Neurocysticercosis as a probable risk factor for hippocampal sclerosis

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.

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Surgical treatment of drug-resistant epilepsy following hippocampal sclerosis

Voprosy neirokhirurgii imeni N N Burdenko ◽

10.17116/neiro20218505131 ◽

2021 ◽

Vol 85 (5) ◽

pp. 31

Author(s):

D.I. Pitskhelauri ◽

E.S. Kudieva ◽

A.G. Melikyan ◽

P.A. Vlasov ◽

M.I. Kamenetskaya ◽

...

Keyword(s):

Surgical Treatment ◽

Hippocampal Sclerosis ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Memory outcome 2 years after anterior temporal lobectomy in patients with drug-resistant epilepsy

Seizure ◽

10.1016/j.seizure.2008.08.008 ◽

2009 ◽

Vol 18 (2) ◽

pp. 139-144 ◽

Cited By ~ 17

Author(s):

Liliana G. Grammaldo ◽

Giancarlo Di Gennaro ◽

Teresa Giampà ◽

Marco De Risi ◽

Giulio N. Meldolesi ◽

...

Keyword(s):

Temporal Lobectomy ◽

Drug Resistant ◽

Anterior Temporal Lobectomy ◽

Drug Resistant Epilepsy

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.4.peds15636 ◽

2016 ◽

Vol 18 (5) ◽

pp. 511-522 ◽

Cited By ~ 13

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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How to Inject Ictal SPECT? From Manual to Automated Injection

10.21203/rs.3.rs-255385/v1 ◽

2021 ◽

Author(s):

Xavier Setoain ◽

Francisco Campos ◽

Antonio Donaire ◽

Maria Mayoral ◽

Andres Perissinotti ◽

...

Keyword(s):

Injection System ◽

Control Group ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Injection Time ◽

Tracer Injection ◽

Ictal Spect ◽

Seizure Focus ◽

Drug Resistant Epilepsy ◽

Automated Injection

Abstract BackgroundSuccessful surgery depends on the accurate localization of epileptogenic zone before surgery. Ictal SPECT is the only imaging modality that allows identification of the ictal onset zone by measuring the regional cerebral blood flow at the time of injection. The main limitations of ictal SPECT in epilepsy are the complex methodology of the tracer injection during a seizure. To overcome these limitations, we present the main features of the first automated injector for ictal SPECT (epijet, LemerPax; La Chapelle -sur-Erdre; France). In this study we compared traditional manual injection with automated injection for ictal SPECT in122 patients with drug-resistant epilepsy. MethodsThe study included 55 consecutive prospective patients with drug-resistant epilepsy undergoing injection with the automated injector. The control group was our retrospective database of a historic pool of 67 patients, injected manually from 2014-2016. Calculated annual exposure/radioactive dose for operators was measured. Injection time, seizure focus localization with ictal SPECT, as well as repeated hospitalizations related to fails injections were compared in these two groups of patients. ResultsThere were no differences in the average injection time with epijet (13 s) compared with the traditional manual injection (14s). The seizure focus was successfully localized with ictal SPECT with epijet in 44/55 (80%) patients and with manual injection in 46/67 (68%) patients (p=0.694). Repeated studies were required in 16/67 (23%) patients in the manual injection group compared to 4 patients (7%) in the epijet group (p=0.022). Calculated annual exposure/dose for operators of 0.39 mSv/year and administered dose error inferior to 5% are other advantages of epijet. ConclusionThe first results using epijet are promising in adjustment of the injection dose, reducing the rate of radiation exposure for patients and nurses, maintaining the same injection time and allowing high SPECT accuracy. These preliminary results support the use of an automated injection system to inject radioactive ictal SPECT doses in epilepsy units.

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An evaluation of kurtosis beamforming in magnetoencephalography to localize the epileptogenic zone in drug resistant epilepsy patients

Clinical Neurophysiology ◽

10.1016/j.clinph.2017.12.040 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1221-1229 ◽

Cited By ~ 9

Author(s):

Michael B.H. Hall ◽

Ida A. Nissen ◽

Elisabeth C.W. van Straaten ◽

Paul L. Furlong ◽

Caroline Witton ◽

...

Keyword(s):

Epileptogenic Zone ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Drug-resistant temporal lobe epilepsy due to cavernous malformations

Neurosurgical FOCUS ◽

10.3171/foc.2006.21.1.9 ◽

2006 ◽

Vol 21 (1) ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Sergio Paolini ◽

Roberta Morace ◽

Giancarlo Di Gennaro ◽

Angelo Picardi ◽

Liliana G. Grammaldo ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Psychosocial Functioning ◽

Temporal Lobectomy ◽

Surgical Removal ◽

Seizure Outcome ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Cavernous Malformations ◽

