Surgical evaluation in children <3 years of age with drug‐resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays

Epilepsia ◽  
2021 ◽  
Author(s):  
Michael Scott Perry ◽  
Sabrina Shandley ◽  
Max Perelman ◽  
Rani K. Singh ◽  
Lily Wong‐Kisiel ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Drug Resistant ◽  
Epilepsy Patient ◽  
Treatment Delays ◽  
Surgical Evaluation ◽  
Drug Resistant Epilepsy

scholarly journals Imaging the Extent and Location of Spatiotemporally Distributed Epileptiform Sources from MEG Measurements

2021 ◽  
Author(s):  
Xiyuan Jiang ◽  
Shuai Ye ◽  
Abbas Sohrabpour ◽  
Anto Bagic ◽  
Bin He
Keyword(s):  
Focal Epilepsy ◽  
Real Data ◽  
Drug Resistant ◽  
Interictal Spikes ◽  
Source Imaging ◽  
Non Invasive ◽  
Eeg Source Imaging ◽  
Surgical Evaluation ◽  
Extended Sources ◽  
Drug Resistant Epilepsy

Non-invasive MEG/EEG source imaging provides valuable information about the epileptogenic brain areas which can be used to aid presurgical planning in focal epilepsy patients suffering from drug-resistant seizures. However, the source extent estimation for electrophysiological source imaging remains to be a challenge and is usually largely dependent on subjective choice. Our recently developed algorithm, fast spatiotemporal iteratively reweighted edge sparsity minimization (FAST-IRES) strategy, has been shown to objectively estimate extended sources from EEG recording, while it has not been applied to MEG recordings. In this work, through extensive numerical experiments and real data analysis in a group of focal drug-resistant epilepsy patients interictal spikes, we demonstrated the ability of FAST-IRES algorithm to image the location and extent of underlying epilepsy sources from MEG measurements. Our results indicate the merits of FAST-IRES in imaging the location and extent of epilepsy sources for pre-surgical evaluation from MEG measurements.

scholarly journals D.01 Earlier treatment with the Ketogenic Diet improves seizure outcome in early-onset drug-resistant epilepsy

2016 ◽  
Vol 43 (S2) ◽  
pp. S13-S13
Author(s):  
M Irwin ◽  
S Aimola ◽  
H Lowe ◽  
Y Liu ◽  
M Zak ◽  
...  
Keyword(s):  
Ketogenic Diet ◽  
Early Onset ◽  
Past History ◽  
Seizure Outcome ◽  
Drug Resistant ◽  
Treatment Delays ◽  
Young Infants ◽  
History Of ◽  
Drug Resistant Epilepsy

Background: The ketogenic diet (KD) is used to treat severe childhood-onset epileptic encephalopathies, such as Infantile Spasms (IS). Unfortunately, limited resources for KD initiation result in treatment delays. We ask if earlier KD treatment of early-onset drug-resistant epilepsy results in better seizure outcomes. Methods: Children who started KD before age 4 years between 2000-present at SickKids Hospital were identified. Six-month seizure outcome was calculated as percent of pre-diet baseline seizure frequency (BSF). Results: 67 children were identified. 30 (44.8%) started KD <2 years old, 37 (55.2%) started KD 2-4 years old. Among <2 years old group, 83.3% achieved 50% reduction in BSF and 36.7% achieved 90% reduction. Among 2-4 year old group, 62.2% achieved 50% reduction in BSF and 24.3% achieved 90% reduction. 38 children had a history of IS; 17 with IS at diet initiation and 21 with past history of IS. 41.2% of the spasms cohort achieved 90% reduction in BSF, compared to 23.8% of the post-spasms cohort. Conclusions: KD was more effective when started before age 2 years than 2-4 years, and more effective in children with IS than in children with past history of IS. A rapid protocol for KD initiation in young infants and children may improve long-term outcomes

sEEG is a Safe Procedure for a Comprehensive Anatomic Exploration of the Insula: A Retrospective Study of 108 Procedures Representing 254 Transopercular Insular Electrodes

2017 ◽  
Vol 14 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Anne Laure Salado ◽  
Laurent Koessler ◽  
Gabriel De Mijolla ◽  
Emmanuelle Schmitt ◽  
Jean-Pierre Vignal ◽  
...  
Keyword(s):  
Clustering Analysis ◽  
Insular Cortex ◽  
Preoperative Assessment ◽  
Homogeneous Distribution ◽  
Safe Procedure ◽  
Drug Resistant ◽  
Computed Tomography Images ◽  
Surgical Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND The exploration of the insula in pre-surgical evaluation of epilepsy is considered to be associated with a high vascular risk resulting in an incomplete exploration of the insular cortex. OBJECTIVE To report a retrospective observational study of insular exploration using stereoelectroencephalography (sEEG) with transopercular and parasagittal oblique intracerebral electrodes from January 2008 to January 2016. The first purpose of this study was to evaluate the surgical risks of insular cortex sEEG exploration. The second purpose was to define the ability of placing intracerebral contacts in the whole insular cortex. METHODS Ninety-nine patients underwent 108 magnetic resonance imaging (MRI)-guided stereotactic implantations of intracerebral electrodes in the context of preoperative assessment of drug-resistant epilepsy, including at least 1 electrode placed in the insular cortex. On postoperative computed tomography images co-registered with MRI, followed by MRI segmentation and application of a transformation matrix, intracerebral contact coordinates of the insular electrodes’ contacts were anatomically localized in the Talairach space. Finally, dispersion and clustering analysis was performed. RESULTS There was no morbidity, in particular hemorrhagic complications, or mortality related to insular electrodes. Statistical comparison of intracerebral contact positions demonstrated that whole insula exploration is possible on the left and right sides. In addition, the clustering analysis showed the homogeneous distribution of the electrodes within the insular cortex. CONCLUSION In the presurgical evaluation of drug-resistant epilepsy, the insular cortex can be explored safely and comprehensively using transopercular sEEG electrodes. Parasagittal oblique trajectories may also be associated to achieve an optimal exploration.

