scholarly journals Indications for Inpatient Magnetoencephalography in Children – An Institution’s Experience

2021 ◽  
Vol 15 ◽  
Author(s):  
Michael W. Watkins ◽  
Ekta G. Shah ◽  
Michael E. Funke ◽  
Stephanie Garcia-Tarodo ◽  
Manish N. Shah ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Surgical Planning ◽  
Tumor Resection ◽  
Intractable Epilepsy ◽  
Epileptogenic Zone ◽  
Long Distance ◽  
Epileptiform Discharges ◽  
Eloquent Cortex ◽  
Functional Areas ◽  
Inpatient Basis

Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing inpatient evaluation, in order to expedite medical or surgical planning. Despite well-established clinical indications for performing MEG in general, there are no current reports that discuss indications or considerations for completion of MEG on an inpatient basis. We conducted a retrospective institutional review of all pediatric MEGs performed between January 2012 and December 2020, and identified 34 cases where MEG was completed as an inpatient. We then reviewed all relevant medical records to determine clinical history, all associated diagnostic procedures, and subsequent treatment plans including epilepsy surgery and post-surgical outcomes. In doing so, we were able to identify five indications for completing the MEG on an inpatient basis: (1) super-refractory status epilepticus (SRSE), (2) intractable epilepsy with frequent electroclinical seizures, and/or frequent or repeated episodes of status epilepticus, (3) intractable epilepsy with infrequent epileptiform discharges on EEG or outpatient MEG, or other special circumstances necessitating inpatient monitoring for successful and safe MEG data acquisition, (4) MEG mapping of eloquent cortex or interictal spike localization in the setting of tumor resection or other urgent neurosurgical intervention, and (5) international or long-distance patients, where outpatient MEG is not possible or practical. MEG contributed to surgical decision-making in the majority of our cases (32 of 34). Our clinical experience suggests that MEG should be considered on an inpatient basis in certain clinical circumstances, where MEG data can provide essential information regarding the localization of epileptogenic activity or eloquent cortex, and be used to develop a treatment plan for surgical management of children with complicated or intractable epilepsy.

The role of magnetoencephalography in epilepsy surgery

2008 ◽  
Vol 25 (3) ◽  
pp. E16 ◽  
Author(s):  
Zulma S. Tovar-Spinoza ◽  
Ayako Ochi ◽  
James T. Rutka ◽  
Cristina Go ◽  
Hiroshi Otsubo
Keyword(s):  
Mr Imaging ◽  
Epilepsy Surgery ◽  
Neuropsychological Testing ◽  
Source Image ◽  
Epileptogenic Zone ◽  
Anatomical Localization ◽  
Functional Mr Imaging ◽  
Eloquent Cortex ◽  
Magnetic Source Image ◽  
Functional Areas

Epilepsy surgery requires the precise localization of the epileptogenic zone and the anatomical localization of eloquent cortex so that these areas can be preserved during cortical resection. Magnetoencephalography (MEG) is a technique that maps interictal magnetic dipole sources onto MR imaging to produce a magnetic source image. Magneto-encephalographic spike sources can be used to localize the epileptogenic zone and be part of the workup of the patient for epilepsy surgery in conjunction with data derived from an analysis of seizure semiology, scalp video electroencephalography, PET, functional MR imaging, and neuropsychological testing. In addition, magnetoencephalographic spike sources can be linked to neuronavigation platforms for use in the neurosurgical field. Finally, paradigms have been developed so that MEG can be used to identify functional areas of the cerebral cortex including the somatosensory, motor, language, and visual evoked fields. The authors review the basic principles of MEG and the utility of MEG for presurgical planning as well as intra-operative mapping and discuss future applications of MEG technology.

scholarly journals Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

2021 ◽  
Vol 22 (8) ◽  
pp. 3860
Author(s):  
Elisa Ren ◽  
Giulia Curia
Keyword(s):  
Animal Models ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Focal Epilepsy ◽  
Ex Vivo ◽  
Hippocampal Sclerosis ◽  
Control Group ◽  
Epileptogenic Zone ◽  
Epileptiform Discharges

Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.

scholarly journals The Use of a CAD/CAM Surgical Obturator Without Impressions to Restore a Maxillectomy Defect

2021 ◽  
Vol 6 ◽  
pp. 247275122199297
Author(s):  
Nicholas Callahan ◽  
Sarah L. Moles ◽  
Michael R. Markiewicz
Keyword(s):  
Surgical Planning ◽  
Tumor Resection ◽  
Free Tissue Transfer ◽  
Digital Impression ◽  
Head And Neck Reconstruction ◽  
Autologous Reconstruction ◽  
Form And Function ◽  
Virtual Surgical Planning ◽  
Tissue Transfer ◽  
Cad Cam

