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Schroeder GM, Karoly PJ, Maturana M, Panagiotopoulou M, Taylor PN, Cook MJ, Wang Y. Chronic intracranial EEG recordings and interictal spike rate reveal multiscale temporal modulations in seizure states. Brain Commun 2023; 5:fcad205. [PMID: 37693811 PMCID: PMC10484289 DOI: 10.1093/braincomms/fcad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/07/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023] Open
Abstract
Many biological processes are modulated by rhythms on circadian and multidien timescales. In focal epilepsy, various seizure features, such as spread and duration, can change from one seizure to the next within the same patient. However, the specific timescales of this variability, as well as the specific seizure characteristics that change over time, are unclear. Here, in a cross-sectional observational study, we analysed within-patient seizure variability in 10 patients with chronic intracranial EEG recordings (185-767 days of recording time, 57-452 analysed seizures/patient). We characterized the seizure evolutions as sequences of a finite number of patient-specific functional seizure network states. We then compared seizure network state occurrence and duration to (1) time since implantation and (2) patient-specific circadian and multidien cycles in interictal spike rate. In most patients, the occurrence or duration of at least one seizure network state was associated with the time since implantation. Some patients had one or more seizure network states that were associated with phases of circadian and/or multidien spike rate cycles. A given seizure network state's occurrence and duration were usually not associated with the same timescale. Our results suggest that different time-varying factors modulate within-patient seizure evolutions over multiple timescales, with separate processes modulating a seizure network state's occurrence and duration. These findings imply that the development of time-adaptive treatments in epilepsy must account for several separate properties of epileptic seizures and similar principles likely apply to other neurological conditions.
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Affiliation(s)
- Gabrielle M Schroeder
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
| | - Philippa J Karoly
- Graeme Clark Institute and St Vincent’s Hospital, University of Melbourne, Parkville, Victoria 3010, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Matias Maturana
- Graeme Clark Institute and St Vincent’s Hospital, University of Melbourne, Parkville, Victoria 3010, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
- Research Department, Seer Medical Pty Ltd., Melbourne, Victoria 3000, Australia
| | - Mariella Panagiotopoulou
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Mark J Cook
- Graeme Clark Institute and St Vincent’s Hospital, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Kaye LC, Poolos ZA, Miller JW, Poolos NP. Clinical factors associated with late seizure remission after failed epilepsy surgery. Epilepsy Behav 2023; 138:109055. [PMID: 36543042 DOI: 10.1016/j.yebeh.2022.109055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some patients who initially fail epilepsy surgery later become seizure-free, but it is not clear how the clinical characteristics of the patients or post-operative modifications of anti-seizure medication (ASM) regimens contribute to late seizure remission. METHODS We performed a retrospective chart review of patients undergoing epilepsy surgery at the University of Washington Regional Epilepsy Center between 2007 and 2017, including patients receiving neocortical resection, temporal lobectomy, and hippocampal laser interstitial therapy (LITT) ablation. We assessed seizure freedom, ASM changes, seizure frequency at the first and last follow-up, and type of lesion. Two-tailed Fisher's exact test and Mann-Whitney U test were used for statistical analyses. RESULTS Two hundred and fifteen patients undergoing epilepsy surgery between 2007 and 2017 had both first and last follow-ups. Ninety-eight (46%) were not seizure-free at the first follow-up (mean 1.1 years post-operative). By the last follow-up (mean 4.7 years post-operative), 20% of those not initially seizure-free had become so. Those who were seizure-free at the last visit had lower median seizures per month in the first post-operative year (0.21 versus 0.95 per month in those not seizure-free, p < 0.001). There was also a significantly higher proportion of patients with cavernomas who were seizure-free at the last visit (25% vs. 1% of those not seizure-free at the last visit; p = 0.001), but no other differences in clinical characteristics. Of the 98 patients who had seizures at the first follow-up, 63% underwent post-operative modification of their ASM regimens. The rate of late seizure freedom was similar for patients with or without ASM changes: 21% were seizure-free at the last visit with ASM changes and 19% without ASM changes. There were no significant differences in which ASMs were changed between those who became seizure-free and those who did not, but patients who were subjected to further medical management were less likely to have had mesial temporal sclerosis (MTS) than those who were not. A number of patients not initially seizure-free who underwent ASM changes achieved seizure freedom as long as 10 years post-surgery. CONCLUSION A substantial proportion of patients who initially fail epilepsy surgery will have late seizure remission. Those with cavernous hemangiomas were more likely to achieve late remission from seizures as were those with lower rates of seizures in the first year after surgery. The chances of achieving remission were similar in those with or without modification of their ASM regimens, but those with pre-operative MTS were more likely to achieve late seizure freedom without medication changes. At the individual level, patients may still achieve seizure freedom with ASM changes as long as ten years after the initial surgery.
