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Ferreira LD, Tabaeizadeh M, Haneef Z. Surgical Outcomes in Post-Traumatic Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis. J Neurotrauma 2024; 41:319-330. [PMID: 37658840 DOI: 10.1089/neu.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Epilepsy surgery provides excellent benefits in post-traumatic epilepsy of the temporal lobe (PTE-TL), but outcomes relative to non-traumatic epilepsy of the temporal lobe (NTE-TL) are less favorable. Large well-designed studies are recommended to further clarify the role of epilepsy surgery in PTE. It is unclear whether epilepsy surgery outcomes in PTE are as robust as described for drug resistant epilepsy (DRE) in general. Prior outcome studies in PTE are limited by small numbers, lack of a control group, or both. We performed a meta-analysis of studies in temporal lobe epilepsy (TLE) to evaluate post-surgical outcomes in those with PTE-TL and compare outcomes to those with NTE-TL. PubMed, EMBASE, and Web of Science databases were queried for studies reporting epilepsy surgery outcomes separately for PTE-TL and NTE-TL. Outcomes were divided into favorable (Engel Class I) or unfavorable (Engel Class II-IV) for comparison. Meta-analyses were performed to evaluate: 1) the proportion of Class I outcomes following epilepsy surgery in PTE-TL; and 2) calculate the odds of Class I surgical outcomes in PTE-TL compared with NTE-TL. Of 3669 articles that reported surgical outcomes in epilepsy, nine studies (n = 886) were identified that reported outcomes for both PTE-TL (n = 219) and NTE-TL (n = 667). The weighted proportion of favorable outcomes (Engel Class I) were high for both PTE-TL (70.1%, 95% CI 61.9%-78.3%) and NTE-TL (75.2%, 95% CI 69.4%-80.2%). Patients with PTE-TL were at greater risk of unfavorable (Engel Class II-IV) outcomes (relative risk 1.36, 95% CI 1.04-1.78) compared with NTE-TL.
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Affiliation(s)
- Liam D Ferreira
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohammad Tabaeizadeh
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Colin J, Rossetti AO, Daniel RT, Bartoli A, Corniola MV, Vulliemoz S, Seeck M. The impact of a history of status epilepticus for epilepsy surgery outcome. Epilepsy Res 2024; 200:107308. [PMID: 38325236 DOI: 10.1016/j.eplepsyres.2024.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/17/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Patients with focal drug resistant epilepsy are excellent candidates for epilepsy surgery. Status epilepticus (SE) and seizure clusters (SC), described in a subset of patients, have both been associated with extended epileptogenic cerebral networks within one or both hemispheres. In this retrospective study, we were interested to determine if a history of SE or SC is associated with a worse surgical outcome. METHODS Data of 244 patients operated between 2000 to 2018 were reviewed, with a follow-up of at least 2 years. Patients with a previous history of SE or SC were compared to operated patients without these conditions (control group, CG). RESULTS We identified 27 (11%) and 38 (15.5%) patients with history of SE or SC, respectively. No difference in post-operative outcome was found for SE and SC patients. Compared to the control group, patients with a history of SE were diagnosed and operated significantly at earlier age(p = 0.01), and after a shorter duration of the disease (p = 0.027), but with a similar age of onset. SIGNIFICANCE A history of SE or SC was not associated with a worse post-operative prognosis. Earlier referral of SE patients for surgery suggests a heightened awareness regarding serious complications of recurrent SE by the referring neurologist or neuropediatrician. While the danger of SE is evident, policies to underline the impact for SC or very frequent seizures might be an efficient approach to accelerate patient referral also for this patient group.
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Affiliation(s)
- J Colin
- EEG and Epilepsy Unit and Neurosurgery Clinics, Department of Clinical Neurosciences, University Hospital of Geneva (HUG) and Faculty of Medicine, Geneva, Switzerland.
| | - A O Rossetti
- Neurology Service, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - R T Daniel
- Neurosurgery Service, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - A Bartoli
- EEG and Epilepsy Unit and Neurosurgery Clinics, Department of Clinical Neurosciences, University Hospital of Geneva (HUG) and Faculty of Medicine, Geneva, Switzerland
| | - M V Corniola
- EEG and Epilepsy Unit and Neurosurgery Clinics, Department of Clinical Neurosciences, University Hospital of Geneva (HUG) and Faculty of Medicine, Geneva, Switzerland
| | - S Vulliemoz
- EEG and Epilepsy Unit and Neurosurgery Clinics, Department of Clinical Neurosciences, University Hospital of Geneva (HUG) and Faculty of Medicine, Geneva, Switzerland
| | - M Seeck
- EEG and Epilepsy Unit and Neurosurgery Clinics, Department of Clinical Neurosciences, University Hospital of Geneva (HUG) and Faculty of Medicine, Geneva, Switzerland.
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Yang B, Zhao B, Li C, Mo J, Guo Z, Li Z, Yao Y, Fan X, Cai D, Sang L, Zheng Z, Gao D, Zhao X, Wang X, Zhang C, Hu W, Shao X, Zhang J, Zhang K. Localizing seizure onset zone by a cortico-cortical evoked potentials-based machine learning approach in focal epilepsy. Clin Neurophysiol 2024; 158:103-113. [PMID: 38218076 DOI: 10.1016/j.clinph.2023.12.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE We aimed to develop a new approach for identifying the localization of the seizure onset zone (SOZ) based on corticocortical evoked potentials (CCEPs) and to compare the connectivity patterns in patients with different clinical phenotypes. METHODS Fifty patients who underwent stereoelectroencephalography and CCEP procedures were included. Logistic regression was used in the model, and six CCEP metrics were input as features: root mean square of the first peak (N1RMS) and second peak (N2RMS), peak latency, onset latency, width duration, and area. RESULTS The area under the curve (AUC) for localizing the SOZ ranged from 0.88 to 0.93. The N1RMS values in the hippocampus sclerosis (HS) group were greater than that of the focal cortical dysplasia (FCD) IIa group (p < 0.001), independent of the distance between the recorded and stimulated sites. The sensitivity of localization was higher in the seizure-free group than in the non-seizure-free group (p = 0.036). CONCLUSIONS This new method can be used to predict the SOZ localization in various focal epilepsy phenotypes. SIGNIFICANCE This study proposed a machine-learning approach for localizing the SOZ. Moreover, we examined how clinical phenotypes impact large-scale abnormality of the epileptogenic networks.
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Affiliation(s)
- Bowen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhihao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zilin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan Yao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuliang Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Du Cai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Dongmei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemin Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Horsley JJ, Thomas RH, Chowdhury FA, Diehl B, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Winston GP, Duncan JS, Wang Y, Taylor PN. Complementary structural and functional abnormalities to localise epileptogenic tissue. EBioMedicine 2023; 97:104848. [PMID: 37898096 PMCID: PMC10630610 DOI: 10.1016/j.ebiom.2023.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND When investigating suitability for epilepsy surgery, people with drug-refractory focal epilepsy may have intracranial EEG (iEEG) electrodes implanted to localise seizure onset. Diffusion-weighted magnetic resonance imaging (dMRI) may be acquired to identify key white matter tracts for surgical avoidance. Here, we investigate whether structural connectivity abnormalities, inferred from dMRI, may be used in conjunction with functional iEEG abnormalities to aid localisation of the epileptogenic zone (EZ), improving surgical outcomes in epilepsy. METHODS We retrospectively investigated data from 43 patients (42% female) with epilepsy who had surgery following iEEG. Twenty-five patients (58%) were free from disabling seizures (ILAE 1 or 2) at one year. Interictal iEEG functional, and dMRI structural connectivity abnormalities were quantified by comparison to a normative map and healthy controls. We explored whether the resection of maximal abnormalities related to improved surgical outcomes, in both modalities individually and concurrently. Additionally, we suggest how connectivity abnormalities may inform the placement of iEEG electrodes pre-surgically using a patient case study. FINDINGS Seizure freedom was 15 times more likely in patients with resection of maximal connectivity and iEEG abnormalities (p = 0.008). Both modalities separately distinguished patient surgical outcome groups and when used simultaneously, a decision tree correctly separated 36 of 43 (84%) patients. INTERPRETATION Our results suggest that both connectivity and iEEG abnormalities may localise epileptogenic tissue, and that these two modalities may provide complementary information in pre-surgical evaluations. FUNDING This research was funded by UKRI, CDT in Cloud Computing for Big Data, NIH, MRC, Wellcome Trust and Epilepsy Research UK.
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Affiliation(s)
- Jonathan J Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia; Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Li Y, Liu P, Lin Q, Zhou D, An D. Postoperative seizure and memory outcome of temporal lobe epilepsy with hippocampal sclerosis: A systematic review. Epilepsia 2023; 64:2845-2860. [PMID: 37611927 DOI: 10.1111/epi.17757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
We conducted a systematic review and meta-analysis to evaluate postoperative seizure and memory outcomes of temporal lobe epilepsy with different hippocampal sclerosis (HS) subtypes classified by International League Against Epilepsy (ILAE) Consensus Guidelines in 2013. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2013 to August 6, 2023. Observational studies reporting seizure and memory outcomes among different HS subtypes were included. We used the Newcastle-Ottawa scale to assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to grade the quality of evidence. Seizure freedom and improved outcome (Engel 1 or ILAE class 1-2) ≥1 year after surgery were defined as the primary and secondary seizure outcome. A random-effects meta-analysis by DerSimonian and Laird method was performed to obtain pooled risk ratio (RRs) with 95% confidence interval (CIs). The memory impairment was narratively reviewed because of various evaluation tools. Fifteen cohort studies with 2485 patients were eligible for the meta-analysis of seizure outcome. Six cohorts with detailed information on postoperative memory outcome were included. The pooled RRs of seizure freedom, with moderate to substantial heterogeneity, were .98 (95% CI = .84-1.15) between HS type 2 and type 1, 1.11 (95% CI = .82-1.52) between type 3 and type 1, and .80 (95% CI = .62-1.03) between the no-HS and HS groups. No significant difference of improved outcome was found between different subtypes (p > .05). The quality of evidence was deemed to be low to very low according to GRADE. The long-term seizure outcome (≥5 years after surgery) and memory impairment remained controversial.
