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

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
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.

Preoperative Epilepsy Network Distribution Correlates With Seizure Recurrence Following Epilepsy Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Long Di ◽  
Elliot G Neal ◽  
Stephanie Maciver ◽  
Fernando L Vale
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Demographic Data ◽  
Brain Network ◽  
Patient Specific ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Postoperative Seizure ◽  
Epileptic Networks

Abstract INTRODUCTION Surgery remains an essential option for the treatment of medically intractable temporal lobe epilepsy. However, only 66% of patients achieve postoperative seizure freedom, perhaps attributable to an incomplete understanding of brain network alterations in surgical candidates. Here, we present a novel network modeling algorithm that may be used to identify key characteristics of epileptic networks correlated with improved surgical outcome. METHODS Twenty-nine patients were prospectively included, and relevant demographic information was attained. Resting-state functional magnetic resonance imaging (MRI) and electroencephalography (EEG) data were recorded and preprocessed. Using our novel algorithm, patient-specific epileptic networks were mapped preoperatively and geographic spread was quantified. Global functional connectivity was also determined using a volumetric functional atlas. Key demographic data and features of epileptic networks were then correlated with surgical outcome using Pearson's product-moment correlation. RESULTS At an average follow-up of 19 mo, 20/29 (69%) patients were seizure-free. Higher rates of seizure recurrence correlated with the localization of the epilepsy network to either temporal lobe (R = –0.415, P = .039), with the stronger correlation found with the localization to the contralateral temporal lobe (R = –0.566, P = .003). When the volumetric functional atlas connectivity was measured, increased connectivity globally was correlated with seizure recurrence (R = –0.541, P = .006). Seizure recurrence also correlated with greater atlas-based connectivity within the contralateral hemisphere (R = –0.390, P = .049). CONCLUSION Network localization to the temporal lobes, in particular the contralateral temporal lobe, and increased atlas-defined connectivity contralateral to the surgery side are associated with seizure recurrence. These findings may reflect network-level disruption that has infiltrated the contralateral temporal lobe contributing to relatively worse surgical outcomes. Further identification of network parameters that predict patient outcomes may aid in patient selection, resection planning, and ultimately the efficacy of epilepsy surgery.

Outcomes of cingulate epilepsy surgery: insights from an institutional and patient-level systematic review and meta-analysis

2021 ◽  
pp. 1-10
Author(s):  
Panagiotis Kerezoudis ◽  
Rohin Singh ◽  
Gregory A. Worrell ◽  
Jamie J. Van Gompel
Keyword(s):  
Epilepsy Surgery ◽  
Literature Search ◽  
Anterior Cingulate ◽  
Postoperative Outcomes ◽  
Cochrane Library ◽  
Rank Test ◽  
Seizure Freedom ◽  
Low Grade ◽  
Cingulate Gyrus

OBJECTIVE Due to their deep and medial location, range of seizure semiologies, and poor localization on ictal electroencephalography (EEG), cingulate gyrus seizures can be difficult to diagnose and treat. The aim of this study was to review the available evidence on postoperative outcomes after cingulate epilepsy surgery. METHODS A comprehensive literature search of the PubMed/MEDLINE, Ovid Embase, Ovid Scopus, and Cochrane Library databases was conducted to identify studies that investigated postoperative outcomes of patients with cingulate epilepsy. Seizure freedom at the last follow-up (at least 12 months) was the primary endpoint. The literature search was supplemented by the authors’ institutional series (4 patients). RESULTS Twenty-one studies were identified, yielding a total of 105 patients (68 with lesional epilepsy [65%]). Median age at surgery was 23 years, and 56% of patients were male. Median epilepsy duration was 7.5 years. Invasive EEG recording was performed on 69% of patients (53% of patients with lesional epilepsy and 97% of those with nonlesional epilepsy, p < 0.001). The most commonly resected region was the anterior cingulate (55%), followed by the posterior (17%) and middle (14%) cingulate. Lesionectomy alone was performed in 9% of patients. Additional extracingulate treatment was performed in 54% of patients (53% of patients with lesional epilepsy vs 57% of those with nonlesional epilepsy, p = 0.87). The most common pathology was cortical dysplasia (54%), followed by low-grade neoplasm (29%) and gliosis (8%). Seizure freedom was noted in 72% of patients (median follow-up 24 months). A neurological deficit was noted in 27% of patients (24% had temporary deficit), with the most common deficit being motor weakness (13%) followed by supplementary motor area syndrome (9.5%). Univariate survival analysis revealed significantly greater probability of seizure freedom in patients with lesional epilepsy (p = 0.015, log-rank test). CONCLUSIONS Surgical treatment of drug-resistant focal epilepsy originating from the cingulate gyrus is safe, leads to low rates of permanent adverse effects, and leads to high rates of long-term seizure freedom in carefully selected patients. These data may serve as a benchmark for surgical counseling of patients with cingulate epilepsy.