Number Of Patients

Object Supratentorial cavernous angiomas may be associated with drug-resistant focal epilepsy. Surgical removal of the malformation may result in seizure control in a number of patients, although in most studies a long history and high frequency of attacks have been recognized as indicators of unfavorable seizure outcome. In the literature, there are no clear indications regarding the optimal diagnostic presurgical workup and the surgical strategy for this particular subgroup of patients with symptomatic epilepsy. In this paper the authors focus on the preoperative workup and the surgical management of the disease in eight consecutive patients undergoing surgery for drug-resistant temporal lobe epilepsy (TLE) due to cavernous malformations (CMs), and the relevant literature on this issue is also reviewed. Methods Preoperatively, all patients were assessed using a noninvasive protocol aimed at localizing the epileptogenic zone on the basis of anatomical, electrical, and clinical criteria. The presurgical assessment yielded an indication for lesionectomy in two cases, lesionectomy plus anteromesial temporal lobectomy in four cases, and lesionectomy plus extended temporal lobectomy in two cases. At follow-up examinations, seizure, neuropsychological, and psychiatric outcomes were all evaluated. Seven patients were categorized in Engel Class IA (seizure free), and one was categorized in Engel Class IB (occasional auras only). No adverse effects on neuropsychological or psychosocial functioning were observed. Conclusions Epilepsy surgery can be performed with excellent results in patients with intractable TLE caused by CMs. Noninvasive presurgical evaluation of these patients may enable a tailored approach, providing complete seizure relief in most cases.

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Norwegian population‐based study of long‐term effects, safety, and predictors of response of vagus nerve stimulation treatment in drug‐resistant epilepsy: The NORPulse study

Epilepsia ◽

10.1111/epi.17152 ◽

2021 ◽

Author(s):

Konstantin H. Kostov ◽

Hrisimir Kostov ◽

Pål Gunnar Larsson ◽

Oliver Henning ◽

Christian Alexander Cornelius Eckmann ◽

...

Keyword(s):

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Population Based ◽

Drug Resistant ◽

Long Term Effects ◽

Population Based Study ◽

Predictors Of Response ◽

Norwegian Population ◽

Drug Resistant Epilepsy

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A prospective controlled study on the impact of anterior temporal lobectomy on dream content

Journal of Neurosurgery ◽

10.3171/2021.3.jns21164 ◽

2021 ◽

pp. 1-9

Author(s):

Holger Joswig ◽

Chloe Gui ◽

Miguel Arango ◽

Andrew G. Parrent ◽

Keith W. MacDougall ◽

...

Keyword(s):

Case Reports ◽

Dream Content ◽

Temporal Lobectomy ◽

Controlled Study ◽

Drug Resistant ◽

Anterior Temporal Lobectomy ◽

Before And After ◽

Drug Resistant Epilepsy ◽

The Impact ◽

Prospective Controlled Study

OBJECTIVE Changes of dream ability and content in patients with brain lesions have been addressed in only about 100 case reports. All of these reports lack data regarding prelesional baseline dream content. Therefore, it was the objective of this study to prospectively assess dream content before and after anterior temporal lobectomy. METHODS Using the Hall and Van de Castle system, 30 dreams before and 21 dreams after anterior temporal lobectomy for drug-resistant epilepsy were analyzed. Fifty-five dreams before and 60 dreams after stereoelectroencephalography served as controls. RESULTS After anterior temporal lobectomy, patients had significantly less physical aggression in their dreams than preoperatively (p < 0.01, Cohen’s h statistic). Dream content of patients undergoing stereoelectroencephalography showed no significant changes. CONCLUSIONS Within the default dream network, the temporal lobe may account for aggressive dream content. Impact of general anesthesia on dream content, as a possible confounder, was ruled out.

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Relation of Structural and Functional Changes in Auditory and Visual Pathways after Temporal Lobe Epilepsy Surgery

Behavioral Sciences ◽

10.3390/bs8100092 ◽

2018 ◽

Vol 8 (10) ◽

pp. 92

Author(s):

Margarita Báez-Martín ◽

Lilia Morales-Chacón ◽

Iván García-Maeso ◽

Bárbara Estupiñán-Díaz ◽

María García-Navarro ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Visual Pathway ◽

Visual Pathways ◽

Temporal Lobectomy ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Anatomical Connectivity ◽

Anatomical Connection

Auditory and visual pathways may be affected as a consequence of temporal lobe epilepsy surgery because of their anatomical relationships with this structure. The purpose of this paper is to correlate the results of the auditory and visual evoked responses with the parameters of tractography of the visual pathway, and with the state of connectivity between respective thalamic nuclei and primary cortices in both systems after the surgical resection of the epileptogenic zone in drug-resistant epileptic patients. Tractography of visual pathway and anatomical connectivity of auditory and visual thalamus-cortical radiations were evaluated in a sample of eight patients. In general, there was a positive relationship of middle latency response (MLR) latency and length of resection, while a negative correlation was found between MLR latency and the anatomical connection strength and anatomical connection probability of the auditory radiations. In the visual pathway, significant differences between sides were found with respect to the number and length of tracts, which was lower in the operated one. Anatomical connectivity variables and perimetry (visual field defect index) were particularly correlated with the latency of P100 wave which was obtained by quadrant stimulation. These results demonstrate an indirect functional modification of the auditory pathway and a direct traumatic lesion of the visual pathway after anterior temporal lobectomy in patients with drug resistant epilepsy.

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