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Affiliation(s)
- Yuming Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Peiwen Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuxing Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Yang Y, Lv J, He C, Shen C, Xu S, Guo Y, Ding Y, Zheng Z, Zhu J, Wang S, Ding M, Wang S. Predictors and prevalence of COVID-19 vaccination in patients with focal epilepsy following resection surgery. Epilepsy Behav 2023; 145:109344. [PMID: 37459719 DOI: 10.1016/j.yebeh.2023.109344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE In light of the ongoing COVID-19 pandemic, vaccination has emerged as the primary and most effective solution. The aim of this study was to examine compliance rates of vaccination and explore the factors that predict vaccine uptake among patients with epilepsy (PWE) who have undergone resection surgery. METHOD To examine the variations in vaccination coverage, safety concerns, and factors influencing vaccination hesitancy among PWE who have undergone resection surgery, this study recruited patients with at least one-year follow-up. We utilized questionnaires to gather clinical characteristics and obtain information regarding COVID-19 vaccines. RESULTS Among the 303 patients included in the study, a majority of 229 (75.58%) achieved a seizure-free outcome (Engel Ia). Of these patients, 178 (58.75%) received at least one dose of COVID-19 vaccine, and the vaccination rate has remained relatively consistent over the past six months. Nearly 94.95% of those who received the vaccine completed the full vaccination regimen, with the majority (n = 174, 97.75%) opting for an inactivated vaccine. Only three patients reported side effects unrelated to epilepsy, and one patient experienced a worsening of typical aura seizures within one month after vaccination. Notably, significant positive associations were observed between COVID-19 vaccine acceptance and adulthood (age 18 years or older) (OR = 1.820, 95% CI = 1.018-3.252, p = 0.043) as well as achieving a seizure-free outcome (OR = 2.823, 95% CI = 1.619-4.921, p < 0.001). Regarding the unvaccinated patients, approximately one-fifth expressed willingness to receive a future COVID-19 vaccine, while the remainder were hesitant (41.60%) or unsure (39.20%) about vaccination. These reservations mainly stemmed from concerns about the potential worsening of seizures and vaccine safety. CONCLUSIONS Inactivated vaccines can be considered safe for individuals with epilepsy who have undergone resection surgery. The likelihood of being vaccinated was found to be comparatively higher among the cohort with seizure-free status or adults. To promote COVID-19 vaccination among children, it is crucial to implement comprehensive education and public awareness campaigns that emphasize the safety of vaccines. These efforts will help encourage widespread acceptance of vaccination and ensure the well-being of individuals with epilepsy.
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Affiliation(s)
- Yuyu Yang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Lv
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenmin He
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunhong Shen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sha Xu
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe Zheng
- Epilepsy Center, Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- Epilepsy Center, Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Wang Y, Schroeder GM, Horsley JJ, Panagiotopoulou M, Chowdhury FA, Diehl B, Duncan JS, McEvoy AW, Miserocchi A, de Tisi J, Taylor PN. Temporal stability of intracranial electroencephalographic abnormality maps for localizing epileptogenic tissue. Epilepsia 2023; 64:2070-2080. [PMID: 37226553 PMCID: PMC10962550 DOI: 10.1111/epi.17663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Identifying abnormalities on interictal intracranial electroencephalogram (iEEG), by comparing patient data to a normative map, has shown promise for the localization of epileptogenic tissue and prediction of outcome. The approach typically uses short interictal segments of approximately 1 min. However, the temporal stability of findings has not been established. METHODS Here, we generated a normative map of iEEG in nonpathological brain tissue from 249 patients. We computed regional band power abnormalities in a separate cohort of 39 patients for the duration of their monitoring period (.92-8.62 days of iEEG data, mean = 4.58 days per patient, >4800 hours recording). To assess the localizing value of band power abnormality, we computedD RS -a measure of how different the surgically resected and spared tissue was in terms of band power abnormalities-over time. RESULTS In each patient, theD RS value was relatively consistent over time. The medianD RS of the entire recording period separated seizure-free (International League Against Epilepsy [ILAE] = 1) and not-seizure-free (ILAE> 1) patients well (area under the curve [AUC] = .69). This effect was similar interictally (AUC = .69) and peri-ictally (AUC = .71). SIGNIFICANCE Our results suggest that band power abnormality D_RS, as a predictor of outcomes from epilepsy surgery, is a relatively robust metric over time. These findings add further support for abnormality mapping of neurophysiology data during presurgical evaluation.
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Affiliation(s)
- Yujiang Wang
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of ComputingNewcastle UniversityNewcastle Upon TyneUK
- Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- UCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - Gabrielle M. Schroeder
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Jonathan J. Horsley
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | - Mariella Panagiotopoulou
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of ComputingNewcastle UniversityNewcastle Upon TyneUK
| | | | - Beate Diehl
- UCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - John S. Duncan
- UCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | | | | | - Jane de Tisi
- UCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - Peter N. Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of ComputingNewcastle UniversityNewcastle Upon TyneUK
- Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- UCL Queen Square Institute of NeurologyQueen SquareLondonUK
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Cuesta P, Bruña R, Shah E, Laohathai C, Garcia-Tarodo S, Funke M, Von Allmen G, Maestú F. An individual data-driven virtual resection model based on epileptic network dynamics in children with intractable epilepsy: a magnetoencephalography interictal activity application. Brain Commun 2023; 5:fcad168. [PMID: 37274829 PMCID: PMC10236945 DOI: 10.1093/braincomms/fcad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
Epilepsy surgery continues to be a recommended treatment for intractable (medication-resistant) epilepsy; however, 30-70% of epilepsy surgery patients can continue to have seizures. Surgical failures are often associated with incomplete resection or inaccurate localization of the epileptogenic zone. This retrospective study aims to improve surgical outcome through in silico testing of surgical hypotheses through a personalized computational neurosurgery model created from individualized patient's magnetoencephalography recording and MRI. The framework assesses the extent of the epileptic network and evaluates underlying spike dynamics, resulting in identification of one single brain volume as a candidate for resection. Dynamic-locked networks were utilized for virtual cortical resection. This in silico protocol was tested in a cohort of 24 paediatric patients with focal drug-resistant epilepsy who underwent epilepsy surgery. Of 24 patients who were included in the analysis, 79% (19 of 24) of the models agreed with the patient's clinical surgery outcome and 21% (5 of 24) were considered as model failures (accuracy 0.79, sensitivity 0.77, specificity 0.82). Patients with unsuccessful surgery outcome typically showed a model cluster outside of the resected cavity, while those with successful surgery showed the cluster model within the cavity. Two of the model failures showed the cluster in the vicinity of the resected tissue and either a functional disconnection or lack of precision of the magnetoencephalography-MRI overlapping could explain the results. Two other cases were seizure free for 1 year but developed late recurrence. This is the first study that provides in silico personalized protocol for epilepsy surgery planning using magnetoencephalography spike network analysis. This model could provide complementary information to the traditional pre-surgical assessment methods and increase the proportion of patients achieving seizure-free outcome from surgery.
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Affiliation(s)
- Pablo Cuesta
- Correspondence to: Pablo Cuesta Pza. Ramón y Cajal, s/n. Ciudad Universitaria 28040 Madrid, Spain E-mail:
| | - Ricardo Bruña
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
| | - Ekta Shah
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Stephanie Garcia-Tarodo
- Département de la femme, de l'enfant et de l'adolescent, Hôpital des Enfants - Hôpitaux Universitaires de Genève, Geneva, 1211 Genève 14, Switzerland
| | - Michael Funke
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
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9
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Steinbrenner M, McDowell A, Centeno M, Moeller F, Perani S, Lorio S, Maziero D, Carmichael DW. Camera-based Prospective Motion Correction in Paediatric Epilepsy Patients Enables EEG-fMRI Localization Even in High-motion States. Brain Topogr 2023; 36:319-337. [PMID: 36939987 PMCID: PMC10164016 DOI: 10.1007/s10548-023-00945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND EEG-fMRI is a useful additional test to localize the epileptogenic zone (EZ) particularly in MRI negative cases. However subject motion presents a particular challenge owing to its large effects on both MRI and EEG signal. Traditionally it is assumed that prospective motion correction (PMC) of fMRI precludes EEG artifact correction. METHODS Children undergoing presurgical assessment at Great Ormond Street Hospital were included into the study. PMC of fMRI was done using a commercial system with a Moiré Phase Tracking marker and MR-compatible camera. For retrospective EEG correction both a standard and a motion educated EEG artefact correction (REEGMAS) were compared to each other. RESULTS Ten children underwent simultaneous EEG-fMRI. Overall head movement was high (mean RMS velocity < 1.5 mm/s) and showed high inter- and intra-individual variability. Comparing motion measured by the PMC camera and the (uncorrected residual) motion detected by realignment of fMRI images, there was a five-fold reduction in motion from its prospective correction. Retrospective EEG correction using both standard approaches and REEGMAS allowed the visualization and identification of physiological noise and epileptiform discharges. Seven of 10 children had significant maps, which were concordant with the clinical EZ hypothesis in 6 of these 7. CONCLUSION To our knowledge this is the first application of camera-based PMC for MRI in a pediatric clinical setting. Despite large amount of movement PMC in combination with retrospective EEG correction recovered data and obtained clinically meaningful results during high levels of subject motion. Practical limitations may currently limit the widespread use of this technology.
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Affiliation(s)
- Mirja Steinbrenner
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.,Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Amy McDowell
- Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK
| | - Maria Centeno
- Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK.,Epilepsy Unit, Neurology Department, Hospital Clinic Barcelona/IDIBAPS, Villarroel 170., Barcelona, 08036, Spain
| | - Friederike Moeller
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Suejen Perani
- Department of Basic and Clinical Neuroscience, KCL Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sara Lorio
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Danilo Maziero
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego Health, San Diego, CA, USA
| | - David W Carmichael
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. .,Developmental Imaging and Biophysics, UCL Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK.
