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Mo J, Dong W, Sang L, Zheng Z, Guo Q, Zhou X, Zhou W, Wang H, Meng X, Yao Y, Wang F, Hu W, Zhang K, Shao X. Multimodal imaging-based diagnostic approach for MRI-negative posterior cortex epilepsy. Ther Adv Neurol Disord 2023; 16:17562864231212254. [PMID: 38021475 PMCID: PMC10657531 DOI: 10.1177/17562864231212254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Posterior cortex epilepsy (PCE) primarily comprises seizures originating from the occipital, parietal, and/or posterior edge of the temporal lobe. Electroclinical dissociation and subtle imaging representation render the diagnosis of PCE challenging. Improved methods for accurately identifying patients with PCE are necessary. Objectives To develop a novel voxel-based image postprocessing method for better visual identification of the neuroimaging abnormalities associated with PCE. Design Multicenter, retrospective study. Methods Clinical and imaging features of 165 patients with PCE were retrospectively reviewed and collected from five epilepsy centers. A total of 37 patients (32.4% female, 20.2 ± 8.9 years old) with magnetic resonance imaging (MRI)-negative PCE were finally included for analysis. Image postprocessing features were calculated over a neighborhood for each voxel in the multimodality data. The postprocessed maps comprised structural deformation, hyperintense signal, and hypometabolism. Five raters from three different centers were blinded to the clinical diagnosis and determined the neuroimaging abnormalities in the postprocessed maps. Results The average accuracy of correct identification was 55.7% (range from 43.2 to 62.2%) and correct lateralization was 74.1% (range from 64.9 to 81.1%). The Cronbach's alpha was 0.766 for the correct identification and 0.683 for the correct lateralization with similar results of the interclass correlation coefficient, thus indicating reliable agreement between the raters. Conclusion The image postprocessing method developed in this study can potentially improve the visual detection of MRI-negative PCE. The technique could lead to an increase in the number of patients with PCE who could benefit from the surgery.
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Affiliation(s)
- Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenyu Dong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, NCRC-ND, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Qiang Guo
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiuming Zhou
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Wenjing Zhou
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Haixiang Wang
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Xianghong Meng
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Yi Yao
- Department of Functional Neurosurgery, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, China
| | - Fengpeng Wang
- Department of Functional Neurosurgery, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, NCRC-ND, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
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Patel S, Markosian C, Dominguez JF, Taha FA, Tomycz LD. Completion Posterior Quadrant Disconnection After Failed Temporal Lobectomy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E552-E553. [PMID: 34432880 DOI: 10.1093/ons/opab307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Abstract
Epilepsy is a chronic seizure disorder that affects about 1% of the global population.1 When seizure freedom cannot be obtained solely through antiseizure medicines (ASMs), the condition is termed medically refractory epilepsy (MRE).2,3 Though posterior quadrant disconnection (PQD) is underutilized in our experience, it is a highly effective surgical procedure for MRE restricted to the temporal, parietal, and/or occipital lobes.4-12 In this operative video, we demonstrate a right-sided completion PQD following failed temporal lobectomy in an 8-yr-old female with focal MRE. We review technical nuances, including (1) extension/revision of prior scalp incision, (2) placement of subdural strip for the identification of phase reversal and central sulcus, (3) disconnection of parietal and occipital lobes, (4) extension of the corticectomy to the pia overlying the falcotentorial junction and into the prior temporal lobectomy defect, and (5) posterior disconnection of the corpus callosum. Postoperatively, the patient experienced subtle left-arm weakness and central fever, both of which resolved. An external ventricular drain (EVD) was placed in the ventricle/operative cavity and left for 3 to 4 d until the draining cerebrospinal fluid (CSF) cleared. As of 3-mo follow-up, she has been seizure-free without complications. In summary, PQD is a safe and effective treatment option for MRE that can be utilized not only as an initial operation but also after failed surgery. Appropriate patient consent was obtained to perform this procedure and present this clinical case and surgical video for academic purposes. Image at 4:00 licensed under CC BY-2.5, 2006, modified from http://upload.wikimedia.org/wikipedia/commons/7/70/Lateral_head_skull.jpg (flipped and rotated). Image at 4:42, Public Domain: Gray H. Anatomy of the Human Body. 1918. Bartleby.com, https://commons.wikimedia.org/wiki/File:Lobes_of_the_brain_NL.svg; flipped, modified. Image at 6:42, Public Domain: House EL, Pansky B. A Functional Approach to Neuroanatomy. 1960. McGraw-Hill Book Company; https://upload.wikimedia.wikipedia.commons/5/52/Lawrence_1960_2.3.png; modified.