Immediate obturation of the patient undergoing maxillectomy who is not undergoing formal autologous reconstruction is important for immediate form and function of the patient. Exophytic tumors, that are large in dimension can make pre-operative obturator formation challenging. Traditional methods of obturator fabrication involve a physical or digital impression. Preoperative virtual surgical planning for tumor resection and reconstruction using free tissue transfer has become a mainstay in head and neck reconstruction. We describe a variation of this for a patient unable to undergo free tissue transfer where the authors used preoperative virtual surgical planning and CAD/CAM technologies to perform tumor resection, and fabricated an obturator based on the CT imaging alone.

scholarly journals Magnetic source imaging for the surgical evaluation of electroencephalography-confirmed secondary bilateral synchrony in intractable epilepsy

2009 ◽  
Vol 111 (6) ◽  
pp. 1248-1256 ◽  
Author(s):  
Edward F. Chang ◽  
Srikantan S. Nagarajan ◽  
Mary Mantle ◽  
Nicholas M. Barbaro ◽  
Heidi E. Kirsch
Keyword(s):  
Mr Imaging ◽  
Intractable Epilepsy ◽  
Focal Lesion ◽  
Seizure Type ◽  
Source Imaging ◽  
Magnetic Source Imaging ◽  
Ms Imaging ◽  
Epileptiform Discharges ◽  
Magnetic Source ◽  
Imaging Results

Object Routine scalp electroencephalography (EEG) cannot always distinguish whether generalized epileptiform discharges are the result of primary bilateral synchrony or secondary bilateral synchrony (SBS) from a focal origin; this is an important distinction because the latter may be amenable to resection. Whole-head magnetoencephalography (MEG) has superior spatial resolution compared with traditional EEG, and can potentially elucidate seizure foci in challenging epilepsy cases in which patients are undergoing evaluation for surgery. Methods Sixteen patients with medically intractable epilepsy in whom SBS was suspected were referred for magnetic source (MS) imaging. All patients had bilateral, synchronous, widespread, and most often generalized spike-wave discharges on scalp EEG studies, plus some other clinical (for example, seizure semiology) or MR imaging feature (for example, focal lesion) suggesting focal onset and hence possible surgical candidacy. The MS imaging modality is the combination of whole-head MEG and parametric reconstruction of corresponding electrical brain sources. An MEG and simultaneous EEG studies were recorded with a 275-channel whole-head system. Single-equivalent current dipoles were estimated from the MEG data, and dipole locations and orientations were superimposed on patients' MR images. Results The MS imaging studies revealed focal dipole clusters in 12 (75%) of the 16 patients, of which a single dipole cluster was identified in 7 patients (44%). Patient age, seizure type, duration of disease, video-EEG telemetry, and MR imaging results were analyzed to determine factors predictive of having clusters revealed on MS imaging. Of these factors, only focal MR imaging anatomical abnormalities were associated with dipole clusters (chi-square test, p = 0.03). Selective resections (including the dipole cluster) in 7 (87%) of 8 patients resulted in seizure-free or rare seizure outcomes (Engel Classes I and II). Conclusions Magnetic source imaging may provide noninvasive anatomical and neurophysiological confirmation of localization in patients in whom there is a suspicion of SBS (based on clinical or MR imaging data), especially in those with an anatomical lesion. Identification of a focal seizure origin has significant implications for both resective and nonresective treatment of intractable epilepsy.

Curative Effect of Tumor Resection under Microscope for Brain Glioma based on Humanized Nursing Model

2021 ◽  
Vol 7 (5) ◽  
pp. 3266-3275
Author(s):  
Lifeng Huang ◽  
Haiyan Xiang ◽  
Weiming Qian
Keyword(s):  
Tumor Resection ◽  
Postoperative Recovery ◽  
Complete Resection ◽  
Good Effect ◽  
Anxiety And Depression ◽  
Brain Glioma ◽  
Curative Effect ◽  
Data Statistics ◽  
Glioma Resection ◽  
Functional Areas

Previous studies have shown that microsurgery has two main roles in glioma resection, that is, the nerve function is well protected and the degree of tumor resection is improved. On the basis of this experiment, the curative effect of tumor resection under microscope for glioma was studied based on humanized nursing model. By randomly dividing 64 patients into two steps and comparing them in many aspects, the study mainly obtained two inspirations: microglioma resection has good effect, and humanized nursing mode has good effect on postoperative recovery. Finally, some Suggestions and principles for microglioma resection were put forward: the principle of timely operation after diagnosis, the principle of complete resection for nonfunctional areas, the principle of protection for important functional areas, and the principle of recovery plan confirmed by disease examination after surgery. In addition, in terms of the influence of humanized nursing mode on the treatment of glioma under the microscope, the data statistics and SPSS tests show that humanized nursing mode can effectively improve the satisfaction of patients and their families. Relieve anxiety and depression and help patients recover; Lower scores in pain rating statistics, etc. In addition, this experiment has a good basis for development, and all the 64 patients successfully completed the operation without serious complications, which further verified the above conclusions, namely, the maturity and reliability of the technique of microscopic tumor resection for glioma. The technique of tumor resection under microscope can be used in combination with humanized nursing mode, which has good promotion value.