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10
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Guo J, Guo M, Liu R, Kong Y, Hu X, Yao L, Lv S, Lv J, Wang X, Kong QX. Seizure Outcome After Surgery for Refractory Epilepsy Diagnosed by 18F-fluorodeoxyglucose positron emission tomography ( 18F-FDG PET/MRI): A Systematic Review and Meta-Analysis. World Neurosurg 2023; 173:34-43. [PMID: 36746239 DOI: 10.1016/j.wneu.2023.01.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE When magnetic resonance imaging (MRI) fails to detect an underlying epileptogenic lesion, the odds of a good outcome after epilepsy surgery are significantly lower (20%-65% compared with 60%-90% if a lesion is detected). We investigated the possible effects of introducing hybrid 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI into the decision algorithm for patients with lesioned and nonlesioned drug-resistant epilepsy. METHODS Three databases were searched from January 1990 to October 2022. We registered the protocol with International Platform of Registered Systematic Review and Meta-analysis Protocols. Studies in which 18F-FDG PET/MRI was conducted with ≥12 months of postsurgical follow-up in patients with refractory epilepsy. Random-effects meta-analysis was used to calculate the proportion of patients with good outcomes. Metaregression was used to investigate sources of heterogeneity. RESULTS We identified 8105 studies, of which 23 (1292 patients in total) were included. The overall good postoperative outcome rate was 71% (95% confidence interval 63.6-74.9). Good outcome was associated with the location of the refractory epileptic lesion (temporal lobe or extratemporal; risk ratio 1.27 [95% confidence interval 1.01-1.52], P = 0.009); Length of postoperative follow-up ≥40 months included in the same study accounted for 0.6% of the observed heterogeneity. CONCLUSIONS Seventy-one percent of patients with refractory epilepsy and 18F-FDG PET/MRI epileptogenic lesion features had a good outcome of epilepsy after surgery. Our findings can be incorporated into routine preoperative consultations and emphasize the importance of the complete resection of the temporal lobe epileptogenic zone for 18F-FDG PET/MRI detection when safe and feasible.
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Affiliation(s)
- Jia Guo
- Clinical Medical College, Jining Medical University, Jining, China
| | - Mujie Guo
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruihan Liu
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China; Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yu Kong
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xibin Hu
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lei Yao
- Clinical Medical College, Jining Medical University, Jining, China
| | - Shaomin Lv
- Clinical Medical College, Jining Medical University, Jining, China
| | - Jiahua Lv
- Clinical Medical College, Jining Medical University, Jining, China
| | - Xinyu Wang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Qing-Xia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China.
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11
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Kurzbuch AR, Cooper B, Israni A, Ellenbogen JR. Non-pharmacological treatment options of drug-resistant epilepsy in subcortical band heterotopia: systematic review and illustrative case. Childs Nerv Syst 2023; 39:451-462. [PMID: 35933521 DOI: 10.1007/s00381-022-05638-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Subcortical band heterotopia is a rare X-linked neuronal migration disorder primarily in females often associated with drug-resistant epilepsy. The aim of this study is to review the literature for non-pharmacological treatment options of drug-resistant epilepsy in subcortical band heterotopia. MATERIAL AND METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review. Entering the keywords "double cortex," "subcortical band heterotopia," and "subcortical laminar heterotopia," we searched Scopus and PubMed databases. We paid particular attention to type of invasive and non-invasive treatment, radiological presentation, and outcome. We also describe a related case report, managed at Alder Hey Children's Hospital, Liverpool. RESULTS The systematic literature review yielded 25 patients with subcortical band heterotopia and drug-resistant epilepsy who underwent non-pharmacological treatment. Including our patient, 26 patients were reported. The patients' mean age at seizure onset was 6.5 years (range 0.2-23) with a female sex predilection (5.25:1). The patients' mean age at invasive or non-invasive treatment was 21.5 years (range 6.5-51). The 26 patients underwent 29 non-pharmacological treatments. Ten patients underwent corpus callosotomy; 8 patients had a formal temporal lobectomy. Three patients had focal cortical resection. Two patients respectively had multiple subpial transections, insertion of a vagal nerve stimulator, or deep brain stimulation of the bilateral anterior nuclei of the thalamus. One patient underwent responsive focal neurostimulation. Another patient had transcutaneous stimulation of the vagal nerve. Sixteen patients reported a reduction or the disappearance of the seizures; 1 patient had no improvement. The outcome of 2 patients was classified class I, of 1 patient class II, of 1 patient class III, and of 5 patients class IV according to the Engel Epilepsy Surgery Outcome Scale. CONCLUSION Mainly corpus callosotomy and formal temporal lobectomy have been performed as non-pharmacological treatment with few cases published overall. Several other invasive procedures and one non-invasive technique are based on case reports. The small number of reported cases prevents drawing a firm conclusion as to which non-pharmacological treatment is the best treatment option for refractive epilepsy in patients with subcortical band heterotopia.
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Affiliation(s)
- Arthur R Kurzbuch
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Ben Cooper
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anil Israni
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jonathan R Ellenbogen
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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12
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Ribeiro L, Ng S, Duffau H. Recurrent insular low-grade gliomas: factors guiding the decision to reoperate. J Neurosurg 2022; 138:1216-1226. [PMID: 36308479 DOI: 10.3171/2022.9.jns221286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Reoperation has been established as an effective therapeutic strategy in recurrent diffuse low-grade gliomas (LGGs). Insular gliomas represent a specific surgical challenge because of the surrounding vascular and functional structures. The aim of this study was to investigate the main clinicoradiological factors guiding the decision to reoperate on recurrent insular LGGs (ILGGs).
METHODS
In this retrospective consecutive series, the authors screened all patients operated on for an ILGG in their institution who further presented with a tumor regrowth without the development of contrast enhancement. They compared patients who were subsequently offered a reoperation under awake mapping at recurrence or who underwent reoperation after adjuvant treatment had reduced the volume of the initial tumor recurrence (with a proven pathological diagnosis of LGG after the second surgery) to patients who were not selected for a reoperation. The first group (reoperated group; n = 20) included all recurrent ILGG patients who underwent second resection, and the second group (nonreoperated group; n = 60) included patients who did not undergo reoperation but underwent adjuvant oncological treatment.
RESULTS
Factors significantly associated with reoperation were extent of resection (EOR) at first surgery (91.9% vs 89.7%, p = 0.014), residual tumor volume (9.5 ± 7.1 mL [range 0–30 mL] vs 6.3 ± 7.3 mL [range 0–30 mL], p = 0.02) at first surgery and left temporopolar infiltration at the time of tumor recurrence (Liebermeister statistical analysis, 4293 voxels survived false discovery rate correction with p < 0.05; maximal z-statistic = 6.50). Infiltration of the anterior perforated substance at tumor recurrence was significantly anticorrelated to reoperation (179 voxels survived false discovery rate correction with p < 0.05; minimal z-statistic = −4.33). The mean EOR was 83.7% at reoperation with a 90% survival rate at last follow-up (9.3 ± 3.8 years), low postsurgical morbidity (Karnofsky Performance Status score ≥ 80 in 95% of patients), a high rate of postoperative professional resumption (95%), and seizure control in 57.1% of patients.
CONCLUSIONS
In selected patients with recurrent ILGG without radiographic evidence of malignant transformation, reoperation with intraoperative awake mapping is associated with favorable oncological outcomes and a low postsurgical morbidity. A greater EOR and a lower residual tumor volume at first surgery were significantly associated with reoperation. Patients who benefited from a second surgery typically had a recurrent pattern within cortical areas (such as the temporopolar region), while other patients typically presented with a deeper infiltrative pattern within the anterior perforated substance and the surrounding white matter pathways. Such original findings may be helpful to select the optimal indications of reoperation in recurrent ILGG.
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Affiliation(s)
- Lucas Ribeiro
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
| | - Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," Institute of Functional Genomics, INSERM U1191, University of Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," Institute of Functional Genomics, INSERM U1191, University of Montpellier, France
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13
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Zhao X, Peng X, Niu K, Li H, He L, Yang F, Wu T, Chen D, Zhang Q, Ouyang M, Guo J, Pan Y. A multi-head self-attention deep learning approach for detection and recommendation of neuromagnetic high frequency oscillations in epilepsy. Front Neuroinform 2022; 16:771965. [PMID: 36156983 PMCID: PMC9500293 DOI: 10.3389/fninf.2022.771965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Magnetoencephalography is a noninvasive neuromagnetic technology to record epileptic activities for the pre-operative localization of epileptogenic zones, which has received increasing attention in the diagnosis and surgery of epilepsy. As reported by recent studies, pathological high frequency oscillations (HFOs), when utilized as a biomarker to localize the epileptogenic zones, result in a significant reduction in seizure frequency, even seizure elimination in around 80% of cases. Thus, objective, rapid, and automatic detection and recommendation of HFOs are highly desirable for clinicians to alleviate the burden of reviewing a large amount of MEG data from a given patient. Despite the advantage, the performance of existing HFOs rarely satisfies the clinical requirement. Consequently, no HFOs have been successfully applied to real clinical applications so far. In this work, we propose a multi-head self-attention-based detector for recommendation, termed MSADR, to detect and recommend HFO signals. Taking advantage of the state-of-the-art multi-head self-attention mechanism in deep learning, the proposed MSADR achieves a more superior accuracy of 88.6% than peer machine learning models in both detection and recommendation tasks. In addition, the robustness of MSADR is also extensively assessed with various ablation tests, results of which further demonstrate the effectiveness and generalizability of the proposed approach.
