scholarly journals Tailored disconnection based on presurgical evidence in catastrophic epilepsy: report of 2 cases

2016 ◽  
Vol 17 (6) ◽  
pp. 679-682 ◽  
Author(s):  
Jun T. Park ◽  
Sunil V. Manjila ◽  
Rachel B. Tangen ◽  
Mark L. Cohen ◽  
Asim M. Shahid ◽  
...  
Keyword(s):  
Neurodevelopmental Outcome ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Older Children ◽  
Presurgical Evaluation ◽  
Neurodevelopmental Outcomes ◽  
Cortical Malformation ◽  
Seizure Reduction ◽  
Epileptic Spasms ◽  
Catastrophic Epilepsy

Catastrophic epilepsy in infants, often due to extensive cortical dysplasia, has devastating consequences with respect to brain development. Conventional lobar, multilobar, or hemispheric resection in these infants is challenging, carrying an increased operative risk compared with that in older children. Removing a larger tissue volume versus removing or disconnecting the epileptogenic region does not always guarantee better seizure outcome. The authors describe 2 infants with catastrophic epilepsy who benefited from individually tailored disconnections based on a hypothesized epileptogenic zone following intensive presurgical evaluation. Two infants with catastrophic epilepsy and epileptic spasms underwent leukotomies between 3 and 12 months of age. They were followed up postoperatively for 19–36 months. Both patients had 90%–100% seizure reduction and a significantly improved neurodevelopmental outcome without postoperative complication. Cortical malformation was seen in both patients. Modifications of established surgical disconnection techniques, tailored to each patient's specific epileptogenic zone, optimized seizure and neurodevelopmental outcomes while minimizing the risks associated with more extensive resections.

Neurodevelopmental Outcomes following Prenatal Diagnosis of Isolated Corpus Callosum Agenesis: A Systematic Review

2021 ◽  
pp. 1-8
Author(s):  
Sara Bernardes da Cunha ◽  
Maria Carolina Carneiro ◽  
Maria Miguel Sa ◽  
Andrea Rodrigues ◽  
Carla Pina
Keyword(s):  
Systematic Review ◽  
Prenatal Diagnosis ◽  
Corpus Callosum ◽  
Neurodevelopmental Outcome ◽  
Supportive Therapy ◽  
Mesh Term ◽  
Older Children ◽  
Neurodevelopmental Outcomes ◽  
Agenesis Of Corpus Callosum ◽  
Corpus Callosum Agenesis

Abnormalities of corpus callosum are one of the most common brain anomalies. Fetuses with isolated corpus callosum agenesis (CCA) have a better prognosis than those with additional anomalies. However, unpredictable neurodevelopmental outcomes of truly isolated CCA make prenatal counseling a challenge. The aim of this review is to evaluate neurodevelopmental outcomes in children with prenatal diagnosis of isolated CCA. Controlled clinical trials published between May 23, 2009, and May 23, 2019, using the MeSH term “agenesis of corpus callosum” were reviewed. A total of 942 articles were identified, and 8 studies were included in the systematic review depending on the inclusion criteria. These studies included 217 fetuses with isolated CCA and no other anomalies at prenatal assessment. Neurodevelopmental outcome was reported to be normal in 83 children with a prenatal diagnosis of isolated CCA confirmed at birth within 128 completed assessments. About 45 children presented borderline, moderate, or severe neurodevelopmental outcome. In this review, neurodevelopment was favorable in two-thirds of the cases, but mild disabilities emerged in older children. Despite this, disabilities can occur later beyond school age and a low risk of severe cognitive impairment exists. Our study highlights the essential early diagnosis and proper supportive therapy.

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 Optimising neurodevelopmental and psychosocial outcomes for survivors with CHD: a research agenda for the next decade

2021 ◽  
pp. 1-3
Author(s):  
Erica Sood ◽  
Jeffrey P Jacobs ◽  
Bradley S Marino
Keyword(s):  
Health Disparities ◽  
Outcomes Research ◽  
Research Agenda ◽  
Clinical Care ◽  
Neurodevelopmental Outcome ◽  
Psychosocial Outcomes ◽  
The United States ◽  
Future Research ◽  
Neurodevelopmental Outcomes ◽  
Working Groups