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Affiliation(s)
- Saarang Patel
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Christopher Markosian
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Firas A Taha
- Department of Neurology, Hackensack University Medical Center, Hackensack, New Jersey, USA.,Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Northeast Regional Epilepsy Group, Hackensack, New Jersey, USA
| | - Luke D Tomycz
- New Jersey Brain and Spine, Montclair, New Jersey, USA
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Markosian C, Dodson V, Zhang HJ, Mahalingam RS, Geller EB, Tomycz LD. Total and partial posterior quadrant disconnection for medically refractory epilepsy: A systematic review. Seizure 2021; 91:66-71. [PMID: 34102378 DOI: 10.1016/j.seizure.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Posterior quadrant disconnection (PQD) is a surgical procedure for medically refractory epilepsy (MRE) involving diffuse regions of the temporo-parieto-occipital lobes. We sought to compare factors and efficacy according to PQD extent. METHODS We performed a systematic review of the literature reporting the use of PQD since 2004. We analyzed various characteristics of pooled cases, including the role of preoperative studies in patient selection, intraoperative techniques, and outcomes. RESULTS Our review of 137 patients from nine studies revealed 66% undergoing total PQD and 34% undergoing partial PQD. Interictal electroencephalography (EEG) findings were predominantly characterized as lateralized for total PQD (56%) and localized within the ipsilateral posterior quadrant in patients undergoing partial PQD (53%). Metabolic functional studies [positron emission tomography (PET) or ictal single-photon emission computed tomography (SPECT)] played a role in surgical decision-making in 42% of patients who underwent total PQD. Wada and/or functional magnetic resonance imaging (fMRI) was more often utilized for partial PQD (22%) than total PQD (3%) as was intracranial electroencephalography (icEEG) (30% versus 13%, respectively). Overall, 75% of total PQD patients achieved seizure freedom [defined as Engel I or International League Against Epilepsy (ILAE) Class 1 outcome] in comparison to 63% of partial PQD patients (p = .078). New visual field deficits were seen in 12% and new or worsened hemiparesis in 6%. For patients in either cohort, concordance of interictal and ictal EEG findings was found to be predictive of seizure freedom (p = .048). CONCLUSION Both total and partial PQD represent effective alternatives for managing patients with MRE whose seizure onset zone (SOZ) involves a diffuse region within the posterior quadrant. While PET and/or SPECT frequently aided in the decision to proceed with total PQD, patients who underwent a tailored, partial multilobar resection were more likely to undergo Wada and/or fMRI testing as well as stage I icEEG studies.
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Affiliation(s)
- Christopher Markosian
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Vincent Dodson
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Helen J Zhang
- Division of Biology and Medicine, Brown University, Providence, Rhode Island, United States
| | - Rajeshwari S Mahalingam
- Institute of Neurology and Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey, United States
| | - Eric B Geller
- Institute of Neurology and Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey, United States
| | - Luke D Tomycz
- New Jersey Brain and Spine, Montclair, New Jersey, United States.
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Aznarez PB, Cabeza MP, Quintana ASA, Lara-Almunia M, Sanchez JA. Evolution of patients with surgically treated drug-resistant occipital lobe epilepsy. Surg Neurol Int 2020; 11:222. [PMID: 32874725 PMCID: PMC7451154 DOI: 10.25259/sni_251_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background This study was to describe the evolution of patients who underwent surgical treatment of drug- resistant occipital lobe epilepsy (OLE) at our institution. Methods We performed a retrospective analysis of data collected from electronic and paper clinical records of 20 patients who were diagnosed of OLE and underwent epilepsy surgery at our institution between 1998 and 2018. We also contacted patients by telephone and asked them to fill out a questionnaire about quality of life in epilepsy (QOLIE-10). Assembled data were analyzed using descriptive statistics. Results The age at surgery ranged between 19 and 55 years. The period encompassing epilepsy onset and the date of surgery was variable. Semiology of seizures included visual symptoms in 75% of patients. In 90% of cases subdural grids, depth electrodes or a combination of both were used to plan the surgery. The most frequent neuroimaging and histopathological finding was cortical dysplasia (55%). The postoperative follow-up period was up to 15 years. The most common score on the Engel scale was I (70%). Visual deficits increased after surgery. Median score on QOLIE-10 questionnaire was 82.5 (interquartile range: 32.5). Conclusion Surgical treatment of drug-resistant OLE offers hopeful results to those patients who have run out of pharmacological options and leads to postoperative deficits that are deemed expectable and occasionally acceptable.
