeh.2016.04.002 ◽

2016 ◽

Vol 60 ◽

pp. 17-20 ◽

Cited By ~ 9

Author(s):

Rachel R. Fabris ◽

Teresa Griffin Cascino ◽

Jay Mandrekar ◽

W. Richard Marsh ◽

Frederic B. Meyer ◽

...

Keyword(s):

Epilepsy Surgery ◽

Focal Epilepsy ◽

Drug Resistant ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Epilepsy In Women

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Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy

JAMA ◽

10.1001/jama.2014.17426 ◽

2015 ◽

Vol 313 (3) ◽

pp. 285 ◽

Cited By ~ 229

Author(s):

Barbara C. Jobst ◽

Gregory D. Cascino

Keyword(s):

Epilepsy Surgery ◽

Focal Epilepsy ◽

Drug Resistant

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Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug-resistant focal epilepsy

Epilepsia ◽

10.1111/epi.13730 ◽

2017 ◽

Vol 58 (5) ◽

pp. 792-800 ◽

Cited By ~ 9

Author(s):

Patricia Dugan ◽

Chad Carlson ◽

Nathalie Jetté ◽

Samuel Wiebe ◽

Marjorie Bunch ◽

...

Keyword(s):

Focal Epilepsy ◽

Adult Patients ◽

Preliminary Evaluation ◽

Drug Resistant ◽

Initial Validation ◽

Grading Scale

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Chronic traumatic encephalopathy in an epilepsy surgery cohort

Neurology ◽

10.1212/wnl.0000000000004927 ◽

2018 ◽

Vol 90 (6) ◽

pp. e474-e478 ◽

Cited By ~ 4

Author(s):

Amy L. Jones ◽

Jeffrey W. Britton ◽

Melissa M. Blessing ◽

Joseph E. Parisi ◽

Gregory D. Cascino

Keyword(s):

Young Adult ◽

Epilepsy Surgery ◽

Focal Epilepsy ◽

Chronic Traumatic Encephalopathy ◽

Neuropsychological Testing ◽

Adult Patients ◽

Drug Resistant ◽

Seizure Disorders ◽

History Of

ObjectiveTo determine the occurrence of chronic traumatic encephalopathy (CTE) in young adult patients undergoing epilepsy surgery.MethodsTen patients who underwent epilepsy surgery were randomly selected for this retrospective study. The patients were 18–45 years of age, had preoperative neuropsychological evaluation, and had 1 year postoperative follow-up. Microscopic sections from resections were evaluated for the presence of CTE with standard stains and antibodies to tau (clone AT8).ResultsThe median age at resection was 32.5 years (range 23–43) and the median duration of seizures was 23.5 years (range 3–28). Eight had a history of head injury. Preoperative neuropsychological testing showed mild to moderate cognitive impairment in 8 patients (80%). Pathologic examination in one patient showed focal sparse tau-immunoreactive lesions along descending rami and cortical gyral depths of the resected frontal lobe. Nine patients had no evidence of CTE. All focal cortical resections showed variable subpial and subcortical gliosis commonly identified in patients with chronic seizure disorders.ConclusionsThe present small retrospective observational study suggests that CTE may occur, but appears uncommon, in young adult patients undergoing surgical treatment for drug-resistant focal epilepsy. The significance of these findings requires further investigation to define the relative importance of tau accumulation in younger adult patients with drug-resistant focal epilepsy and cognitive decline.

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Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study

Neuroradiology ◽

10.1007/s00234-021-02884-8 ◽

2022 ◽

Author(s):

R. H. G. J. van Lanen ◽

C. J. Wiggins ◽

A. J. Colon ◽

W. H. Backes ◽

J. F. A. Jansen ◽

...

Keyword(s):

Epilepsy Surgery ◽

High Field ◽

Focal Epilepsy ◽

Good Clinical Practice ◽

Lesion Detection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Drug Resistant ◽

Ultra High Field ◽

Prospective Longitudinal

Abstract Purpose Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). Methods We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. Results All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. Conclusion This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number www.trialregister.nl: NTR7536.

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