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Affiliation(s)
- Lesley C Kaye
- University of Colorado School of Medicine, Department of Neurology, Division of Epilepsy, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue, Mail Stop L950, Aurora, CO 80045, USA.
| | - Zoe A Poolos
- Carleton College, 1 North College Street, Northfield, MN 55057, USA.
| | - John W Miller
- University of Washington School of Medicine, Department of Neurology, Regional Epilepsy Center, 325 9th Avenue, MS 359745, Seattle, WA 98104, USA.
| | - Nicholas P Poolos
- University of Washington School of Medicine, Department of Neurology, Regional Epilepsy Center, 325 9th Avenue, MS 359745, Seattle, WA 98104, USA.
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Efficacy of cenobamate for uncontrolled focal seizures in patients with previous epilepsy-related surgery: Post hoc analysis of a phase 3, multicenter, open-label study. Epilepsy Res 2022; 184:106952. [DOI: 10.1016/j.eplepsyres.2022.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
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4
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Weiss SA, Pastore T, Orosz I, Rubinstein D, Gorniak R, Waldman Z, Fried I, Wu C, Sharan A, Slezak D, Worrell G, Engel J, Sperling MR, Staba RJ. Graph theoretical measures of fast ripples support the epileptic network hypothesis. Brain Commun 2022; 4:fcac101. [PMID: 35620169 PMCID: PMC9128387 DOI: 10.1093/braincomms/fcac101] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
The epileptic network hypothesis and epileptogenic zone hypothesis are two
theories of ictogenesis. The network hypothesis posits that coordinated activity
among interconnected nodes produces seizures. The epileptogenic zone hypothesis
posits that distinct regions are necessary and sufficient for seizure
generation. High-frequency oscillations, and particularly fast ripples, are
thought to be biomarkers of the epileptogenic zone. We sought to test these
theories by comparing high-frequency oscillation rates and networks in surgical
responders and non-responders, with no appreciable change in seizure frequency
or severity, within a retrospective cohort of 48 patients implanted with
stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye
movement sleep and semi-automatically detected and quantified high-frequency
oscillations. Each electrode contact was localized in normalized coordinates. We
found that the accuracy of seizure onset zone electrode contact classification
using high-frequency oscillation rates was not significantly different in
surgical responders and non-responders, suggesting that in non-responders the
epileptogenic zone partially encompassed the seizure onset zone(s)
(P > 0.05). We also found that in the
responders, fast ripple on oscillations exhibited a higher spectral content in
the seizure onset zone compared with the non-seizure onset zone
(P < 1 × 10−5).
By contrast, in the non-responders, fast ripple had a lower spectral content in
the seizure onset zone
(P < 1 × 10−5).