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Affiliation(s)
- Xiangyu Zhao
- Information Technology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing, China
- National Engineering Research Center for Information Technology in Agriculture, Beijing, China
| | - Xueping Peng
- Australian Artificial Intelligence Institute, Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia
- *Correspondence: Xueping Peng
| | - Ke Niu
- Computer School, Beijing Information Science and Technology University, Beijing, China
| | - Hailong Li
- Department of Radiology, Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili He
- Department of Radiology, Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Feng Yang
- Information Technology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing, China
| | - Ting Wu
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Magnetoencephalography, Nanjing Brain Hospital, Affiliated to Nanjing Medical University, Nanjing, China
- Ting Wu
| | - Duo Chen
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiusi Zhang
- Information Technology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing, China
| | - Menglin Ouyang
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jiayang Guo
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
- Department of Hematology, School of Medicine, Xiamen University, Xiamen, China
- Jiayang Guo
| | - Yijie Pan
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Ningbo Institute of Information Technology Application, Chinese Academy of Sciences, Ningbo, China
- Yijie Pan
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14
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Barba C, Giometto S, Lucenteforte E, Pellacani S, Matta G, Bettiol A, Minghetti S, Falorni L, Melani F, Di Giacomo G, Giordano F, De Masi S, Guerrini R. Seizure Outcome of Temporal Lobe Epilepsy Surgery in Adults and Children: A Systematic Review and Meta-Analysis. Neurosurgery 2022; 91:676-683. [PMID: 35960753 DOI: 10.1227/neu.0000000000002094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) surgery is associated with the best seizure outcome in adults, although its long-term results remain suboptimal. Retrospective pediatric studies suggest better figures whose determinants are poorly understood. OBJECTIVE To conduct a systematic review and meta-analysis of studies on the efficacy of TLE surgery in children (age younger than 18 years) and adults. METHODS We searched MEDLINE, Embase, and Cochrane Library for TLE surgery original research from January 1, 1990, until May 12, 2020. The outcome measures were seizure freedom since surgery and seizure freedom either at last or longest follow-up. We meta-analyzed the proportion of children and adults achieving either Engel I/International League Against Epilepsy (ILAE) 1 or Engel IA/ILAE 1A outcome by follow-up duration, type of surgery, histopathology, neuroimaging, quality of the studies, and publication period. We used a random effects model with Freeman-Tukey double arcsine transformation of proportions. RESULTS From 40 409 records identified, we included 277 studies (30 848 patients). The proportions of patients achieving Engel I/ILAE 1 and Engel IA/ILAE 1A outcomes were 0.74 (95% CI, 0.69-0.78) and 0.61 (0.48-0.74) for children and 0.69 (0.67-0.71) and 0.56 (0.52-0.60) for adults. Histopathology significantly influenced Engel I/ILAE 1 outcome in adults but not in children (P < .0001), while the type of surgery significantly influenced Engel I/ILAE 1 outcome in children but not in adults. CONCLUSION The proportion of seizure freedom after TLE surgery was higher in children, although not significantly. Histopathology and the surgical approach can influence seizure outcome, with age-related variability.
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Affiliation(s)
- Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Pellacani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Giulia Matta
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Minghetti
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Lavinia Falorni
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | | | - Flavio Giordano
- University of Florence, Florence, Italy.,Neurosurgery Department, Meyer Children's Hospital, Florence, Italy
| | | | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
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15
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Hale AT, Chari A, Scott RC, Cross JH, Rozzelle CJ, Blount JP, Tisdall MM. Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing? Brain 2022; 145:3755-3762. [PMID: 35883201 DOI: 10.1093/brain/awac275] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/18/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
Epilepsy surgery is an established safe and effective treatment for selected candidates with drug-resistant epilepsy. In this opinion piece, we outline the clinical and experimental evidence for selectively considering epilepsy surgery prior to drug resistance. Our rationale for expedited surgery is based on the observations that, 1) a high proportion of patients with lesional epilepsies (e.g. focal cortical dysplasia, epilepsy associated tumours) will progress to drug-resistance, 2) surgical treatment of these lesions, especially in non-eloquent areas of brain, is safe, and 3) earlier surgery may be associated with better seizure outcomes. Potential benefits beyond seizure reduction or elimination include less exposure to anti-seizure medications (ASM), which may lead to improved developmental trajectories in children and optimize long-term neurocognitive outcomes and quality of life. Further, there exists emerging experimental evidence that brain network dysfunction exists at the onset of epilepsy, where continuing dysfunctional activity could exacerbate network perturbations. This in turn could lead to expanded seizure foci and contribution to the comorbidities associated with epilepsy. Taken together, we rationalize that epilepsy surgery, in carefully selected cases, may be considered prior to drug resistance. Lastly, we outline the path forward, including the challenges associated with developing the evidence base and implementing this paradigm into clinical care.
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Affiliation(s)
- Andrew T Hale
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rod C Scott
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Paediatric Neurology, Nemours Children's Hospital, Wilmington, DE, USA.,Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - J Helen Cross
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - Curtis J Rozzelle
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Martin M Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
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16
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Chisolm PF, Warner JD, Hale AT, Estevez-Ordonez D, Murdaugh D, Rozzelle CJ, Blount JP. Quantifying and Reporting Outcomes in Pediatric Epilepsy Surgery: A Systematic Review. Epilepsia 2022; 63:2754-2781. [PMID: 35847999 DOI: 10.1111/epi.17369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several instruments and outcomes measures have been reported in pediatric patients undergoing epilepsy surgery. The objective of this systematic review is to summarize, evaluate, and quantify outcome metrics for the surgical treatment of pediatric epilepsy that address seizure frequency, neuropsychological, and health-related quality of life (HRQL). METHODS We performed a systematic review according to PRISMA guidelines to identify publications between 2010 and June 2021 from PubMed, Embase, and the Cochrane Database of Systematic Reviews that report clinical outcomes in pediatric epilepsy surgery. RESULTS Eighty-one papers were included for review. Overall, rates of post-operative seizure frequency were the most common metric reported (n= 78 studies, 96%). Among the seizure frequency metrics, the Engel Epilepsy Surgery Outcome Scale (n= 48 studies, 59%) was most commonly reported. Neuropsychological outcomes, performed in 32 studies (40%) were assessed using 36 different named metrics. Health-Related Quality of Life (HRQL) outcomes were performed in 16 studies (20%) using 13 different metrics. Forty-six studies (57%) reported postoperative changes in anti-epileptic drug (AED) regimen and time-to-event analysis was performed in 15 (19%) studies. Only 13 outcomes metrics (1/5 seizure frequency, 6/13 HRQL, 6/36 neuropsychological) have been validated for use in pediatric patients with epilepsy and only 13 have been assessed through reliability studies (4/5 seizure frequency, 6/13 HRQL, and 3/36 neuropsychological). Of the 81 included studies, 17 (21%) used at least one validated metric. SIGNIFICANCE Outcome variable metrics in pediatric epilepsy surgery are highly variable. While nearly all studies report seizure frequency, there is considerable variation in reporting. HRQL and neuropsychological outcomes are less frequently and much more heterogeneously reported. Reliable and validated outcomes metrics should be used to increase standardization and accuracy of reporting outcomes in pediatric patients undergoing epilepsy surgery.
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Affiliation(s)
- Paul F Chisolm
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey D Warner
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Donna Murdaugh
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
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17
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Zhao Z, Li H, Wang S, Chen C, He C, Hu L, Zheng Z, Zhu J, Ding M, Wang S, Ding Y. Patterns of hypometabolism in frontal lobe epilepsy originating in different frontal regions. Ann Clin Transl Neurol 2022; 9:1336-1344. [PMID: 35836348 PMCID: PMC9463953 DOI: 10.1002/acn3.51630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Analysis of FDG‐PET imaging commonly shows that hypometabolism extends into extra‐epileptogenic zones (extra‐EZ). This study investigates the distribution patterns of hypometabolism in frontal lobe epilepsy (FLE) originating in different frontal regions. Methods Sixty‐four patients with FLE were grouped by EZ localization according to Brodmann areas (BAs): Group 1 (the frontal motor and premotor area), BAs 4, 6, and 8; Group 2 (the inferior frontal gyrus and opercular area), BAs 44, 45, and 47; Group 3 (the dorsal prefrontal area), BAs 9, 10, 11, and 46; and Group 4 (the medial frontal and anterior cingulate gyrus), BAs 32 and 24. Regions of extra‐EZ hypometabolism were statistically analyzed between FLE groups and healthy controls. Correlation analysis was performed to identify relationships between the intensity of hypometabolism and clinical characteristics. Results Significant hypometabolism in the ipsilateral (Groups 1 and 4) or bilateral (Groups 2 and 3) anterior insulae was found. Groups 1 and 4 presented with limited distribution of extra‐EZ hypometabolism, whereas Groups 2 and 3 showed widely distributed extra‐EZ hypometabolism in the rectus gyrus, cingulate gyrus, and other regions. Additionally, the intensity of hypometabolism was correlated with epilepsy duration in Groups 2 and 3. Conclusions All FLE groups showed hypometabolism in the anterior insula. In addition, distinct patterns of extra‐EZ hypometabolism were identified for each FLE group. This quantitative FDG‐PET analysis expanded our understanding of the topography of epileptic networks and can guide EZ localization in the future.
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Affiliation(s)
- Zexian Zhao
- Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenmin He
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingli Hu
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhe Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junming Zhu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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18
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Taylor PN, Papasavvas CA, Owen TW, Schroeder GM, Hutchings FE, Chowdhury FA, Diehl B, Duncan JS, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Wang Y. Normative brain mapping of interictal intracranial EEG to localize epileptogenic tissue. Brain 2022; 145:939-949. [PMID: 35075485 PMCID: PMC9050535 DOI: 10.1093/brain/awab380] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/14/2022] Open
Abstract
The identification of abnormal electrographic activity is important in a wide range of neurological disorders, including epilepsy for localizing epileptogenic tissue. However, this identification may be challenging during non-seizure (interictal) periods, especially if abnormalities are subtle compared to the repertoire of possible healthy brain dynamics. Here, we investigate if such interictal abnormalities become more salient by quantitatively accounting for the range of healthy brain dynamics in a location-specific manner. To this end, we constructed a normative map of brain dynamics, in terms of relative band power, from interictal intracranial recordings from 234 participants (21 598 electrode contacts). We then compared interictal recordings from 62 patients with epilepsy to the normative map to identify abnormal regions. We proposed that if the most abnormal regions were spared by surgery, then patients would be more likely to experience continued seizures postoperatively. We first confirmed that the spatial variations of band power in the normative map across brain regions were consistent with healthy variations reported in the literature. Second, when accounting for the normative variations, regions that were spared by surgery were more abnormal than those resected only in patients with persistent postoperative seizures (t = -3.6, P = 0.0003), confirming our hypothesis. Third, we found that this effect discriminated patient outcomes (area under curve 0.75 P = 0.0003). Normative mapping is a well-established practice in neuroscientific research. Our study suggests that this approach is feasible to detect interictal abnormalities in intracranial EEG, and of potential clinical value to identify pathological tissue in epilepsy. Finally, we make our normative intracranial map publicly available to facilitate future investigations in epilepsy and beyond.