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Affiliation(s)
| | - Marta Pastor Cabeza
- Department of Neurosurgery, Germans Trias i Pujol Hospital, Badalona, Catalonia, Spain
| | | | - Monica Lara-Almunia
- Department of Neurosurgery, Jimenez Diaz Foundation University Hospital, Madrid
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Shi J, Gao Z, Gao J, Li G, Chen Y. Predictors and outcome surgery for posterior cortex epilepsies. Clin Neurol Neurosurg 2018; 171:124-128. [DOI: 10.1016/j.clineuro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/29/2023]
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Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ. Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 82:350-358. [PMID: 28419330 PMCID: PMC5640459 DOI: 10.1093/neuros/nyx158] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results. OBJECTIVE To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery. METHODS We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined. RESULTS We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58-2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03-6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes. CONCLUSION Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.
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Affiliation(s)
- Stephen C Harward
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - William C Chen
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - John D Rolston
- Department of Neuro-logical Surgery, University of California San Francisco, San Francisco, California
| | - Michael M Haglund
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Ramantani G, Stathi A, Brandt A, Strobl K, Schubert-Bast S, Wiegand G, Korinthenberg R, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Posterior cortex epilepsy surgery in childhood and adolescence: Predictors of long-term seizure outcome. Epilepsia 2017; 58:412-419. [PMID: 28098941 DOI: 10.1111/epi.13654] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the long-term seizure outcome of children and adolescents who were undergoing epilepsy surgery in the parietooccipital cortex and determine their predictive factors. METHODS We retrospectively analyzed the data of 50 consecutive patients aged 11.1 (mean) ± 5.1 (standard deviation) years at surgery. All patients but one had a magnetic resonance imaging (MRI)-visible lesion. Resections were parietal in 40%, occipital in 32%, and parietooccipital in 28% cases; 24% patients additionally underwent a resection of the posterior border of the temporal lobe. Etiology included focal cortical dysplasia in 44%, benign tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, angiocentric glioma, and pilocystic astrocytoma) in 32%, peri- or postnatal ischemic lesions in 16%, and tuberous sclerosis in 8% cases. RESULTS At last follow-up (mean 8 years, range 1.5-18 years), 60% patients remained seizure-free (Engel class I): 30% had discontinued and 20% had reduced antiepileptic drugs. Most seizure recurrences (71%) occurred within the first 6 months, and only three patients presented with seizures ≥2 years after surgery. Independent predictors of seizure recurrence included left-sided as well as parietal epileptogenic zones and resections. Longer epilepsy duration to surgery was identified as the only modifiable independent predictor of seizure recurrence. SIGNIFICANCE Our study demonstrates that posterior cortex epilepsy surgery is highly effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Most importantly, our data supports the early consideration of surgical intervention in children and adolescents with refractory posterior cortex epilepsy.
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Affiliation(s)
| | - Angeliki Stathi
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, University Hospital Freiburg, Freiburg, Germany
| | | | - Susanne Schubert-Bast
- Department of Neuropediatrics and Metabolic Disease, University Children's Hospital, Heidelberg, Germany
| | - Gert Wiegand
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Vera van Velthoven
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Simultaneous SEEG-MEG-EEG recordings Overcome the SEEG limited spatial sampling. Epilepsy Res 2016; 128:68-72. [PMID: 27816896 DOI: 10.1016/j.eplepsyres.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
During presurgical evaluation of pharmacoresistant partial epilepsies, stereoelectroencephalography (SEEG) records interictal and ictal activities directly but is inherently limited in spatial sampling. In contrast, scalp-EEG and MEG are less sensitive but provide a global view on brain activity. Therefore, recording simultaneously these three modalities should provide a better understanding of the underlying brain sources by taking advantage of the different sensitivities of the three recording techniques. We performed trimodal EEG-MEG-SEEG recordings in a 19-year-old woman with pharmacoresistant cryptogenic posterior cortex epilepsy. Sub-continuous and highly focal spikes that were not visible at the surface were marked on SEEG by an epileptologist. Surface signals, MEG and scalp-EEG, were then averaged locked on SEEG spikes. MEG sources were reconstructed based on a moving dipole approach (Brainstorm software). This analysis revealed source within the left occipital pole, located posteriorly to the SEEG leads presenting the maximal number of spikes, in a region not explored by SEEG. In summary, simultaneous recordings provide a new framework for obtaining a view on brain signals that is both local and global, thereby overcoming the inherent SEEG limited spatial sampling.