We constructed two different networks of fast ripple with a spectral content
>350 Hz. The first was a rate–distance network that
multiplied the Euclidian distance between fast ripple-generating contacts by the
average rate of fast ripple in the two contacts. The radius of the
rate–distance network, which excluded seizure onset zone nodes,
discriminated non-responders, including patients not offered resection or
responsive neurostimulation due to diffuse multifocal onsets, with an accuracy
of 0.77 [95% confidence interval (CI) 0.56–0.98]. The second fast
ripple network was constructed using the mutual information between the timing
of the events to measure functional connectivity. For most non-responders, this
network had a longer characteristic path length, lower mean local efficiency in
the non-seizure onset zone, and a higher nodal strength among non-seizure onset
zone nodes relative to seizure onset zone nodes. The graphical theoretical
measures from the rate–distance and mutual information networks of 22
non- responsive neurostimulation treated patients was used to train a support
vector machine, which when tested on 13 distinct patients classified
non-responders with an accuracy of 0.92 (95% CI 0.75–1). These
results indicate patients who do not respond to surgery or those not selected
for resection or responsive neurostimulation can be explained by the epileptic
network hypothesis that is a decentralized network consisting of widely
distributed, hyperexcitable fast ripple-generating nodes.
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Affiliation(s)
- Shennan A Weiss
- Dept. of Neurology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Tomas Pastore
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Iren Orosz
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Daniel Rubinstein
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard Gorniak
- Dept. of Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Zachary Waldman
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Itzhak Fried
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Chengyuan Wu
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Ashwini Sharan
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Diego Slezak
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Gregory Worrell
- Dept. of Neurology, Mayo Systems Electrophysiology Laboratory (MSEL), USA
- Dept. of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Jerome Engel
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Michael R. Sperling
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard J Staba
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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Jin L, Choi JY, Bulacio J, Alexopoulos AV, Burgess RC, Murakami H, Bingaman W, Najm I, Wang ZI. Multimodal Image Integration for Epilepsy Presurgical Evaluation: A Clinical Workflow. Front Neurol 2021; 12:709400. [PMID: 34421808 PMCID: PMC8372749 DOI: 10.3389/fneur.2021.709400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Multimodal image integration (MMII) is a promising tool to help delineate the epileptogenic zone (EZ) in patients with medically intractable focal epilepsies undergoing presurgical evaluation. We report here the detailed methodology of MMII and an overview of the utility of MMII at the Cleveland Clinic Epilepsy Center from 2014 to 2018, exemplified by illustrative cases. The image integration was performed using the Curry platform (Compumedics Neuroscan™, Charlotte, NC, USA), including all available diagnostic modalities such as Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), single-photon emission computed tomography (SPECT) and Magnetoencephalography (MEG), with additional capability of trajectory planning for intracranial EEG (ICEEG), particularly stereo-EEG (SEEG), as well as surgical resection planning. In the 5-year time span, 467 patients underwent MMII; of them, 98 patients (21%) had a history of prior neurosurgery and recurring seizures. Of the 467 patients, 425 patients underwent ICEEG implantation with further CT co-registration to identify the electrode locations. A total of 351 patients eventually underwent surgery after MMII, including 197 patients (56%) with non-lesional MRI and 223 patients (64%) with extra-temporal lobe epilepsy. Among 269 patients with 1-year post-operative follow up, 134 patients (50%) had remained completely seizure-free. The most common histopathological finding is focal cortical dysplasia. Our study illustrates the usefulness of MMII to enhance SEEG electrode trajectory planning, assist non-invasive/invasive data interpretation, plan resection strategy, and re-evaluate surgical failures. Information presented by MMII is essential to the understanding of the anatomo-functional-electro-clinical correlations in individual cases, which leads to the ultimate success of presurgical evaluation of patients with medically intractable focal epilepsies.