Early Epileptiform Discharges and Clinical Signs Predict Nonconvulsive Status Epilepticus on Continuous EEG

2018 ◽  
Vol 29 (3) ◽  
pp. 388-395 ◽  
Author(s):  
Johannes Koren ◽  
Johannes Herta ◽  
Simone Draschtak ◽  
Georg Pötzl ◽  
Franz Fürbass ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Clinical Signs ◽  
Nonconvulsive Status Epilepticus ◽  
Epileptiform Discharges ◽  
Continuous Eeg

Interhemispheric Subdural Electrodes: Technique, Utility, and Safety

2013 ◽  
Vol 73 (2) ◽  
pp. ons253-ons260 ◽  
Author(s):  
Tarek Abuelem ◽  
David Elliot Friedman ◽  
Satish Agadi ◽  
Angus A. Wilfong ◽  
Daniel Yoshor
Keyword(s):  
Patient Monitoring ◽  
Intractable Epilepsy ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Epileptic Focus ◽  
Epileptogenic Zone ◽  
Invasive Monitoring ◽  
Cortical Function ◽  
Subdural Electrodes ◽  
Dorsolateral Cortex

Abstract BACKGROUND: Invasive monitoring using subdural electrodes is often valuable for characterizing the anatomic source of seizures in intractable epilepsy. Covering the interhemispheric surface with subdural electrodes represents a particular challenge, with a potentially higher risk of complications than covering the dorsolateral cortex. OBJECTIVE: To better understand the safety and utility of interhemispheric subdural electrodes (IHSE). METHODS: We retrospectively reviewed the charts of 24 patients who underwent implantation of IHSE by a single neurosurgeon from 2003 to 2010. Generous midline exposure, meticulous preservation of veins, and sharp microdissection were used to facilitate safe interhemispheric grid placement under direct visualization. RESULTS: The number of IHSE contacts implanted ranged from 10 to 106 (mean = 39.8) per patient. Monitoring lasted for 5.5 days on average (range, 2-24 days), with an adequate sample of seizures captured in all patients before explantation, and with a low complication rate similar to that reported for grid implantation of the dorsolateral cortex. One patient (of 24) experienced symptomatic mass effect. No other complications clearly related to grid implantation and monitoring, such as clinically evident neurological deficits, infection, hematoma, or infarction, were noted. Among patients implanted with IHSE, monitoring led to a paramedian cortical resection in 67%, a resection in a region not covered by IHSE in 17%, and explantation without resection in 17%. CONCLUSION: When clinical factors suggest the possibility of an epileptic focus at or near the midline, invasive monitoring of the paramedian cortex with interhemispheric grids can be safely used to define the epileptogenic zone and map local cortical function.

Electrical cortical stimulation for treatment of intractable epilepsy originating from eloquent cortex: surgical accuracy and clinical efficacy

2019 ◽  
Vol 162 (2) ◽  
pp. 261-269
Author(s):  
Ching-Yi Lee ◽  
Tony Wu ◽  
Chun-Wei Chang ◽  
Siew-Na Lim ◽  
Mei-Yun Cheng ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Intractable Epilepsy ◽  
Cortical Stimulation ◽  
Eloquent Cortex

scholarly journals Ring chromosome 20 syndrome – A rare chromosomal cause of refractory epilepsy in children

2017 ◽  
Vol 04 (01) ◽  
pp. 087-089 ◽  
Author(s):  
Umesh Kalane ◽  
Chaitanya Datar ◽  
Shilpa Kalane
Keyword(s):  
Chromosomal Abnormalities ◽  
Refractory Epilepsy ◽  
Genetic Disorders ◽  
Epileptiform Activity ◽  
Intractable Epilepsy ◽  
Ring Chromosome ◽  
Normal Karyotype ◽  
Epileptiform Discharges ◽  
Chromosome 20 ◽  
Work Up

AbstractGenetic disorders and chromosomal abnormalities have been shown to represent 2–3% of all cases of epilepsy. Ring chromosome 20 syndrome is a rare chromosomal abnormality and a rare cause of intractable epilepsy. Exact prevalence of ring chromosome 20 is not known. We report a case of a 10-year old boy who had had intractable epilepsy since 2 years of age. Birth history was insignificant and there was no obvious dysmorphism. His motor milestones were normal but cognition and speech were delayed. Electroencephalography showed progressive worsening from initial bi-frontal epileptiform activity to generalized discharges. Neuroimaging and metabolic work up was normal. Karyotype study showed ring chromosome 20. Diagnosis of ring chromosome 20 or r(20) syndrome was made. Ring chromosome 20 syndrome is a rare cause of refractory epilepsy A patient who present with intractable epilepsy with frontal epileptiform discharges, mental developmental delay, without dysmorphic features should be suspected of chromosomal abnormalities especially ring chromosome 20.

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