Stereoelectroencephalography Versus Subdural Strip Electrode Implantations: Feasibility, Complications, and Outcomes in 500 Intracranial Monitoring Cases for Drug-Resistant Epilepsy

Neurosurgery ◽  
2020 ◽  
Vol 87 (1) ◽  
pp. E23-E30 ◽  
Author(s):  
Holger Joswig ◽  
Jonathan C Lau ◽  
Mahmoud Abdallat ◽  
Andrew G Parrent ◽  
Keith W MacDougall ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Seizure Outcome ◽  
Drug Resistant ◽  
Single Center ◽  
Strip Electrode ◽  
Dose Area Product ◽  
Single Center Study ◽  
Drug Resistant Epilepsy ◽  
Area Product ◽  
Center Study

Abstract BACKGROUND Both stereoelectroencephalography (SEEG) and subdural strip electrodes (SSE) are used for intracranial electroencephalographic recordings in the invasive investigation of patients with drug-resistant epilepsy. OBJECTIVE To compare SEEG and SSE with respect to feasibility, complications, and outcome in this single-center study. METHODS Patient characteristics, periprocedural parameters, complications, and outcome were acquired from a pro- and retrospectively managed databank to compare SEEG and SSE cases. RESULTS A total of 500 intracranial electroencephalographic monitoring cases in 450 patients were analyzed (145 SEEG and 355 SSE). Both groups were of similar age, gender distribution, and duration of epilepsy. Implantation of each SEEG electrode took 13.9 ± 7.6 min (20 ± 12 min for each SSE; P &lt; .01). Radiation exposure to the patient was 4.3 ± 7.7 s to a dose area product of 14.6 ± 27.9 rad*cm2 for SEEG and 9.4 ± 8.9 s with 21 ± 22.4 rad*cm2 for SSE (P &lt; .01). There was no difference in the length of stay (12.2 ± 7.2 and 12 ± 6.3 d). The complication rate was low in both groups. No infections were seen in SEEG cases (2.3% after SSE). The rate of hemorrhage was 2.8% for SEEG and 1.4% for SSE. Surgical outcome was similar. CONCLUSION SEEG allows targeting deeply situated foci with a non-inferior safety profile to SSE and seizure outcome comparable to SSE.

scholarly journals B.03 Safety and effectiveness of insular resections for drug-resistant epilepsy

2017 ◽  
Vol 44 (S2) ◽  
pp. S11-S11
Author(s):  
S Vuddagiri ◽  
L Bello-Espinosa ◽  
S Singh ◽  
S Wiebe ◽  
Y Agha-khani ◽  
...  
Keyword(s):  
Insular Cortex ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Total Resection ◽  
Temporal Epilepsy ◽  
Surgical Evaluation ◽  
Drug Resistant Epilepsy ◽  
Age Range

Background: Insular cortex involvement as a part of epileptogenic zone is often suspected in the context of operculo-insular semiology and can be confirmed by routine interrogation of the insula with stereo-electroencephalography (SEEG). However the safety and efficacy of insular resections remains unclear. Methods: We reviewed all the patients who underwent insular resection for drug-resistant epilepsy, from 2002 – 2016, in the Calgary Epilepsy Program. Details of the comprehensive pre-surgical evaluation, surgery performed, complications and seizure outcome at the latest follow-up were collected. Results: Fifteen patients (8 males, 7 females) with age range 3 – 41 years were identified. MRI was normal in 9 patients. The decision to resect the Insula was made based on clinical semiology and structural and functional imaging in 6 patients and on SEEG findings in 9 patients. Insular resection was total in 11 and partial in 4 patients. Four (26%) patients had transient hemiparesis and 1 patient had permanent mild upper extremity weakness following total resection. After a mean follow-up period of 45.6 months (range 2 – 150 months), 40% of the patients are seizure free. Conclusions: Insular cortex resections for drug resistant epilepsy can be performed safely and may contribute to additional effectiveness in seizure outcomes in patients with challenging extra-temporal epilepsy.

Long-term use of the ketogenic diet in drug resistant epilepsy syndromes during childhood: Differences between responders and non-responders in seizure types, EEG, and outcome

2008 ◽  
Vol 39 (05) ◽  
Author(s):  
A Dressler ◽  
E Reithofer ◽  
B Stöcklin ◽  
F Benninger ◽  
M Freilinger ◽  
...  
Keyword(s):  
Ketogenic Diet ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

A RARE CASE OF DRUG-RESISTANT EPILEPSY ASSOCIATED WITH CORTICAL MICRODYSGENESIS

2018 ◽  
Vol 26 (2) ◽  
pp. 13-18
Author(s):  
Yu.M. Zabrodskaya ◽  
◽  
D.A. Sitovskaya ◽  
S.M. Malyshev ◽  
T.V. Sokolova ◽  
...  
Keyword(s):  
Rare Case ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy
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