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Affiliation(s)
- Peter N Taylor
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Christoforos A Papasavvas
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Thomas W Owen
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Gabrielle M Schroeder
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Frances E Hutchings
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
| | - Fahmida A Chowdhury
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Beate Diehl
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Anna Miserocchi
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Jane de Tisi
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Sjoerd B Vos
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Matthew C Walker
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
| | - Yujiang Wang
- CNNP Laboratory (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle Helix, Newcastle University, Newcastle-upon-Tyne, NE4 5TG, UK
- UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London WC1N 3BG, UK
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19
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Cook C, Baxendale S. Preoperative predictors of postoperative satisfaction with surgery. Epilepsy Behav 2022; 129:108612. [PMID: 35203015 DOI: 10.1016/j.yebeh.2022.108612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient reported outcome measures (PROMs) are an important metric in the assessment of outcomes following elective treatments such as epilepsy surgery. The Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19) is a new (2020), valid, and reliable measure of patient satisfaction that provides measures of satisfaction in multiple domains. This study examined preoperative psychiatric predictors of ESSQ-19 scores. METHODS All patients who underwent epilepsy surgery at our center in the decade between January 2010 and 2020 and who were at least one year out from surgery were invited to complete the ESSQ-19 (n = 284). RESULTS Responses were received from 29% of the sample. Non responders did not differ from responders in age, type of surgery, sex, or seizure outcome, but had a lower Verbal Comprehension Index score. Reported satisfaction rates were high in each ESSQ-19 domain (Seizure control, mean = 83.9; Psychosocial function, mean = 72.4; Surgical Complications, mean = 86.4; Recovery from surgery, mean = 77.4; Overall satisfaction, mean = 80.8) and broadly comparable to those reported in the original validation sample for the ESSQ-19. Preoperative levels of anxiety predicted postoperative satisfaction with recovery from surgery and psychosocial outcomes, with high levels of preoperative anxiety associated with higher levels of dissatisfaction in both sub domains. CONCLUSIONS Satisfaction with some aspects of postoperative outcome is not just dependent upon postoperative factors, but can be predicted from preoperative levels of anxiety. Clinicians offering preoperative counseling and preparation with respect to patients' expectations of surgical outcome should be cognizant of the possible impact of anxiety on postoperative satisfaction, particularly with respect to psychosocial function.
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Affiliation(s)
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, United Kingdom.
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20
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Sóki N, Richter Z, Karádi K, Lőrincz K, Horváth R, Gyimesi C, Szekeres-Paraczky C, Horváth Z, Janszky J, Dóczi T, Seress L, Ábrahám H. Investigation of synapses in the cortical white matter in human temporal lobe epilepsy. Brain Res 2022; 1779:147787. [PMID: 35041843 DOI: 10.1016/j.brainres.2022.147787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022]
Abstract
Temporal lobe epilepsy (TLE) is one of the most common focal pharmacotherapy-resistant epilepsy in adults. Previous studies have shown significantly higher numbers of neurons in the neocortical white matter in TLE patients than in controls. The aim of this work was to investigate whether white matter neurons are part of the neuronal circuitry. Therefore, we studied the distribution and density of synapses in surgically resected neocortical tissue of pharmacotherapy-resistant TLE patients. Neocortical white matter of temporal lobe from non-epileptic patients were used as controls. Synapses and neurons were visualized with immunohistochemistry using antibodies against synaptophysin and NeuN, respectively. The presence of synaptophysin in presynaptic terminals was verified by electron microscopy. Quantification of immunostaining was performed and the data of the patients' cognitive tests as well as clinical records were compared to the density of neurons and synapses. Synaptophysin density in the white matter of TLE patients was significantly higher than in controls. In TLE, a significant correlation was found between synaptophysin immunodensity and density of white matter neurons. Neuronal as well as synaptophysin density significantly correlated with scores of verbal memory of TLE patients. Neurosurgical outcome of TLE patients did not significantly correlate with histological data, although, higher neuronal and synaptophysin densities were observed in patients with favorable post-surgical outcome. Our results suggest that white matter neurons in TLE patients receive substantial synaptic input and indicate that white matter neurons may be integrated in epileptic neuronal networks responsible for the development or maintenance of seizures.
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Affiliation(s)
- Noémi Sóki
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Zsófia Richter
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, University of Pécs Medical School Szigeti u. 12. Pécs, 7624, Hungary
| | - Katalin Lőrincz
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Réka Horváth
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Csilla Gyimesi
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Cecília Szekeres-Paraczky
- Human Brain Research Laboratory, Institute of Experimental Medicine, ELKH Szigony u. 43. Budapest, 1083, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - László Seress
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Hajnalka Ábrahám
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary.
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21
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Liu H, Gao Y, Zhang J, Zhang J. Epilepsy EEG classification method based on supervised locality preserving canonical correlation analysis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:624-642. [PMID: 34903005 DOI: 10.3934/mbe.2022028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Existing epileptic seizure automatic detection systems are often troubled by high-dimensional electroencephalogram (EEG) features. High-dimensional features will not only bring redundant information and noise, but also reduce the response speed of the system. In order to solve this problem, supervised locality preserving canonical correlation analysis (SLPCCA), which can effectively use both sample category information and nonlinear relationships between features, is introduced. And an epileptic signal classification method based on SLPCCA is proposed. Firstly, the power spectral density and the fluctuation index of the frequency slice wavelet transform are extracted as features from the EEG fragments. Next, SLPCCA obtains the optimal projection direction by maximizing the weight correlation between the paired samples in the class and their neighbors. And the projection combination of original features in the optimal direction is the fusion feature. The fusion features are then input into LS-SVM for training and testing. This method is verified on the Bonn dataset and the CHB-MIT dataset and gets good results. On various classification tasks of Bonn data set, the proposed method achieves an average classification accuracy of 99.16%. On the binary classification task of the inter-seizure and seizure epileptic EEG of the CHB-MIT dataset, the proposed method achieves an average accuracy of 97.18%. The experimental results show that the algorithm achieves excellent results compared with several state-of-the-art methods. In addition, the parameter sensitivity of SLPCCA and the relationship between the dimension of the fusion features and the classification results are discussed. Therefore, the stability and effectiveness of the method are further verified.
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Affiliation(s)
- Hongming Liu
- Zhuoyue Honors College, Hangzhou Dianzi University, Hangzhou, China
- College of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Yunyuan Gao
- College of Automation, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, China
| | - Jianhai Zhang
- College of Computer & Software, Hangzhou Dianzi University, Hangzhou, China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, China
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22
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Willard A, Antonic-Baker A, Chen Z, O'Brien TJ, Kwan P, Perucca P. Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia: A Systematic Review and Meta-analysis. Neurology 2021; 98:e236-e248. [PMID: 34893558 DOI: 10.1212/wnl.0000000000013066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) has been associated with poorer post-surgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histological diagnosis, including patients with abnormal as well as normal pre-operative MRI. However, in clinical workflow, patient selection for surgery is based on pre-operative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD. METHODS We devised our study protocol in accordance with PRISMA guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel Class I, ILAE Classes 1-2, or "seizure-free" status. Meta-regression was performed to investigate sources of heterogeneity. RESULTS Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed patients for ≥24 months post-surgery. The overall post-surgical favorable outcome rate was 70% (95% CI: 64-75). There was high inter-study heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion [risk ratio, RR=2.42 (95% CI: 1.55-3.76), p<0.001] and location of the FCD lesion in the temporal lobe [RR=1.38 (95% CI: 1.07-1.79), p=0013], but not lesion extent, intracranial EEG use, or FCD histological type. The number of FCD histological types included in the same study accounted for 7.6% of the observed heterogeneity. CONCLUSIONS 70% of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome following resective surgery. Our findings can be incorporated in routine pre-operative counselling and reinforce the importance of resecting completely the MRI-detected FCD where this is safe and feasible.
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Affiliation(s)
- Anna Willard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Terence John O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia .,Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.,Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia
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23
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Zhang T, Li Y, Zhao S, Xu Y, Zhang X, Wu S, Dou X, Yu C, Feng J, Ding Y, Zhu J, Chen Z, Zhang H, Tian M. High-resolution pediatric age-specific 18F-FDG PET template: a pilot study in epileptogenic focus localization. Eur J Nucl Med Mol Imaging 2021; 49:1560-1573. [PMID: 34746970 PMCID: PMC8940757 DOI: 10.1007/s00259-021-05611-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022]
Abstract
Background PET imaging has been widely used in diagnosis of neurological disorders; however, its application to pediatric population is limited due to lacking pediatric age–specific PET template. This study aims to develop a pediatric age–specific PET template (PAPT) and conduct a pilot study of epileptogenic focus localization in pediatric epilepsy. Methods We recruited 130 pediatric patients with epilepsy and 102 age-matched controls who underwent 18F-FDG PET examination. High-resolution PAPT was developed by an iterative nonlinear registration-averaging optimization approach for two age ranges: 6–10 years (n = 17) and 11–18 years (n = 50), respectively. Spatial normalization to the PAPT was evaluated by registration similarities of 35 validation controls, followed by estimation of potential registration biases. In a pilot study, epileptogenic focus was localized by PAPT-based voxel-wise statistical analysis, compared with multi-disciplinary team (MDT) diagnosis, and validated by follow-up of patients who underwent epilepsy surgery. Furthermore, epileptogenic focus localization results were compared among three templates (PAPT, conventional adult template, and a previously reported pediatric linear template). Results Spatial normalization to the PAPT significantly improved registration similarities (P < 0.001), and nearly eliminated regions of potential biases (< 2% of whole brain volume). The PAPT-based epileptogenic focus localization achieved a substantial agreement with MDT diagnosis (Kappa = 0.757), significantly outperforming localization based on the adult template (Kappa = 0.496) and linear template (Kappa = 0.569) (P < 0.05). The PAPT-based localization achieved the highest detection rate (89.2%) and accuracy (80.0%). In postsurgical seizure-free patients (n = 40), the PAPT-based localization also achieved a substantial agreement with resection areas (Kappa = 0.743), and the highest detection rate (95%) and accuracy (80.0%). Conclusion The PAPT can significantly improve spatial normalization and epileptogenic focus localization in pediatric epilepsy. Future pediatric neuroimaging studies can also benefit from the unbiased spatial normalization by PAPT. Trial registration. NCT04725162: https://clinicaltrials.gov/ct2/show/NCT04725162 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05611-w.
