To Stick or Not to Stick? Scalp and Intracranial EEG Evaluation Both Help Achieve Good Surgical and Neuropsychiatric Outcomes in Epilepsy Surgery up to 20 Years Post-Surgery

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

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The Irritative Zone and Seizure Onset Zone in Acute ECOG: The Quest for Relevant Epileptogenic Tissue

Invasive Studies of the Human Epileptic Brain ◽

10.1093/med/9780198714668.003.0010 ◽

2018 ◽

pp. 120-130

Author(s):

André Palmini ◽

Eliseu Paglioli

Keyword(s):

Epilepsy Surgery ◽

Cost Effective ◽

Careful Analysis ◽

Cortical Surface ◽

Interictal Spikes ◽

Intracranial Eeg ◽

Seizure Onset Zone ◽

Cost Effective Approach ◽

Lesion Type ◽

Refractory Seizures

Acute intraoperative electrocorticography (ECoG) is a time-honoured technique to identify the relevant epileptogenic tissue (RET) and hence guide cortical resection to control medically refractory seizures. ECoG identifies the RET through careful analysis of pattern, morphology, frequency, and localization of interictal spikes recorded directly from the exposed cortical surface. Because the development and dissemination of chronic intracranial EEG recording techniques has put emphasis on ictal recordings (thus defining an ictal onset zone), acute ECoG is often considered unnecessary in surgical planning. The chapter describes limitations and advantages of acute ECoG to define the RET in comparison with more costly and risky procedures, particularly subdural grid and SEEG recording. Specifically, it shows how the integration of lesion type and sequentially recorded ECoG spikes during operation may provide a highly cost-effective approach to successful epilepsy surgery.

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Subclinical seizures detected on intracranial EEG: Patient characteristics and impact on surgical outcome in a single pediatric epilepsy surgery center

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.108040 ◽

2021 ◽

Vol 121 ◽

pp. 108040

Author(s):

Melissa Tsuboyama ◽

Chellamani Harini ◽

Shanshan Liu ◽

Bo Zhang ◽

Jeffrey Bolton

Keyword(s):

Epilepsy Surgery ◽

Surgical Outcome ◽

Patient Characteristics ◽

Pediatric Epilepsy ◽

Intracranial Eeg ◽

Pediatric Epilepsy Surgery ◽

Surgery Center

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The diagnostic utility of intracranial EEG monitoring for epilepsy surgery in children

Epilepsia ◽

10.1111/epi.12983 ◽

2015 ◽

Vol 56 (7) ◽

pp. 1065-1070 ◽

Cited By ~ 13

Author(s):

Paula Brna ◽

Michael Duchowny ◽

Trevor Resnick ◽

Catalina Dunoyer ◽

Sanjiv Bhatia ◽

...

Keyword(s):

Epilepsy Surgery ◽

Diagnostic Utility ◽

Eeg Monitoring ◽

Intracranial Eeg

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Invasive Presurgical Evaluation : From Intraoperative ECoG to Chronic Intracranial EEG(Epilepsy Surgery)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.16.171 ◽

2007 ◽

Vol 16 (3) ◽

pp. 171-176

Author(s):

Koichi Baba

Keyword(s):

Epilepsy Surgery ◽

Special Issue ◽

Presurgical Evaluation ◽

Intracranial Eeg

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Intracranial EEG in the 21st Century

Epilepsy Currents ◽

10.1177/1535759720934852 ◽

2020 ◽

Vol 20 (4) ◽

pp. 180-188 ◽

Cited By ~ 1

Author(s):

Barbara C. Jobst ◽

Fabrice Bartolomei ◽

Beate Diehl ◽

Birgit Frauscher ◽

Philippe Kahane ◽

...

Keyword(s):