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Affiliation(s)
- Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | - Joon Yul Choi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | | | | | | | - William Bingaman
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
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7
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Ma J, Wu J, Chen H, Chen Y, Xu D, Tian X, Jing W, Wang X. Response to antiepileptic drugs after unsuccessful epilepsy surgery: A multivariate analysis of 103 patients. Seizure 2020; 81:222-227. [PMID: 32862118 DOI: 10.1016/j.seizure.2020.08.014] [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: 05/13/2020] [Revised: 07/30/2020] [Accepted: 08/13/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECT Epilepsy patients may still have seizures after surgery, and there have been few studies on the response to antiepileptic drugs (AEDs) after surgery failure. The purpose of this study was to analyze the response to AEDs after unsuccessful epilepsy surgery. METHODS Patients who underwent unsuccessful epilepsy surgery between January 1999 and January 2019 were evaluated. Patient demographics, etiology, factors related to surgery and AED use patterns were assessed. RESULTS After excluding the 5 patients who were lost to follow-up and the 2 patients who died, the records of 103 consecutive patients were analyzed. Ninety patients (87.4 %) had seizure recurrence within one year after surgery, 2 (1.9 %) patients had recurrence from one year to two years after surgery, and 11 (10.7 %) patients had recurrence two or more years after surgery (2-10 years). After surgery failure, the patients tried at least 2 kinds of AEDs with different mechanisms for more than 2 years. The average total number of AEDs used was 5.97, the average number of AEDs used before surgery was 3.21, and the average number of AEDs used after surgery was 4.02. After retreatment with AEDs, 10 patients (9.7 %) were seizure-free, 18 patients' (17.5 %) seizures were alleviated, and 75 patients (72.8 %) had seizures as they did prior to the adjustments. The number of AEDs used before and after surgery and the total number of AEDs were not significantly different among the seizure free group, alleviated seizure group and no change group. There were no significant differences in seizure onset age, surgery age, etiology, time between seizure onset and surgery, magnetic resonance imaging, seizure type, localization and lateralization of the surgery site among the three groups. CONCLUSIONS The results showed that a small percentage of patients (27.2 %) who undergo unsuccessful epilepsy surgery benefit from AED adjustments; however, the vast majority of patients (72.8 %) do not benefit from AED adjustments.
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Affiliation(s)
- Junhong Ma
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Junhong Wu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China
| | - Hongnian Chen
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China
| | - Yuanyuan Chen
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China
| | - Demei Xu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China
| | - Xin Tian
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China.
| | - Wei Jing
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China; Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China.
| | - Xuefeng Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, 1Youyi Road, Chongqing, 400016, China.
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8
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Hsieh HY, Chang CW, Cheng MY, Yan JL, Lim SN, Tseng WEJ, Chiang HI, Li HT, Chang BL, Lee CH, Lin CY, Wu T, Chang CN. Aggressive cytoreduction and multiple subpial cortical transections may obtain good surgical outcomes in refractory epilepsy with multiple epileptic foci. Biomed J 2020; 44:346-352. [PMID: 34183308 PMCID: PMC8358210 DOI: 10.1016/j.bj.2020.03.003] [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: 11/23/2018] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Backgrounds Epilepsy surgery is the most efficacious therapeutic modality for patients with medical refractory epilepsy, especially resective surgery. However, the variable etiologies and multiple epileptic foci are usually associated with the outcomes. The aim of this study was to demonstrate that combination of different intervention procedures might be an alternative option for patients of refractory epilepsy. Methods We retrospectively analyzed pre-operative and post-surgical outcomes in 30 patients who received epilepsy surgery between January 1, 2010 and December 31, 2014 at Chang Gung Memorial Hospital (CGMH), Linkou, according to Engel's classification. Results Twenty-six of the 30 patients (86.7%) had good outcomes, sum of class I and class II after epilepsy surgery. The good outcome rate of our complicated group was 80.0% (12/15), compared to 93.3% (14/15) in the simple group, but no significant differences between the two groups (p = 0.569). Four patients whose epileptic foci involved eloquent area and received multiple subpial cortical transection, and good outcome rate was 75% (3/4). At last, six patients had previously failed epilepsy surgery and received a reoperation, with a good outcome rate of 83.3% (5/6). Conclusion After complete pre-surgical evaluation and combined interventional procedures, the patients with refractory epilepsy had satisfactory outcomes and few neurological complications. Moreover, re-operation can improve the outcome in some patients who previously failed epilepsy surgery.