Abstract Neurodevelopmental and psychosocial impairments negatively impact health-related quality of life for survivors with CHD and complicate the transition to independent adulthood. Risk for neurodevelopmental and psychosocial impairments is influenced by a complex interplay among genetic, foetal, surgical, perioperative, family, and social factors, requiring a multi-pronged approach to neuroprotection and intervention. To ensure future research can ultimately reduce the burden of CHD for individuals, families, and society, the most pressing issues in cardiac neurodevelopment requiring scientific investigation must be identified. Through funding from an R13 Grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health of the United States of America, the Cardiac Neurodevelopmental Outcome Collaborative convened a two-day meeting of international experts in cardiac neurodevelopmental and psychosocial research, clinical care, and health disparities, including patient and family stakeholders, to define the cardiac neurodevelopmental and psychosocial outcomes research agenda for the next decade. Seven multidisciplinary working groups were formed to address key domains crucial to the advancement of cardiac neurodevelopmental and psychosocial outcomes research: 1) Foetal Brain Development and Neuroprotection, 2) Surgical/Perioperative Neuroprotection and Neurodevelopment, 3) Characterization of Neurodevelopmental and Psychological Outcomes, 4) Neurodevelopmental and Psychosocial Intervention, 5) Parent Mental Health and Family Functioning, 6) Neurodevelopmental Education, Outreach and Advocacy, and 7) Health Disparities and Neurodevelopmental Outcomes. Working groups identified significant gaps in knowledge and critical questions that must be answered to further knowledge, policy, care, and outcomes. The development of a research agenda in cardiac neurodevelopmental and psychosocial outcomes is critical for informing collaborative initiatives and allocation of funding for research to scientific inquiries of highest value to key stakeholders.

scholarly journals The benefit of the diffusion kurtosis imaging in presurgical evaluation in patients with focal MR-negative epilepsy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michaela Bartoňová ◽  
Marek Bartoň ◽  
Pavel Říha ◽  
Lubomír Vojtíšek ◽  
Milan Brázdil ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Diffusion Kurtosis Imaging ◽  
Epileptogenic Zone ◽  
Diffusion Weighted Mri ◽  
Specific Detection ◽  
Presurgical Evaluation ◽  
Brain Areas ◽  
Specific Restriction ◽  
Diffusion Kurtosis ◽  
Selection Of

AbstractThe effectivity of diffusion-weighted MRI methods in detecting the epileptogenic zone (EZ) was tested. Patients with refractory epilepsy (N=25) who subsequently underwent resective surgery were recruited. First, the extent of white matter (WM) asymmetry from mean kurtosis (MK) was calculated in order to detect the lobe with the strongest impairment. Second, a newly developed metric was used, reflecting a selection of brain areas with concurrently increased mean Diffusivity, reduced fractional Anisotropy, and reduced mean Kurtosis (iDrArK). A two-step EZ detection was performed as (1) lobe-specific detection, (2) iDrArK voxel-wise detection (with a possible lobe-specific restriction if the result of the first step was significant in a given subject). The method results were compared with the surgery resection zones. From the whole cohort (N=25), the numbers of patients with significant results were: 10 patients in lobe detection and 9 patients in EZ detection. From these subsets of patients with significant results, the impaired lobe was successfully detected with 100% accuracy; the EZ was successfully detected with 89% accuracy. The detection of the EZ using iDrArK was substantially more successful when compared with solo diffusional parameters (or their pairwise combinations). For a subgroup with significant results from step one (N=10), iDrArK without lobe restriction achieved 37.5% accuracy; lobe-restricted iDrArK achieved 100% accuracy. The study shows the plausibility of MK for detecting widespread WM changes and the benefit of combining different diffusional voxel-wise parameters.

scholarly journals The proportion of seizure onset zone contacts resected is not associated with outcome following SEEG-guided resective epilepsy surgery in children

2021 ◽  
Author(s):  
Mehdi Khan ◽  
Aswin Chari ◽  
Kiran Seunarine ◽  
Christin Eltze ◽  
Friederike Moeller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Imaging Data ◽  
Seizure Onset ◽  
Binary Logistic Regression Model ◽  
Primary Analysis ◽  
Seizure Onset Zone

AbstractPurposeChildren undergoing stereoelectroencephalography (SEEG)-guided epilepsy surgery represent a complex cohort. We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing SEEG-guided resective epilepsy surgery.MethodsPatients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Seizure outcomes were classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.ResultsOf 94 patients undergoing SEEG, 29 underwent subsequent focal resection of whom 22 had sufficient imaging data to be included in the primary analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF and 7 (31.8%) NSF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p<0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p=0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome, although the interpretation was limited by pseudo-complete separation of the data.ConclusionHistopathology is a significant predictor of surgical outcomes in children undergoing SEEG-guided resective epilepsy surgery. The percentage of SOZ contacts resected was not associated with SF. Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.

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.