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Marchi A, Bonini F, Lagarde S, McGonigal A, Gavaret M, Scavarda D, Carron R, Aubert S, Villeneuve N, Médina Villalon S, Bénar C, Trebuchon A, Bartolomei F. Occipital and occipital "plus" epilepsies: A study of involved epileptogenic networks through SEEG quantification. Epilepsy Behav 2016; 62:104-14. [PMID: 27454330 DOI: 10.1016/j.yebeh.2016.06.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/14/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
Compared with temporal or frontal lobe epilepsies, the occipital lobe epilepsies (OLE) remain poorly characterized. In this study, we aimed at classifying the ictal networks involving OLE and investigated clinical features of the OLE network subtypes. We studied 194 seizures from 29 consecutive patients presenting with OLE and investigated by stereoelectroencephalography (SEEG). Epileptogenicity of occipital and extraoccipital regions was quantified according to the 'epileptogenicity index' (EI) method. We found that 79% of patients showed widespread epileptogenic zone organization, involving parietal or temporal regions in addition to the occipital lobe. Two main groups of epileptogenic zone organization within occipital lobe seizures were identified: a pure occipital group and an occipital "plus" group, the latter including two further subgroups, occipitotemporal and occipitoparietal. In 29% of patients, the epileptogenic zone was found to have a bilateral organization. The most epileptogenic structure was the fusiform gyrus (mean EI: 0.53). Surgery was proposed in 18/29 patients, leading to seizure freedom in 55% (Engel Class I). Results suggest that, in patient candidates for surgery, the majority of cases are characterized by complex organization of the EZ, corresponding to the occipital plus group.
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Affiliation(s)
- Angela Marchi
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Francesca Bonini
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Aileen McGonigal
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Martine Gavaret
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Didier Scavarda
- APHM, Timone Hospital, Paediatric Neurosurgery Department, Marseille 13005, France
| | - Romain Carron
- APHM, Timone Hospital, Functional and Stereotactical Neurosurgery Department, Marseille 13005, France
| | - Sandrine Aubert
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France
| | - Nathalie Villeneuve
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France
| | - Samuel Médina Villalon
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France
| | - Christian Bénar
- Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Agnes Trebuchon
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille 13005, France; Aix-Marseille Université, Institut de Neuroscience des Systèmes, UMR_S 1106, Marseille 13005, France.
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Hu Y, Mi X, Xu X, Fang W, Zeng K, Yang M, Li C, Wang S, Li M, Wang X. The Brain Activity in Brodmann Area 17: A Potential Bio-Marker to Predict Patient Responses to Antiepileptic Drugs. PLoS One 2015; 10:e0139819. [PMID: 26439500 PMCID: PMC4595505 DOI: 10.1371/journal.pone.0139819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 07/28/2015] [Indexed: 12/29/2022] Open
Abstract
In this study, we aimed to predict newly diagnosed patient responses to antiepileptic drugs (AEDs) using resting-state functional magnetic resonance imaging tools to explore changes in spontaneous brain activity. We recruited 21 newly diagnosed epileptic patients, 8 drug-resistant (DR) patients, 11 well-healed (WH) patients, and 13 healthy controls. After a 12-month follow-up, 11 newly diagnosed epileptic patients who showed a poor response to AEDs were placed into the seizures uncontrolled (SUC) group, while 10 patients were enrolled in the seizure-controlled (SC) group. By calculating the amplitude of fractional low-frequency fluctuations (fALFF) of blood oxygen level-dependent signals to measure brain activity during rest, we found that the SUC patients showed increased activity in the bilateral occipital lobe, particularly in the cuneus and lingual gyrus compared with the SC group and healthy controls. Interestingly, DR patients also showed increased activity in the identical cuneus and lingual gyrus regions, which comprise Brodmann's area 17 (BA17), compared with the SUC patients; however, these abnormalities were not observed in SC and WH patients. The receiver operating characteristic (ROC) curves indicated that the fALFF value of BA17 could differentiate SUC patients from SC patients and healthy controls with sufficient sensitivity and specificity prior to the administration of medication. Functional connectivity analysis was subsequently performed to evaluate the difference in connectivity between BA17 and other brain regions in the SUC, SC and control groups. Regions nearby the cuneus and lingual gyrus were found positive connectivity increased changes or positive connectivity changes with BA17 in the SUC patients, while remarkably negative connectivity increased changes or positive connectivity decreased changes were found in the SC patients. Additionally, default mode network (DMN) regions showed negative connectivity increased changes or negative changes with BA17 in the SUC patients. The abnormal increased in BA17 activity may be a key point that plays a substantial role in facilitating seizure onset.
