scholarly journals The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Márton Tóth ◽  
Péter Barsi ◽  
Zoltán Tóth ◽  
Katalin Borbély ◽  
János Lückl ◽  
...  
Keyword(s):  
Decision Making ◽  
Fdg Pet ◽  
Hybrid Imaging ◽  
Clinical Decision Making ◽  
Trial Registration ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Resective Surgery ◽  
Epileptogenic Lesion

Abstract Background When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. Methods In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. Results The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. Conclusions The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. Trial registration Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.

scholarly journals Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation (SEEG-Guided RF-TC) in Patients with Drug-Resistant Focal Epilepsy

2017 ◽  
Vol 3 (1) ◽  
pp. 40-47
Author(s):  
Chengwei Xu ◽  
Wenjing Zhou
Keyword(s):  
Radio Frequency ◽  
Surgical Resection ◽  
Seizure Frequency ◽  
Palliative Treatment ◽  
Focal Epilepsy ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Functional Area ◽  
Presurgical Evaluation ◽  
Epileptic Patients

For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography (SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation (RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.

scholarly journals Novel Neurotechnological Interventions for Pediatric Drug-Resistant Epilepsy: Physician Perspectives

2020 ◽  
pp. 088307382096693
Author(s):  
Patrick J. McDonald ◽  
Viorica Hrincu ◽  
Mary B. Connolly ◽  
Mark J. Harrison ◽  
George M. Ibrahim ◽  
...  
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Qualitative Content Analysis ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Drug Resistant ◽  
Ethical Considerations ◽  
Pediatric Drug ◽  
Drug Resistant Epilepsy

This qualitative study investigated factors that guide physicians’ choices for minimally invasive and neuromodulatory interventions as alternatives to conventional surgery or medical management for pediatric drug-resistant epilepsy. North American physicians were recruited to one of 4 focus groups at national conferences. Discussions were analyzed using qualitative content analysis. A pragmatic neuroethics framework was applied to interpret results. Discussions revealed 2 major thematic branches: (1) clinical decision making and (2) ethical considerations. Under clinical decision making, physicians emphasized scientific evidence and patient candidacy when assessing neurotechnologies for patients. Ongoing seizures without intervention was important for safety and neurodevelopment. Under ethical considerations, resource allocation, among other financial considerations for technology adoption, were considerable sources of pressure on decision making. Access to neurotechnology was a salient theme differentiating Canadian and American contexts. When assessing novel neurotechnological interventions for pediatric drug-resistant epilepsy, physicians balance clinical and ethical factors to guide decision making and best practice.

scholarly journals Influence of Prior Authorization Requirements on Provider Clinical Decision Making

2021 ◽  
Author(s):  
Stephen Salzbrenner ◽  
Maxwell Lydiatt ◽  
Brandon Heldin ◽  
Lawrence M. Scheier ◽  
Harrison Greene ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Health Plan ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Trial Registration ◽  
Prior Authorization ◽  
Step Therapy ◽  
Effective Use

Abstract Background: Prior authorization (PA) of medications is widely used by payers in the United States as a way to promote safe and effective use of medications and to control costs. However, PA-related tasks such as completing forms, submitting forms, researching medical history and submitting required documentation can all contribute to burden on healthcare providers. This study examines how such tasks and affect provider burden and treatment decisions. Methods: We developed and administered a nationwide, cross-sectional online survey of medical providers in the United States in 2020 based on a convenience sample of 100,000 providers (physicians, nurse practitioners, and physician assistants). Path analysis was used to test the associations between provider practice characteristics, step therapy and other health plan requirements, perceived burdens of PA, and communication issues with insurers on prescribing behaviors, which included prescribing a different medication, avoiding prescribing of newer medications, and modifying a diagnosis. Weighted analyses were also conducted to account for sample bias due to non-response. Results: A total of 1173 providers (1.2% response rate) provided 1147 usable surveys. The sample was 49.6% female, and a majority were MD/DO providers (85%). Step therapy requirements had the largest influence on prescribing a different medication than planned (b = .22, 95% CI = .160-.285) and avoiding prescribing a newer medication despite meeting evidence-based guidelines (b = .24, 95% CI = .181-.309). A unit-weighted index of perceived PA burden risk was associated with prescribing a different medication (b = .09, 95% CI = .012-.128) and modifying a diagnosis to obtain PA approval (b = .14, 95% CI = .065-.195). Communication issues were associated with prescribing a different medication (b = .11, 95% CI = .029-.186), while health plan requirements (e.g., clinical documentation) was significantly associated with all three prescribing outcomes. Weighted analyses showed that the study conclusions were unlikely to have been biased by nonresponse. Conclusions: Providers report altering prescribing and modifying diagnoses to avoid PA requirements and related burdens. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications. Trial Registration: NA Keywords: clinical decision making, health plan, prior authorization, provider burden, specialty types, workaroundsTrial Registration: NA

scholarly journals Resurgence of Polymyxin B for MDR/XDR Gram-Negative Infections: An Overview of Current Evidence