scholarly journals Seizure Freedom After Epilepsy Surgery and Higher Baseline Cognition May Be Associated With a Negatively Correlated Epilepsy Network in Temporal Lobe Epilepsy

2021 ◽  
Vol 14 ◽  
Author(s):  
Elliot G. Neal ◽  
Mike R. Schoenberg ◽  
Stephanie Maciver ◽  
Yarema B. Bezchlibnyk ◽  
Fernando L. Vale
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Memory Function ◽  
Brain Regions ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Temporal Lobes ◽  
Scalp Eeg ◽  
The Brain

Background: Brain regions positively correlated with the epileptogenic zone in patients with temporal lobe epilepsy vary in spread across the brain and in the degree of correlation to the temporal lobes, thalamus, and limbic structures, and these parameters have been associated with pre-operative cognitive impairment and seizure freedom after epilepsy surgery, but negatively correlated regions have not been as well studied. We hypothesize that connectivity within a negatively correlated epilepsy network may predict which patients with temporal lobe epilepsy will respond best to surgery.Methods: Scalp EEG and resting state functional MRI (rsfMRI) were collected from 19 patients with temporal lobe epilepsy and used to estimate the irritative zone. Using patients’ rsfMRI, the negatively correlated epilepsy network was mapped by determining all the brain voxels that were negatively correlated with the voxels in the epileptogenic zone and the spread and average connectivity within the network was determined.Results: Pre-operatively, connectivity within the negatively correlated network was inversely related to the spread (diffuseness) of that network and positively associated with higher baseline verbal and logical memory. Pre-operative connectivity within the negatively correlated network was also significantly higher in patients who would go on to be seizure free.Conclusion: Patients with higher connectivity within brain regions negatively correlated with the epilepsy network had higher baseline memory function, narrower network spread, and were more likely to be seizure free after surgery.

scholarly journals Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China

Brain ◽  
2020 ◽  
Vol 143 (2) ◽  
pp. 570-581 ◽  
Author(s):  
Shiyong Liu ◽  
Tao Yu ◽  
Yuguang Guan ◽  
Kai Zhang ◽  
Ping Ding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Tuberous Sclerosis Complex ◽  
Intelligence Quotient ◽  
Influence Factors ◽  
Seizure Freedom ◽  
Postoperative Seizure

Abstract At least 50% of patients with tuberous sclerosis complex present with intractable epilepsy; for these patients, resective surgery is a treatment option. Here, we report a nationwide multicentre retrospective study and analyse the long-term seizure and neuropsychological outcomes of epilepsy surgery in patients with tuberous sclerosis complex. There were 364 patients who underwent epilepsy surgery in the study. Patients’ clinical data, postoperative seizure outcomes at 1-, 4-, and 10-year follow-ups, preoperative and postoperative intelligence quotients, and quality of life at 1-year follow-up were collected. The patients’ ages at surgery were 10.35 ± 7.70 years (range: 0.5–47). The percentage of postoperative seizure freedom was 71% (258/364) at 1-year, 60% (118/196) at 4-year, and 51% (36/71) at 10-year follow-up. Influence factors of postoperative seizure freedom were the total removal of epileptogenic tubers and the presence of outstanding tuber on MRI at 1- and 4-year follow-ups. Furthermore, monthly seizure (versus daily seizure) was also a positive influence factor for postoperative seizure freedom at 1-year follow-up. The presence of an outstanding tuber on MRI was the only factor influencing seizure freedom at 10-year follow-up. Postoperative quality of life and intelligence quotient improvements were found in 43% (112/262) and 28% (67/242) of patients, respectively. Influence factors of postoperative quality of life and intelligence quotient improvement were postoperative seizure freedom and preoperative low intelligence quotient. The percentage of seizure freedom in the tuberectomy group was significantly lower compared to the tuberectomy plus and lobectomy groups at 1- and 4-year follow-ups. In conclusion, this study, the largest nationwide multi-centre study on resective epilepsy surgery, resulted in improved seizure outcomes and quality of life and intelligence quotient improvements in patients with tuberous sclerosis complex. Seizure freedom was often achieved in patients with an outstanding tuber on MRI, total removal of epileptogenic tubers, and tuberectomy plus. Quality of life and intelligence quotient improvements were frequently observed in patients with postoperative seizure freedom and preoperative low intelligence quotient.