DOZ047.81: Neurodevelopmental outcome in infants with AE: developmental trajectories in the first year of life

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F Bevilacqua ◽  
B Ragni ◽  
L Valfrè ◽  
A Conforti ◽  
A Braguglia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Motor Development ◽  
Developmental Trajectories ◽  
Neurodevelopmental Outcome ◽  
First Year ◽  
Neurodevelopmental Outcomes ◽  
Prospective Longitudinal Study ◽  
First Year Of Life ◽  
Prospective Longitudinal

Abstract Background Esophageal atresia (EA) prognosis have improved significantly over the past three decades. Research and clinical attention has shifted to neurodevelopmental outcomes and quality of life. Aim The aim of this study wasto examine neurodevelopmental outcomes and to identify clinical and sociodemographic risk factors in a cohort of infants with EA. Methods An observational prospective longitudinal study was conducted between 2009 and 2017. Neurodevelopment was assessed at 6 and 12 months by Bayley Scales of Infants and Toddler Development—3rd Edition. Clinical and sociodemographic variables included were gender, birthweight, gestational age, associated malformations, number of hospitalizations, surgeries and dilatations at 12 months, days of mechanical ventilation, parental age, education level, and socioeconomic status. Results Ninety-six infants were enrolled in the study at 6 months and 73 of them were evaluated also at 12 months. Analysis showed significant differences between motor development at 6 and 12 months (M6 = 95.39, SD = 15.71; M12 = 91.83, SD = 12.87; t = 0.245, P = 0.017); significant differences emerged also between cognitive development at 6 and 12 months (M6 = 91.80, SD = 11.70; M12 = 100.92, SD = 15.39; t = −5.10, p = .000). Infants with long-gap AE achieved the worst scores in cognitive (r = -.28, P < .01) and motor scales (r = -.36, P < .01) at 6 months and in motor scale at 12 months (r = −0.30, P < 0.05). More days of mechanical ventilation were related to a lower score in both the cognitive (6 months r = −0.26, P < 0.05; 12 months r = −0.26, P < 0.05) and motor scale (6 months: r = −0.38, P < 0.01; 12 months r = −0.42, P < 0.01). A major number of interventions in the first year of life were related to lower scores in the motor scale at 12 months (r = −0.43, P < 0.01). Conclusions Infants operated on for AE are at risk of neurodevelopmental impairment in the first year of life. Findings support the association between neurodevelopmental outcomes and clinical risk factors. Careful interdisciplinary follow-up is essential for early detection of neurodevelopmental delay.

scholarly journals 37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e14-e15
Author(s):  
Po-Yin Cheung ◽  
Morteza Hajihosseini ◽  
Irina Dinu ◽  
Heather Switzer ◽  
Charlene M T Robertson
Keyword(s):  
Early Childhood ◽  
Hearing Loss ◽  
Cardiac Surgery ◽  
Cerebral Palsy ◽  
Preterm Infants ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Neurodevelopmental Outcome ◽  
Neurodevelopmental Outcomes

Abstract Background Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. Objectives To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at &lt;37+0 weeks gestation) with CCHD and neonatal OHS. Design/Methods We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Results From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table). Conclusion For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.

scholarly journals Association of fast ripples on intracranial EEG and outcomes after epilepsy surgery

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2235-e2245
Author(s):  
Päivi Nevalainen ◽  
Nicolás von Ellenrieder ◽  
Petr Klimeš ◽  
François Dubeau ◽  
Birgit Frauscher ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Slow Wave Sleep ◽  
Seizure Outcome ◽  
Incomplete Resection ◽  
Epileptogenic Zone ◽  
Poor Prognostic Factor ◽  
Individual Level ◽  
Poor Outcome ◽  
Surgery Outcome ◽  
The Individual

ObjectiveTo examine whether fast ripples (FRs) are an accurate marker of the epileptogenic zone, we analyzed overnight stereo-EEG recordings from 43 patients and hypothesized that FR resection ratio, maximal FR rate, and FR distribution predict postsurgical seizure outcome.MethodsWe detected FRs automatically from an overnight recording edited for artifacts and visually from a 5-minute period of slow-wave sleep. We examined primarily the accuracy of removing ≥50% of total FR events or of channels with FRs to predict postsurgical seizure outcome (Engel class I = good, classes II–IV = poor) according to the whole-night and 5-minute analysis approaches. Secondarily, we examined the association of low overall FR rates or absence or incomplete resection of 1 dominant FR area with poor outcome.ResultsThe accuracy of outcome prediction was highest (81%, 95% confidence interval [CI] 67%–92%) with the use of the FR event resection ratio and whole-night recording (vs 72%, 95% CI 56%–85%, for the visual 5-minute approach). Absence of channels with FR rates >6/min (p = 0.001) and absence or incomplete resection of 1 dominant FR area (p < 0.001) were associated with poor outcome.ConclusionsFRs are accurate in predicting epilepsy surgery outcome at the individual level when overnight recordings are used. Absence of channels with high FR rates or absence of 1 dominant FR area is a poor prognostic factor that may reflect suboptimal spatial sampling of the epileptogenic zone or multifocality, rather than an inherently low sensitivity of FRs.Classification of evidenceThis study provides Class II evidence that FRs are accurate in predicting epilepsy surgery outcome.

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