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Affiliation(s)
- Yida Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiujuan Mi
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xin Xu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Kebin Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Mingming Yang
- Department of Pediatrics, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, People’s Republic of China
| | - Chenyu Li
- Department of Neurology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, People’s Republic of China
| | - Shasha Wang
- The Nursing Department, Chongqing Three Gorges Central Hospital, Chongqing, People’s Republic of China
| | - Minghui Li
- The Nursing Department, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- * E-mail:
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Ibrahim GM, Fallah A, Albert GW, Withers T, Otsubo H, Ochi A, Akiyama T, Donner EJ, Weiss S, Snead OC, Drake JM, Rutka JT. Occipital lobe epilepsy in children: Characterization, evaluation and surgical outcomes. Epilepsy Res 2012; 99:335-45. [DOI: 10.1016/j.eplepsyres.2011.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/26/2011] [Accepted: 12/26/2011] [Indexed: 11/26/2022]
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Carrette E, Vonck K, De Herdt V, Van Dycke A, El Tahry R, Meurs A, Raedt R, Goossens L, Van Zandijcke M, Van Maele G, Thadani V, Wadman W, Van Roost D, Boon P. Predictive factors for outcome of invasive video-EEG monitoring and subsequent resective surgery in patients with refractory epilepsy. Clin Neurol Neurosurg 2009; 112:118-26. [PMID: 20005033 DOI: 10.1016/j.clineuro.2009.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This is a descriptive study of patients who underwent invasive video-EEG monitoring (IVEM) at Ghent University Hospital. The aim of the study is to identify predictive factors for outcome of IVEM and resective surgery (RS). These factors may optimize the patient flow following the non-invasive presurgical evaluation towards IVEM and RS or other treatments. PATIENTS AND METHODS Over the past 16 years, 68/710 refractory epilepsy patients included in the presurgical evaluation protocol (M/F 41/27, mean age 33 years) underwent IVEM at Ghent University Hospital. Patient features and follow-up data were collected from the patients' medical files and the electronic patient database at the neurology and neurosurgery department. Predictive factors for IVEM outcome were identified by comparing features of patients with a positive IVEM outcome (i.e. ictal onset zone identification) and patients with a negative IVEM outcome. Predictive factors for RS outcome were identified by comparing features of patients with Engel class I and patients with Engel class II-IV outcome. RESULTS In 56/68 patients (82%) IVEM outcome was positive. The occurrence of a seizure-free interval in the patient's history and a non-localizing ictal scalp EEG in patients with a structural abnormality on MRI (p<0.05) were predictive factors for a negative IVEM outcome. 32/68 patients underwent RS. In 22/32 (70%) patients RS resulted in an Engel class I outcome. A structural abnormality on MRI was a predictive factor for a positive RS outcome in patients in whom a focal or regional focus was resected (p<0.05). CONCLUSION This study shows that IVEM identifies one or more ictal onset zone(s) in up to 80% of patients. The potential of IVEM to identify the ictal onset zone is unlikely in patients with a seizure-free interval in their medical history and a non-localizing ictal scalp EEG during the non-invasive presurgical evaluation. Half of these patients underwent RS with long-term seizure freedom in 70%. Patients with structural MRI lesions have the highest chance of seizure freedom. These findings may contribute to the optimization of patient management during both the invasive and non-invasive presurgical work-up.
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Affiliation(s)
- Evelien Carrette
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium.