Epilepsy surgery for Rasmussen encephalitis: the UCLA experience

2020 ◽  
Vol 26 (4) ◽  
pp. 389-397
Author(s):  
Nikhil Bellamkonda ◽  
H. Westley Phillips ◽  
Jia-Shu Chen ◽  
Alexander M. Tucker ◽  
Cassia Maniquis ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Outcome Data ◽  
Seizure Freedom ◽  
Rasmussen Encephalitis ◽  
Seizure Recurrence ◽  
Functional Hemispherectomy ◽  
Significant Difference ◽  
Seizure Relapse ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure

OBJECTIVERasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution.METHODSThe records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children’s Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed.RESULTSThe cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11–355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention.CONCLUSIONSA large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.

Prediction of seizure freedom after epilepsy surgery – Critical reappraisal of significance of intracranial EEG parameters

2020 ◽  
Vol 131 (11) ◽  
pp. 2682-2690
Author(s):  
David Steinbart ◽  
Mirja Steinbrenner ◽  
Frank Oltmanns ◽  
Martin Holtkamp
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Freedom ◽  
Intracranial Eeg

scholarly journals The delta between postoperative seizure freedom and persistence: Automatically detected focal slow waves after epilepsy surgery

2017 ◽  
Vol 13 ◽  
pp. 256-263 ◽  
Author(s):  
Margit Schönherr ◽  
Hermann Stefan ◽  
Hajo M. Hamer ◽  
Karl Rössler ◽  
Michael Buchfelder ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Slow Waves ◽  
Seizure Freedom ◽  
Postoperative Seizure

scholarly journals Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery

2015 ◽  
Vol 73 (3) ◽  
pp. 212-217 ◽  
Author(s):  
Lucas Crociati Meguins ◽  
Rodrigo Antônio Rocha da Cruz Adry ◽  
Sebastião Carlos da Silva-Junior ◽  
Gerardo Maria de Araújo Filho ◽  
Lúcia Helena Neves Marques
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Seizure Control ◽  
Seizure Outcome ◽  
Seizure Onset ◽  
Postoperative Seizure

Objective To investigate the influence of patient’s age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE). Method A retrospective observational investigation performed from a cohort of patients from 2000 to 2012. Results A total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01). Conclusion Patients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures.

scholarly journals Blinded study: prospectively defined high frequency oscillations predict seizure outcome in individual patients

2021 ◽  
Author(s):  
Vasileios Dimakopoulos ◽  
Pierre Mégevand ◽  
Ece Boran ◽  
Shahan Momjian ◽  
Margitta Seeck ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
High Frequency ◽  
Dwell Time ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Intracranial Eeg ◽  
Retest Reliability ◽  
High Frequency Oscillations ◽  
Test Retest Reliability

Abstract Interictal high frequency oscillations are discussed as biomarkers for epileptogenic brain tissue that should be resected in epilepsy surgery to achieve seizure freedom. The prospective classification of tissue sampled by individual electrode contacts remains a challenge. We have developed an automated, prospective definition of clinically relevant high frequency oscillations in intracranial EEG from Montreal and tested it in recordings from Zurich. We here validated the algorithm on intracranial EEG that was recorded in an independent epilepsy centre so that the analysis was blinded to seizure outcome. We selected consecutive patients who underwent resective epilepsy surgery in Geneva with postsurgical follow-up &gt; 12 months. We analysed long-term recordings during sleep that we segmented into intervals of 5 minutes. High frequency oscillations were defined in the ripple (80-250 Hz) and the fast ripple (250-500 Hz) frequency bands. Contacts with the highest rate of ripples co-occurring with fast ripples designated the relevant area. As a validity criterion, we calculated the test-retest reliability of the high frequency oscillations area between the 5 min intervals (dwell time ≥50%). If the area was not fully resected and the patient suffered from recurrent seizures, this was classified as a true positive prediction. We included recordings from 16 patients (median age 32 years, range 18-53 years) with stereotactic depth electrodes and/or with subdural electrode grids (median follow-up 27 months, range 12-55 months). For each patient, we included several 5 min intervals (median 17 intervals). The relevant area had high test-retest reliability across intervals (median dwell time 95%). In two patients, the test-retest reliability was too low (dwell time &lt; 50%) so that outcome prediction was not possible. The area was fully included in the resected volume in 2/4 patients who achieved postoperative seizure freedom (specificity 50%) and was not fully included in 9/10 patients with recurrent seizures (sensitivity 90%), leading to an accuracy of 79%. An additional exploratory analysis suggested that high frequency oscillations were associated with interictal epileptic discharges only in channels within the relevant area and not associated in channels outside the area. We thereby validated the automated procedure to delineate the clinically relevant area in each individual patient of an independently recorded dataset and achieved the same good accuracy as in our previous studies. The reproducibility of our results across datasets is promising for a multicentre study to test the clinical application of high frequency oscillations to guide epilepsy surgery.

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