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Affiliation(s)
- Hsiang-Yao Hsieh
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiun-Lin Yan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Tao Li
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih Yin Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurology, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurosurgery, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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9
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Conte F, Legros B, Van Paesschen W, Avbersek A, Muglia P, Depondt C. Long-term seizure outcomes in patients with drug resistant epilepsy. Seizure 2018; 62:74-78. [DOI: 10.1016/j.seizure.2018.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/26/2023] Open
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10
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Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ. Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia 2017; 58:2133-2142. [PMID: 28994113 DOI: 10.1111/epi.13920] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series and reviews. Therefore, our group performed the first quantitative meta-analysis of the literature from the past 30 years to assess for rates and predictors of successful reoperations. METHODS A PubMed search was conducted for studies reporting outcomes of repeat epilepsy surgery. Studies were excluded if they reported fewer than five eligible patients or had average follow-ups < 1 year, and patients were excluded from analysis if they received a nonresective intervention. Outcomes were stratified by each variable of interest, and quantitative meta-analysis was performed to generate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Seven hundred eighty-two patients who received repeat resective epilepsy surgery from 36 studies were included. Engel I outcome was observed in 47% (n = 369) of patients. Significant predictors of seizure freedom included congruent over noncongruent electrophysiology data (OR = 3.6, 95% CI = 1.6-8.2), lesional over nonlesional epilepsy (OR = 3.2, 95% CI = 1.9-5.3), and surgical limitations over disease-related factors associated with failure of the first surgery (OR = 2.6, 95% CI = 1.3-5.3). Among patients with at least one of these predictors, seizure freedom was achieved in 58%. Conversely, the use of invasive monitoring was associated with worse outcome (OR = 0.4, 95% CI = 0.2-0.9). Temporal lobe over extratemporal/multilobe resection (OR = 1.5, 95% CI = 0.8-3.0) and abnormal over normal preoperative magnetic resonance imaging (OR = 1.9, 95% CI = 0.6-5.4) showed nonsignificant trends toward seizure freedom. SIGNIFICANCE This analysis supports considering further resection in patients with intractable epilepsy who continue to have debilitating seizures after an initial surgery, especially in the context of factors predictive of a favorable outcome.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Alvin Y Chan
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Stephen C Harward
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Carrie Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Abstract
Autonomic regulation therapy (ART) is a rapidly emerging therapy in the management of congestive heart failure secondary to systolic dysfunction. Modulation of the cardiac neuronal hierarchy can be achieved with bioelectronics modulation of the spinal cord, cervical vagus, baroreceptor, or renal nerve ablation. This review will discuss relevant preclinical and clinical research in ART for systolic heart failure. Understanding mechanistically what is being stimulated within the autonomic nervous system by such device-based therapy and how the system reacts to such stimuli is essential for optimizing stimulation parameters and for the future development of effective ART.
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Ryzí M, Ošlejšková H, Rektor I, Novák Z, Hemza J, Chrastina J, Svoboda M, Hermanová M, Brázdil M. Long-term approach to patients with postsurgical seizures. Epilepsia 2016; 57:597-604. [DOI: 10.1111/epi.13343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michal Ryzí
- Department of Child Neurology; Brno Epilepsy Center; Brno University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Hana Ošlejšková
- Department of Child Neurology; Brno Epilepsy Center; Brno University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Ivan Rektor
- First Department of Neurology; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
- Central European Institute of Technology (CEITEC); Masaryk University; Brno Czech Republic
| | - Zdeněk Novák
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Jan Hemza
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Jan Chrastina
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses; Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Markéta Hermanová
- First Department of Pathological Anatomy; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Milan Brázdil
- First Department of Neurology; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
- Central European Institute of Technology (CEITEC); Masaryk University; Brno Czech Republic
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Englot DJ. Failed epilepsy surgery: It is not too late. Epilepsy Res 2015; 113:151-2. [PMID: 25843789 DOI: 10.1016/j.eplepsyres.2015.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/07/2015] [Accepted: 03/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, United States; Department of Neurological Surgery, University of California, San Francisco, CA, United States.
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