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Affiliation(s)
- Teng Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Yuting Li
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Shuilin Zhao
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Yuanfan Xu
- Hangzhou Universal Medical Imaging Diagnostic Center, Hangzhou, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Xiaofeng Dou
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Congcong Yu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Junming Zhu
- Department of Neurosurgery, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zexin Chen
- Center of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China. .,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
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24
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Schommer L, Streltzov N, Andrew A, Bujarski K. Factors associated with suicidal ideation in an epilepsy center in Northern New England. Epilepsy Behav 2021; 121:108009. [PMID: 34023812 DOI: 10.1016/j.yebeh.2021.108009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Suicidal ideation (SI), defined as thoughts and feelings of ending one's life, is a known risk factor for completed suicide. Although studies show that rates of SI are elevated in persons with epilepsy (PWE) compared to the general population, it is presently unclear how disease, social, and psychological factors contribute to its frequency and severity. With an overarching goal to develop a screening tool for suicide prevention, the objective of this study was to understand the rate, severity, and factors associated with SI in a large cohort of PWE. A generalized linear mixed model was used to test the relationship between changes in SI and disease, social, and psychological variables in 2450 PWE over a period of four years. The prevalence of SI was 23.6%. Associated disease factors included increased seizure frequency, severity, and recency. SI was impacted by employment status, but not by driving. Depression scores and aggression were highly associated with frequency and severity of SI. These findings highlight that disease, social, and psychological factors impact levels of SI in PWE and that screening for suicide prevention in PWE should include measures of such factors.
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Affiliation(s)
- Lindsay Schommer
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, United States.
| | - Nicholas Streltzov
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States
| | - Angeline Andrew
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, United States
| | - Krzysztof Bujarski
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States
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25
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Edmonds BD, Welch W, Sogawa Y, Mountz J, Bagić A, Patterson C. The Role of Magnetoencephalography and Single-Photon Emission Computed Tomography in Evaluation of Children With Drug-Resistant Epilepsy. J Child Neurol 2021; 36:673-679. [PMID: 33663250 DOI: 10.1177/0883073821996558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgery holds the best outcomes for drug-resistant epilepsy in children, making localization of a seizure focus essential. However, there is limited research on the contribution of magnetoencephalography and single-photon emission computed tomography (SPECT) to the presurgical evaluation of lesional and nonlesional pediatric patients. This study proposed to evaluate the concordance of SPECT and magnetoencephalography (MEG) to scalp electroencephalography (EEG) to determine their effective contribution to the presurgical evaluation. On review, MEG and SPECT studies for 28 drug-resistant epilepsy cases were completed at Children's Hospital of Pittsburgh from May 2012 to August 2018. Although not reaching statistical significance, MEG had increased lobar concordance with EEG compared with SPECT (68% vs 46%). MEG or SPECT results effectively provided localization data leading to 6 surgical evaluations and 3 resections with outcomes of Engel class I or II at 12 months. This study suggests MEG and SPECT provide valuable localizing information for presurgical epilepsy evaluation of children with drug-resistant epilepsy.
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Affiliation(s)
- Benjamin D Edmonds
- Division of Child Neurology, 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Welch
- Division of Child Neurology, 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yoshimi Sogawa
- Division of Child Neurology, 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Mountz
- 6595University of Pittsburgh Medical Center, Department of Radiology, Nuclear Medicine Division, Pittsburgh, PA, USA
| | - Anto Bagić
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Christina Patterson
- Division of Child Neurology, 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Foley E, Quitadamo LR, Walsh AR, Bill P, Hillebrand A, Seri S. MEG detection of high frequency oscillations and intracranial-EEG validation in pediatric epilepsy surgery. Clin Neurophysiol 2021; 132:2136-2145. [PMID: 34284249 DOI: 10.1016/j.clinph.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the feasibility of automatically detecting high frequency oscillations (HFOs) in magnetoencephalography (MEG) recordings in a group of ten paediatric epilepsy surgery patients who had undergone intracranial electroencephalography (iEEG). METHODS A beamforming source-analysis method was used to construct virtual sensors and an automatic algorithm was applied to detect HFOs (80-250 Hz). We evaluated the concordance of MEG findings with the sources of iEEG HFOs, the clinically defined seizure onset zone (SOZ), the location of resected brain structures, and with post-operative outcome. RESULTS In 8/9 patients there was good concordance between the sources of MEG HFOs and iEEG HFOs and the SOZ. Significantly more HFOs were detected in iEEG relative to MEG t(71) = 2.85, p < .05. There was good concordance between sources of MEG HFOs and the resected area in patients with good and poor outcome, however HFOs were also detected outside of the resected area in patients with poor outcome. CONCLUSION Our findings demonstrate the feasibility of automatically detecting HFOs non-invasively in MEG recordings in paediatric patients, and confirm compatibility of results with invasive recordings. SIGNIFICANCE This approach provides support for the non-invasive detection of HFOs to aid surgical planning and potentially reduce the need for invasive monitoring, which is pertinent to paediatric patients.
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Affiliation(s)
- Elaine Foley
- Aston Institute of Health and Neurodevelopment, College of Health and Life Sciences, Aston University, Birmingham, UK.
| | - Lucia R Quitadamo
- Aston Institute of Health and Neurodevelopment, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - A Richard Walsh
- Children's Epilepsy Surgery Program, The Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Peter Bill
- Children's Epilepsy Surgery Program, The Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, De Boelelaan, 1117 Amsterdam, the Netherlands
| | - Stefano Seri
- Aston Institute of Health and Neurodevelopment, College of Health and Life Sciences, Aston University, Birmingham, UK; Children's Epilepsy Surgery Program, The Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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De Witt Hamer PC, Klein M, Hervey-Jumper SL, Wefel JS, Berger MS. Functional Outcomes and Health-Related Quality of Life Following Glioma Surgery. Neurosurgery 2021; 88:720-732. [PMID: 33517431 PMCID: PMC7955971 DOI: 10.1093/neuros/nyaa365] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/25/2020] [Indexed: 12/19/2022] Open
Abstract
Functional outcome following glioma surgery is defined as how the patient functions or feels. Functional outcome is a coprimary end point of surgery in patients with diffuse glioma, together with oncological outcome. In this review, we structure the functional outcome measurements following glioma surgery as reported in the last 5 yr. We review various perspectives on functional outcome of glioma surgery with available measures, and offer suggestions for their use. From the recent neurosurgical literature, 160 publications were retrieved fulfilling the selection criteria. In these publications, neurological outcomes were reported most often, followed by activities of daily living, seizure outcomes, neurocognitive outcomes, and health-related quality of life or well-being. In more than a quarter of these publications functional outcome was not reported. A minimum essential consensus set of functional outcome measurements would benefit comparison across neurosurgical reports. The consensus set should be based on a combination of clinician- and patient-reported outcomes, assessed at a predefined time before and after surgery. The selected measurements should have psychometric properties supporting the intended use including validity-related evidence, reliability, and sensitivity to detect meaningful change with minimal burden to ensure compliance. We circulate a short survey as a start towards reporting guidelines. Many questions remain to better understand, report, and improve functional outcome following glioma surgery.
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Affiliation(s)
- Philip C De Witt Hamer
- Correspondence: Philip C. De Witt Hamer, MD, PhD, Amsterdam UMC, Vrije Universiteit, Department of Neurosurgery, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
| | - Martin Klein
- Amsterdam UMC, Vrije Universiteit, Department of Medical Psychology, Neuroscience Campus, Amsterdam, Netherlands
| | - Shawn L Hervey-Jumper
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California
| | - Jeffrey S Wefel
- University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology and Department of Radiation Oncology, Houston, Texas
| | - Mitchel S Berger
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Whiting AC, Morita-Sherman M, Li M, Vegh D, Machado de Campos B, Cendes F, Wang X, Bingaman W, Jehi LE. Automated analysis of cortical volume loss predicts seizure outcomes after frontal lobectomy. Epilepsia 2021; 62:1074-1084. [PMID: 33756031 DOI: 10.1111/epi.16877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients undergoing frontal lobectomy demonstrate lower seizure-freedom rates than patients undergoing temporal lobectomy and several other resective interventions. We attempted to utilize automated preoperative quantitative analysis of focal and global cortical volume loss to develop predictive volumetric indicators of seizure outcome after frontal lobectomy. METHODS Ninety patients who underwent frontal lobectomy were stratified based on seizure freedom at a mean follow-up time of 3.5 (standard deviation [SD] 2.5) years. Automated quantitative analysis of cortical volume loss organized by distinct brain region and laterality was performed on preoperative T1-weighted magnetic resonance imaging (MRI) studies. Univariate statistical analysis was used to select potential predictors of seizure freedom. Backward variable selection and multivariate logistical regression were used to develop models to predict seizure freedom. RESULTS Forty-eight of 90 (53.3%) patients were seizure-free at the last follow-up. Several frontal and extrafrontal brain regions demonstrated statistically significant differences in both volumetric cortical volume loss and volumetric asymmetry between the left and right sides in the seizure-free and non-seizure-free cohorts. A final multivariate logistic model utilizing only preoperative quantitative MRI data to predict seizure outcome was developed with a c-statistic of 0.846. Using both preoperative quantitative MRI data and previously validated clinical predictors of seizure outcomes, we developed a model with a c-statistic of 0.897. SIGNIFICANCE This study demonstrates that preoperative cortical volume loss in both frontal and extrafrontal regions can be predictive of seizure outcome after frontal lobectomy, and models can be developed with excellent predictive capabilities using preoperative MRI data. Automated quantitative MRI analysis can be quickly and reliably performed in patients with frontal lobe epilepsy, and further studies may be developed for integration into preoperative risk stratification.