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Jehi LE, O’Dwyer R, Najm I, Alexopoulos A, Bingaman W. A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery. Epilepsia 2009; 50:2040-52. [DOI: 10.1111/j.1528-1167.2009.02070.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yu T, Wang Y, Zhang G, Cai L, Du W, Li Y. Posterior cortex epilepsy: diagnostic considerations and surgical outcome. Seizure 2009; 18:288-92. [PMID: 19136282 DOI: 10.1016/j.seizure.2008.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 11/12/2008] [Accepted: 11/20/2008] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the role of various pre-surgical evaluations in posterior cortex epilepsy (PCE) and its surgical outcome. METHODS A retrospective analysis of clinical and laboratory data from 43 PCE patients referred for surgery was performed. The diagnosis was established by standard pre-surgical evaluation modalities including semiology, MRI, interictal and ictal scalp video-EEG as well as additional intracranial EEG monitoring in selected cases. RESULTS The 43 patients included 11 parietal lobe epilepsies, 13 occipital lobe epilepsies, and 19 patients with seizures originating from parieto-occipito-posterior temporal cortex. Thirty-three (76.7%) patients experienced at least one type of aura. Seventeen patients showed complex focal seizures, which were followed by secondarily generalized tonic-clonic seizures in seven of them; eighteen patients predominantly showed simple motor seizures (clonic seizures in 6, tonic seizures in 7, and versive seizures in 5). Long-term visual field deficits were observed in 8 patients. Other transient neurological deficits occurred in 7 patients. All patients received the follow-up study lasting 1-5 years, and achieved Engel's I in 26 cases, II in 5, III in 5, and IV-V in 7. Malformation of cortical development was diagnosed in 41.9% of our surgical population. No significant relationship was found between the diagnostic accuracy of any pre-surgical evaluating modality and surgical outcome in this series. CONCLUSIONS Surgical treatment is effective for PCE. Accurate localization of epileptogenic zone and eloquent cortex are two key factors for favorable outcome. None of the diagnostic modalities shows obvious predictive value for favorable surgical outcome.
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Affiliation(s)
- Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, China
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Gavaret M, Trébuchon A, Bartolomei F, Marquis P, McGonigal A, Wendling F, Regis J, Badier JM, Chauvel P. Source localization of scalp-EEG interictal spikes in posterior cortex epilepsies investigated by HR-EEG and SEEG. Epilepsia 2008; 50:276-89. [PMID: 18717708 DOI: 10.1111/j.1528-1167.2008.01742.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the validity of scalp-electroencephalography (EEG)-interictal spike (IIS) source localization in posterior cortex epilepsies (PCE). METHODS Eleven patients with drug-resistant PCE were studied with high-resolution EEG (HR-EEG) and stereoelectroencephalography (SEEG). Sixty-four scalp channels, a realistic head model, and different algorithms [multiple signal classification (MUSIC) and equivalent current dipoles] were used. Results were compared to intracerebral SEEG recordings. For SEEG, a semiautomatic detection of intracerebral IIS was used, allowing a classification of intracerebral IIS into one of three groups: Medial, lateral, and mediolateral. RESULTS In the medial group (two patients), scalp-EEG IIS were usually absent for one patient whereas for the other, scalp-EEG was misleading. Indeed, scalp-EEG IIS had a posterior projection, predominantly contralateral to the source. In the lateral group (two patients), scalp-EEG IIS were subcontinuous and accurately localized. In the mediolateral group (seven patients), intracerebral interictal distribution was complex and bilateral for four of seven patients. Source localizations were able to determine only a part, whether lateral or medial, of the intracerebral interictal distribution. DISCUSSION The accuracy of scalp-EEG IIS source localization is dependant on the type of intracerebral interictal distribution. In the most frequent type of PCE, patients proved to have a complex interictal distribution between both medial and lateral cortices, and source localizations always underestimated intracerebral IIS. In cases where intracranial sources were quite focal, surface EEG sources were localized with accuracy, even in medial occipital lobe structures.
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Affiliation(s)
- Martine Gavaret
- INSERM UMR 751, Laboratoire de Neurophysiologie et Neuropsychologie, Marseille, France.
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Dalmagro CL, Bianchin MM, Velasco TR, Alexandre V, Walz R, Terra-Bustamante VC, Inuzuka LM, Wichert-Ana L, Araújo D, Serafini LN, Carlotti CG, Assirati JA, Machado HR, Santos AC, Sakamoto AC. Clinical features of patients with posterior cortex epilepsies and predictors of surgical outcome. Epilepsia 2005; 46:1442-9. [PMID: 16146440 DOI: 10.1111/j.1528-1167.2005.70904.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome. METHODS We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome. RESULTS Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p<0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution. CONCLUSIONS Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.
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Affiliation(s)
- Charles L Dalmagro
- Epilepsy Surgery Center, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo Ribeirão Preto, Brazil
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