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 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.

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.

Cognitive Impairment and Mossy Fiber Sprouting in a Rat Model of Drug-Resistant Epilepsy Induced by Lithium–Pilocarpine

2021 ◽  
Vol 18 ◽  
Author(s):  
Jing Wu ◽  
Likun Wang ◽  
Yuanxin Huang ◽  
Qian Wu ◽  
Xingmei Luo ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Cognitive Impairment ◽  
Spatial Memory ◽  
Seizure Frequency ◽  
Rat Model ◽  
Memory Impairment ◽  
Mossy Fiber ◽  
Drug Resistant ◽  
Spontaneous Seizures ◽  
Drug Resistant Epilepsy

Background: The mossy fiber sprouting (MFS) in the dentate gyrus is a common pathological change of epilepsy. Previous studies suggested that it is associated with drug-resistant epilepsy, and mossy cells control spontaneous seizures and spatial memory. Methods: We investigated the correlations among cognitive impairment, MFS, seizure frequency and drug resistance in a rat model of epilepsy induced by lithium–pilocarpine. Phenytoin and phenobarbital were used to screen drug resistance. Cognitive function and MFS were detected through the novel object recognition (NOR) test, Morris water maze (MWM) test and Timm staining. Results: The results showed that object memory and spatial memory functions were both significantly impaired in rats with epilepsy, and only spatial memory impairment was more severe in rats with drug-resistant epilepsy. More frequent spontaneous seizures and more obvious MFS were observed in the drug-resistant rats. The seizure frequency was significantly associated with the MWM performance but not with the NOR performance in rats with epilepsy. The degree of MFS was significantly associated with seizure frequency and spatial memory function. Conclusion: Taken together, these correlations among drug resistance, seizure frequency, spatial memory impairment and MFS suggested the possibility of a common pathological mechanism. More studies are needed to clarify the underlying mechanism behind these correlations and the detailed role of MFS in epilepsy. The mechanism of mossy cell change may be an important target for the treatment of seizures, drug resistance and cognitive dysfunction in patients with 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.

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.

Vagus nerve stimulation for drug-resistant epilepsy

2019 ◽  
Vol 20 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Laura Pérez-Carbonell ◽  
Howard Faulkner ◽  
Sean Higgins ◽  
Michalis Koutroumanidis ◽  
Guy Leschziner
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Therapeutic Option ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

scholarly journals Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery

Seizure ◽  
2011 ◽  
Vol 20 (7) ◽  
pp. 580-582 ◽  
Author(s):  
Mar Carreño ◽  
Juan Luis Becerra ◽  
Joaquín Castillo ◽  
Iratxe Maestro ◽  
Antonio Donaire ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Epilepsy Surgery ◽  
Drug Resistant ◽  
Social Outcome ◽  
Drug Resistant Epilepsy

scholarly journals Neurocysticercosis as a probable risk factor for hippocampal sclerosis

2018 ◽  
Vol 76 (11) ◽  
pp. 783-790 ◽  
Author(s):  
Gagandeep Singh ◽  
Josemir W. Sander
Keyword(s):  
Hippocampal Sclerosis ◽  
Taenia Solium ◽  
Population Based ◽  
Temporal Lobectomy ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Common Risk Factors ◽  
Longitudinal Imaging ◽  
Drug Resistant Epilepsy ◽  
Pathology Reports

ABSTRACT Neurocysticercosis is one of the most common risk factors for epilepsy but its association with drug-resistant epilepsy remains uncertain. Conjectures of an association with drug-resistant epilepsy have been fueled by reports of an association between calcific neurocysticercosis lesions (CNL) and hippocampal sclerosis (HS) from specialized epilepsy centers in Taenia solium-endemic regions. The debate arising from these reports is whether the association is causal. Evidence for the association is not high quality but sufficiently persuasive to merit further investigation with longitudinal imaging studies in population-based samples from geographically-diverse regions. The other controversial point is the choice of a surgical approach for drug-resistant epilepsy associated with CNL-HS. Three approaches have been described: standard anteromesial temporal lobectomy, lesionectomy involving a CNL alone and lesionectomy with anteromesial temporal lobectomy (for dual pathology); reports of the latter two approaches are limited. Presurgical evaluation should consider possibilities of delineating the epileptogenic zone/s in accordance with all three approaches.

scholarly journals Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode

2016 ◽  
Vol 18 (5) ◽  
pp. 511-522 ◽  
Author(s):  
Alexander G. Weil ◽  
Aria Fallah ◽  
Evan C. Lewis ◽  
Sanjiv Bhatia
Keyword(s):  
Epilepsy Surgery ◽  
Electrode Placement ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Age At Surgery ◽  
Feasible Alternative ◽  
The Mean ◽  
Drug Resistant Epilepsy

OBJECTIVE Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy. METHODS The authors performed a retrospective analysis of all children (< 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015. RESULTS Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5–16 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4–8), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40–92). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula. CONCLUSIONS Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.

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