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Affiliation(s)
- Alexander C Whiting
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Manshi Li
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah Vegh
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas UNICAMP, Campinas, Brazil
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara E Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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Guo J, Li H, Sun X, Qi L, Qiao H, Pan Y, Xiang J, Ji R. Detecting High Frequency Oscillations for Stereoelectroencephalography in Epilepsy via Hypergraph Learning. IEEE Trans Neural Syst Rehabil Eng 2021; 29:587-596. [PMID: 33534708 DOI: 10.1109/tnsre.2021.3056685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Successful epilepsy surgeries depend highly on pre-operative localization of epileptogenic zones. Stereoelectroencephalography (SEEG) records interictal and ictal activities of the epilepsy in order to precisely find and localize epileptogenic zones in clinical practice. While it is difficult to find distinct ictal onset patterns generated the seizure onset zone from SEEG recordings in a confined region, high frequency oscillations are commonly considered as putative biomarkers for the identification of epileptogenic zones. Therefore, automatic and accurate detection of high frequency oscillations in SEEG signals is crucial for timely clinical evaluation. This work formulates the detection of high frequency oscillations as a signal segment classification problem and develops a hypergraph-based detector to automatically detect high frequency oscillations such that human experts can visually review SEEG signals. We evaluated our method on 4,000 signal segments from clinical SEEG recordings that contain both ictal and interictal data obtained from 19 patients who suffer from refractory focal epilepsy. The experimental results demonstrate the effectiveness of the proposed detector that can successfully localize interictal high frequency oscillations and outperforms multiple peer machine learning methods. In particular, the proposed detector achieved 90.7% in accuracy, 80.9% in sensitivity, and 96.9% in specificity.
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31
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Grigorovsky V, Jacobs D, Breton VL, Tufa U, Lucasius C, Del Campo JM, Chinvarun Y, Carlen PL, Wennberg R, Bardakjian BL. Delta-gamma phase-amplitude coupling as a biomarker of postictal generalized EEG suppression. Brain Commun 2020; 2:fcaa182. [PMID: 33376988 PMCID: PMC7750942 DOI: 10.1093/braincomms/fcaa182] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
Postictal generalized EEG suppression is the state of suppression of electrical activity at the end of a seizure. Prolongation of this state has been associated with increased risk of sudden unexpected death in epilepsy, making characterization of underlying electrical rhythmic activity during postictal suppression an important step in improving epilepsy treatment. Phase-amplitude coupling in EEG reflects cognitive coding within brain networks and some of those codes highlight epileptic activity; therefore, we hypothesized that there are distinct phase-amplitude coupling features in the postictal suppression state that can provide an improved estimate of this state in the context of patient risk for sudden unexpected death in epilepsy. We used both intracranial and scalp EEG data from eleven patients (six male, five female; age range 21–41 years) containing 25 seizures, to identify frequency dynamics, both in the ictal and postictal EEG suppression states. Cross-frequency coupling analysis identified that during seizures there was a gradual decrease of phase frequency in the coupling between delta (0.5–4 Hz) and gamma (30+ Hz), which was followed by an increased coupling between the phase of 0.5–1.5 Hz signal and amplitude of 30–50 Hz signal in the postictal state as compared to the pre-seizure baseline. This marker was consistent across patients. Then, using these postictal-specific features, an unsupervised state classifier—a hidden Markov model—was able to reliably classify four distinct states of seizure episodes, including a postictal suppression state. Furthermore, a connectome analysis of the postictal suppression states showed increased information flow within the network during postictal suppression states as compared to the pre-seizure baseline, suggesting enhanced network communication. When the same tools were applied to the EEG of an epilepsy patient who died unexpectedly, ictal coupling dynamics disappeared and postictal phase-amplitude coupling remained constant throughout. Overall, our findings suggest that there are active postictal networks, as defined through coupling dynamics that can be used to objectively classify the postictal suppression state; furthermore, in a case study of sudden unexpected death in epilepsy, the network does not show ictal-like phase-amplitude coupling features despite the presence of convulsive seizures, and instead demonstrates activity similar to postictal. The postictal suppression state is a period of elevated network activity as compared to the baseline activity which can provide key insights into the epileptic pathology.
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Affiliation(s)
| | - Daniel Jacobs
- Institute of Biomedical Engineering, University of Toronto, Canada
| | | | - Uilki Tufa
- Institute of Biomedical Engineering, University of Toronto, Canada
| | - Christopher Lucasius
- Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada
| | | | - Yotin Chinvarun
- Comprehensive Epilepsy Program and Neurology Unit, Phramongkutklao Hospital, Thailand
| | - Peter L Carlen
- Institute of Biomedical Engineering, University of Toronto, Canada.,Department of Physiology, University of Toronto, Canada.,Division of Neurology, Toronto Western Hospital, Canada
| | | | - Berj L Bardakjian
- Institute of Biomedical Engineering, University of Toronto, Canada.,Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada
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Kikuchi K, Togao O, Yamashita K, Momosaka D, Nakayama T, Kitamura Y, Kikuchi Y, Baba S, Sagiyama K, Ishimatsu K, Kamei R, Mukae N, Iihara K, Suzuki SO, Iwaki T, Hiwatashi A. Diagnostic accuracy for the epileptogenic zone detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. Eur Radiol 2020; 31:2915-2922. [PMID: 33063184 PMCID: PMC8043950 DOI: 10.1007/s00330-020-07389-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/18/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To examine the utility of FDG-PET/MRI in patients with epilepsy by comparing the diagnostic accuracy of PET/MRI and PET/CT in epileptogenic zone (EZ) detection. METHODS This prospective study included 31 patients (17 males, 14 females) who underwent surgical resection for EZ. All patients were first scanned using FDG-PET/CT followed immediately with FDG-PET/MRI. Two series of PET plus standalone MR images were interpreted independently by five board-certified radiologists. A 4-point visual score was used to assess image quality. Sensitivities and visual scores from both PETs and standalone MRI were compared using the McNemar test with Bonferroni correction and Dunn's multiple comparisons test. RESULTS The EZs were confirmed histopathologically via resection as hippocampal sclerosis (n = 11, 35.5%), gliosis (n = 8, 25.8%), focal cortical dysplasia (n = 6, 19.4%), and brain tumours (n = 6, 19.4%) including cavernous haemangioma (n = 3), dysembryoplastic neuroepithelial tumour (n = 1), ganglioglioma (n = 1), and polymorphous low-grade neuroepithelial tumour of the young (n = 1). The sensitivity of FDG-PET/MRI was significantly higher than that of FDG-PET/CT and standalone MRI (FDG-PET/MRI vs. FDG-PET/CT vs. standalone MRI; 77.4-90.3% vs. 58.1-64.5% vs. 45.2-80.6%, p < 0.0001, respectively). The visual scores derived from FDG-PET/MRI were significantly higher than those of FDG-PET/CT, as well as standalone MRI (2.8 ± 1.2 vs. 2.0 ± 1.1 vs. 2.1 ± 1.2, p < 0.0001, respectively). Compared to FDG-PET/CT, FDG-PET/MRI increased the visual score (51.9%, increased visual scores of 2 and 3). CONCLUSIONS The diagnostic accuracy for the EZ detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. KEY POINTS • Sensitivity of FDG-PET/MRI was significantly higher than that of FDG-PET/CT and standalone MRI (FDG-PET/MRI vs. FDG-PET/CT vs. standalone MRI; 77.4-90.3% vs. 58.1-64.5% vs. 45.2-80.6%, p < 0.0001, respectively). • Visual scores derived from FDG-PET/MRI were significantly higher than those of FDG-PET/CT and standalone MRI (2.8 ± 1.2 vs. 2.0 ± 1.1 vs. 2.1 ± 1.2, p < 0.0001, respectively). • Compared to FDG-PET/CT, FDG-PET/MRI increased the visual score (51.9%, increased visual scores of 2 and 3).
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Affiliation(s)
- Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daichi Momosaka
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Nakayama
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshitomo Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryotaro Kamei
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Iwaki
- Department of Neuropathology Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data. Epilepsy Behav 2020; 111:107196. [PMID: 32554230 DOI: 10.1016/j.yebeh.2020.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to assess the long-term outcomes of epilepsy surgery between 1995 and 2015 in South Wales, UK, linking case note review, postal questionnaire, and routinely collected healthcare data. METHOD We identified patients from a departmental database and collected outcome data from patient case notes, a postal questionnaire, and the QOLIE-31-P and linked with Welsh routinely collected data in the Secure Anonymised Information Linkage (SAIL) databank. RESULTS Fifty-seven patients were included. Median age at surgery was 34 years (11-70), median: 24 years (2-56) after onset of habitual seizures. Median follow-up was 7 years (2-19). Twenty-eight (49%) patients were free from disabling seizures (Engel Class 1), 9 (16%) experienced rare disabling seizures (Class 2), 13 (23%) had worthwhile improvements (Class 3), and 7 (12%) had no improvement (Class 4). There was a 30% mean reduction in total antiepileptic drug (AED) load at five years postsurgery. Thirty-eight (66.7%) patients experienced tonic-clonic seizures presurgery verses 8 (14%) at last review. Seizure-free patients self-reported a greater overall quality of life (QOL; QOLIE-31-P) when compared with those not achieving seizure freedom. Seizure-free individuals scored a mean of 67.6/100 (100 is best), whereas those with continuing seizures scored 46.0/100 (p < 0.006). There was a significant decrease in the median rate of hospital admissions for any cause after epilepsy surgery (9.8 days per 1000 patient days before surgery compared with 3.9 after p < 0.005). SIGNIFICANCE Epilepsy surgery was associated with significant improvements in seizures, a reduced AED load, and an improved QOL that closely correlated with seizure outcomes and reduced hospital admission rates following surgery. Despite this, there was a long delay from onset of habitual seizures to surgery. The importance of long-term follow-up is emphasized in terms of evolving medical needs and health and social care outcomes.