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Suneel Kumar Garg ◽  
Omender Singh ◽  
Deven Juneja ◽  
Niraj Tyagi ◽  
Amandeep Singh Khurana ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Current Evidence ◽  
Drug Resistant ◽  
Gram Negative

Polymyxin B has resurged in recent years as a last resort therapy for Gram-negative multidrug-resistant (MDR) and extremely drug resistant (XDR) infections. Understanding newer evidence on polymyxin B is necessary to guide clinical decision making. Here, we present a literature review of polymyxin B in Gram-negative infections with update on its pharmacology.

Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?

2015 ◽  
Vol 51 ◽  
pp. 133-139 ◽  
Author(s):  
Ramshekhar N. Menon ◽  
Ashalatha Radhakrishnan ◽  
Ramanathapuram Parameswaran ◽  
Bejoy Thomas ◽  
Chandrashekharan Kesavadas ◽  
...  
Keyword(s):  
Decision Making ◽  
Fdg Pet ◽  
Partial Epilepsy ◽  
Drug Resistant ◽  
Surgical Decision ◽  
Surgical Decision Making

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 18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

2021 ◽  
Author(s):  
Anthime FLAUS ◽  
Charles MELLERIO ◽  
Sebastian RODRIGO ◽  
Vincent BRULON ◽  
Vincent LEBON ◽  
...  
Keyword(s):  
Decision Making ◽  
Fdg Pet ◽  
Visual Analysis ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Surgical Decision ◽  
Promising Tool ◽  
Drug Resistant Epilepsy ◽  
Additional Value ◽  
Surgical Decision Making

Abstract Purpose: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.Methods: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 year-old) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), confidence in results, location of PET abnormalities and presence of a structural lesion on MRI. The clinical impact on surgical strategy and outcome was assessed independently.Results: The location of epilepsy was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 of them. PET alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. PET/MR was considered better performing than PET+MR in 56% of patients. The increase in sensitivity was 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 40% of patients, consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome was obtained in 13/14 patients who underwent a cortical resection.Conclusion: Hybrid PET/MR improves the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

scholarly journals Clinical and prognostic 18F-FDG PET/CT role in recurrent vulvar cancer: a multicentric experience

2021 ◽  
Author(s):  
Domenico Albano ◽  
Mattia Bonacina ◽  
Giordano Savelli ◽  
Paola Ferro ◽  
Elena Busnardo ◽  
...  
Keyword(s):  
Decision Making ◽  
Predictive Value ◽  
Fdg Pet ◽  
Clinical Decision Making ◽  
Vulvar Cancer ◽  
Multicentric Study ◽  
Hpv Status ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
The Impact

Abstract Purpose The aim of this retrospective multicentric study was to investigate the diagnostic performance, the prognostic value and the impact of 18F-FDG PET/CT on treatment decision-making in patients with suspected recurrent vulvar cancer (VC). Materials and methods Sixty-three patients affected by VC performed 18F-FDG-PET/CT for restaging purposes in case of suspected clinical and/or radiological recurrence. Histopatology results if available and/or clinical-imaging follow-up for at least 12 months were considered as reference standard. The diagnostic accuracy and the clinical impact of 18F-FDG PET/CT were investigated. Progression free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier curves. Results Fifty-two (82.5%) PET/CT showed the presence of recurrence, while the remaining 11 (17.5%) were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT were 100% (95%CI 93–100%), 92% (95%CI 62–100%), 98% (95%CI 89–99%), 100% and 98% (95%CI 92–100%). A relevant impact of 18F-FDG PET/CT imaging was registered in 28 cases: in 12 cases moving from local therapy to chemotherapy due to the recognition of disseminate localizations; in 10 showing the site of recurrence in presence of negative conventional imaging, and in 6 cases confirming to be true negative and avoiding unnecessary therapies. Beside advanced age and HPV status, a positive restaging 18F-FDG PET/CT scan was significantly correlated with shorter PFS and OS compared to negative scan (p < 0.001). Conclusions 18F-FDG PET/CT demonstrated to be an accurate tool in the assessing of recurrent VC with high sensitivity and specificity and with a significant impact on clinical decision-making. Restaging 18F-FDG PET/CT findings were associated with survival.

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