Epilepsy Surgery ◽

21St Century ◽

High Frequency ◽

Low Frequency ◽

Epileptogenic Zone ◽

Noninvasive Methods ◽

Intracranial Eeg ◽

Advantages And Disadvantages ◽

Gamma Range ◽

The Future

Intracranial electroencephalography (iEEG) has been the mainstay of identifying the seizure onset zone (SOZ), a key diagnostic procedure in addition to neuroimaging when considering epilepsy surgery. In many patients, iEEG has been the basis for resective epilepsy surgery, to date still the most successful treatment for drug-resistant epilepsy. Intracranial EEG determines the location and resectability of the SOZ. Advances in recording and implantation of iEEG provide multiple options in the 21st century. This not only includes the choice between subdural electrodes (SDE) and stereoelectroencephalography (SEEG) but also includes the implantation and recordings from microelectrodes. Before iEEG implantation, especially in magnetic resonance imaging -negative epilepsy, a clear hypothesis for seizure generation and propagation should be based on noninvasive methods. Intracranial EEG implantation should be planned by a multidisciplinary team considering epileptic networks. Recordings from SDE and SEEG have both their advantages and disadvantages. Stereo-EEG seems to have a lower rate of complications that are clinically significant, but has limitations in spatial sampling of the cortical surface. Stereo-EEG can sample deeper areas of the brain including deep sulci and hard to reach areas such as the insula. To determine the epileptogenic zone, interictal and ictal information should be taken into consideration. Interictal spiking, low frequency slowing, as well as high frequency oscillations may inform about the epileptogenic zone. Ictally, high frequency onsets in the beta/gamma range are usually associated with the SOZ, but specialized recordings with combined macro and microelectrodes may in the future educate us about onset in higher frequency bands. Stimulation of intracranial electrodes triggering habitual seizures can assist in identifying the SOZ. Advanced computational methods such as determining the epileptogenicity index and similar measures may enhance standard clinical interpretation. Improved techniques to record and interpret iEEG may in the future lead to a greater proportion of patients being seizure free after epilepsy surgery.

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Scalp and Intracranial EEG in Medically Intractable Extratemporal Epilepsy with Normal MRI

ISRN Neurology ◽

10.5402/2012/942849 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Tarek Zakaria ◽

Katherine Noe ◽

Elson So ◽

Gregory D. Cascino ◽

Nicholas Wetjen ◽

...

Keyword(s):

Epilepsy Surgery ◽

Surgical Outcome ◽

Favorable Outcome ◽

Rank Test ◽

Seizure Freedom ◽

Intracranial Eeg ◽

Scalp Eeg ◽

Kaplan Meier ◽

Postoperative Seizure ◽

Beta Frequency

Purpose. To investigate EEG and SPECT in the surgical outcome of patients with normal MRI (nonlesional) and extratemporal lobe epilepsy. Methods. We retrospectively identified 41 consecutive patients with nonlesional extratemporal epilepsy who underwent epilepsy surgery between 1997 and 2007. The history, noninvasive diagnostic studies (scalp EEG, MRI, and SPECT) and intracranial EEG (iEEG) monitoring was reviewed. Scalp and iEEG ictal onset patterns were defined. The association of preoperative studies and postoperative seizure freedom was analyzed using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard. Results. Thirty-six of 41 patients had adequate information with a minimum of 1-year followup. Favorable surgical outcome was identified in 49% of patients at 1 year, and 35% at 4-year. On scalp EEG, an ictal onset pattern consisting of focal beta-frequency discharge (>13–125 Hz) was associated with favorable surgical outcome (P=0.02). Similarly, a focal fast-frequency oscillation (>13–125 Hz) on iEEG at ictal onset was associated with favorable outcome (P=0.03). Discussion. A focal fast-frequency discharge at ictal onset identifies nonlesional MRI, extratemporal epilepsy patients likely to have a favorable outcome after resective epilepsy surgery.

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Quality of life and epilepsy surgery in childhood and adolescence

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000100006 ◽

2011 ◽

Vol 69 (1) ◽

pp. 23-26 ◽

Cited By ~ 12

Author(s):

Isabella C. Gagliardi ◽

Catarina A. Guimarães ◽

Elisabete A.P. Souza ◽

Kátia M.R. Schmutzler ◽

Marilisa M. Guerreiro

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Wilcoxon Test ◽

Childhood And Adolescence ◽

Health Issues ◽

Post Surgery ◽

Before And After ◽

General Improvement ◽

Improvement Method

Epilepsy can affect the quality of life (QOL) of patients. The temporal lobe epilepsy (TLE) is often refractory to medication, which has an adverse impact on QOL. The surgery can be a form to control the seizures and to improve the QOL of the patients. OBJECTIVE: The aim of this study was to verify the QOL of children and adolescents with TLE who underwent surgery for epilepsy, comparing QOL before and after surgery and investigating which parameters showed improvement. METHOD: We used semi-structured questionnaire in the pre-and post-surgery in 13 patients. The data were analyzed using the Wilcoxon test. RESULTS: The analysis showed that there was general improvement in the QOL postoperatively. There was improvement in general health issues, adverse effects of antiepileptic drugs and the relationship with parents. CONCLUSION: When properly indicated, epilepsy surgery improves quality of life of patients with TLE.

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