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Khatri D, Das KK, Gosal JS, Attri G, Singh A, Bhaisora KS, Mehrotra A, Sardhara J, Verma PK, Srivastava AK, Jaiswal AK, Behari S. Surgery in High-Grade Insular Tumors: Oncological and Seizure Outcomes from 41 Consecutive Patients. Asian J Neurosurg 2020; 15:537-544. [PMID: 33145204 PMCID: PMC7591198 DOI: 10.4103/ajns.ajns_18_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/25/2020] [Accepted: 04/05/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Insular high-grade gliomas are uncommon and constitute approximately 10% of all intracranial high-grade gliomas. Several publications in the recent years have thrown substantial light in the understanding of insular low-grade gliomas. However, there is a paucity of information concerning the spectrum of high-grade lesions affecting the insula, the mode of presentation vis-à-vis low-grade gliomas, and the survival rates to modern therapy. Aims and Objectives: We aim to highlight various clinical patterns, histo-pathological spectrum and the survival rates in patients with high-grade insular lesions. Also, we explore the factors that govern favourable outcomes. Materials and Methods: A retrospective study of 41 patients operated for high-grade insular tumors at our institute between March 2010 to December 2018 was done to evaluate the clinico-radiological features, surgical nuances, survival rates and seizure outcomes. Results: Raised intracranial pressure was the most frequent clinical presentation (n=28/41, 68.3%). Nearly 60% of the patients (n=25) had involvement of all four Berger-Sanai zones. The high-grade tumors encountered in our series were: glioblastoma (n=15), gliosarcoma (n=3), and embryonal tumor, not otherwise specified in 3 patients, while 21 patients had grade 3 astrocytoma. 33 out of 41 patients (80.5%) in our study showed excellent seizure control (ILAE grade 1A) at follow-up. Clinical presentation with seizures (P = 0.01, HR=0.3), WHO grade IV histopathology (P = 0.04, HR=3.7) and development of recurrence (P = 0.05, HR=5.5) were found to be independent predictors of OS. Conclusion: Insular high-grade gliomas are commoner than thought and nearly half of these are grade IV tumors (51%). A presentation with seizures may indicate precursor low-grade gliomas and portend a better survival. A maximum “safe” surgical resection, keeping the postoperative quality of life in mind, should be the goal.
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Affiliation(s)
- Deepak Khatri
- Department of Neurosurgery, Lenox Hill Hospital, New York, USA
| | - Kuntal Kanti Das
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Gagandeep Attri
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Amanjot Singh
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Anant Mehrotra
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | | | - Sanjay Behari
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Qi L, Fan X, Tao X, Chai Q, Zhang K, Meng F, Hu W, Sang L, Yang X, Qiao H. Identifying the Epileptogenic Zone With the Relative Strength of High-Frequency Oscillation: A Stereoelectroencephalography Study. Front Hum Neurosci 2020; 14:186. [PMID: 32581741 PMCID: PMC7296092 DOI: 10.3389/fnhum.2020.00186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background High-frequency oscillation (HFO) represents a promising biomarker of epileptogenicity. However, the significant interindividual differences among patients limit its application in clinical practice. Here, we applied and evaluated an individualized, frequency-based approach of HFO analysis in stereoelectroencephalography (SEEG) data for localizing the epileptogenic zones (EZs). Methods Clinical and SEEG data of 19 patients with drug-resistant focal epilepsy were retrospectively analyzed. The individualized spectral power of all signals recorded by electrode array, i.e., the relative strength of HFO, was computed with a wavelet method for each patient. Subsequently, the clinical value of the relative strength of HFO for identifying the EZ was evaluated. Results Focal increase in the relative strength of HFO in SEEG recordings were identified in all 19 patients. HFOs identified inside the clinically identified seizure onset zone had more spectral power than those identified outside (p < 0.001), and HFOs in 250–500 Hz band (fast ripples) seemed to be more specific identifying the EZ than in those in 80–250 Hz band (ripples) (p < 0.01). The resection of brain regions generating HFOs resulted in a favorable seizure outcome in 17 patients (17/19; 89.5%), while in the cases of other patients with poor outcomes, the brain regions generating HFOs were not removed completely. Conclusion The relative strength of HFO, especially fast ripples, is a promising effective biomarker for identifying the EZ and can lead to a favorable seizure outcome if used to guide epilepsy surgery.
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Affiliation(s)
- Lei Qi
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Fengtai Hospital, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaorong Tao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Chai
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lin Sang
- Beijing Fengtai Hospital, Beijing, China
| | | | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Thohar Arifin M, Muttaqin Z, Bakhtiar Y, Andar E, Priambada D, Kurnia H, Risdianto A, Tsaniadi K, Kusnarto G, Bunyamin J. Seizure Outcomes in Patients with Complete versus Anterior Corpus Callosotomy: Analysis of Outcome. Int J Gen Med 2020; 13:105-110. [PMID: 32280261 PMCID: PMC7127778 DOI: 10.2147/ijgm.s247438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/06/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Corpus callosotomy (CCT) is a palliative procedure to treat injurious drop attacks or multifocal/generalized seizures in which resection of the epileptogenic focus is not feasible. We are presenting our experience in treating intractable epilepsy patients by CCT procedures. Methods We observed 16 patients who underwent callosotomy (male to female ratio 7:9; adult to pediatric ratio 3:13). Initial seizure frequency was reported ranged from 1 to 2 attacks daily to very often (more than 20 episodes daily). Results Our observation showed that among patients with drop attacks, complete and >90% seizure freedom was reported by 4 and 6 of 13 patients, respectively (76.9% combined). Conclusion Our observation showed that corpus callosotomy yielded good outcome in patients with intractable epilepsy in Indonesia. Our observation showed total callosotomy achieved complete seizure freedom better compared to partial callosotomy patients.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Erie Andar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Dody Priambada
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Happy Kurnia
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Ajid Risdianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Krisna Tsaniadi
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Gunadi Kusnarto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
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Xiang J, Maue E, Fan Y, Qi L, Mangano FT, Greiner H, Tenney J. Kurtosis and skewness of high-frequency brain signals are altered in paediatric epilepsy. Brain Commun 2020; 2:fcaa036. [PMID: 32954294 PMCID: PMC7425348 DOI: 10.1093/braincomms/fcaa036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 01/15/2023] Open
Abstract
Intracranial studies provide solid evidence that high-frequency brain signals are a new biomarker for epilepsy. Unfortunately, epileptic (pathological) high-frequency signals can be intermingled with physiological high-frequency signals making these signals difficult to differentiate. Recent success in non-invasive detection of high-frequency brain signals opens a new avenue for distinguishing pathological from physiological high-frequency signals. The objective of the present study is to characterize pathological and physiological high-frequency signals at source levels by using kurtosis and skewness analyses. Twenty-three children with medically intractable epilepsy and age-/gender-matched healthy controls were studied using magnetoencephalography. Magnetoencephalographic data in three frequency bands, which included 2–80 Hz (the conventional low-frequency signals), 80–250 Hz (ripples) and 250–600 Hz (fast ripples), were analysed. The kurtosis and skewness of virtual electrode signals in eight brain regions, which included left/right frontal, temporal, parietal and occipital cortices, were calculated and analysed. Differences between epilepsy and controls were quantitatively compared for each cerebral lobe in each frequency band in terms of kurtosis and skewness measurements. Virtual electrode signals from clinical epileptogenic zones and brain areas outside of the epileptogenic zones were also compared with kurtosis and skewness analyses. Compared to controls, patients with epilepsy showed significant elevation in kurtosis and skewness of virtual electrode signals. The spatial and frequency patterns of the kurtosis and skewness of virtual electrode signals among the eight cerebral lobes in three frequency bands were also significantly different from that of the controls (2–80 Hz, P < 0.001; 80–250 Hz, P < 0.00001; 250–600 Hz, P < 0.0001). Compared to signals from non-epileptogenic zones, virtual electrode signals from epileptogenic zones showed significantly altered kurtosis and skewness (P < 0.001). Compared to normative data from the control group, aberrant virtual electrode signals were, for each patient, more pronounced in the epileptogenic lobes than in other lobes(kurtosis analysis of virtual electrode signals in 250–600 Hz; odds ratio = 27.9; P < 0.0001). The kurtosis values of virtual electrode signals in 80–250 and 250–600 Hz showed the highest sensitivity (88.23%) and specificity (89.09%) for revealing epileptogenic lobe, respectively. The combination of virtual electrode and kurtosis/skewness measurements provides a new quantitative approach to distinguishing pathological from physiological high-frequency signals for paediatric epilepsy. Non-invasive identification of pathological high-frequency signals may provide novel important information to guide clinical invasive recordings and direct surgical treatment of epilepsy.
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Affiliation(s)
- Jing Xiang
- MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ellen Maue
- MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Yuyin Fan
- MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Department of Pediatric Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Lei Qi
- MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Department of Neurosurgery, Beijing Fengtai Hospital, Beijing 100071, China
| | - Francesco T Mangano
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Hansel Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jeffrey Tenney
- MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Hemispherotomy can cause post-operative strabismus. Brain Dev 2020; 42:41-47. [PMID: 31521421 DOI: 10.1016/j.braindev.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hemispherotomy, which involves disconnecting hemispherical fibers, is a treatment option for medically intractable epilepsy. As various neurological disorders can cause strabismus, we hypothesized that hemispherotomy can cause post-operative strabismus in patients with medically intractable epilepsy. METHODS Nineteen patients underwent the Hirschberg test before and after hemispherical disconnection surgery. Among the 19 patients, 16 patients (six females and 10 males; mean age, 12.2 years; range, 0.17-43 years) who underwent hemispherotomy were included in this study. RESULTS The difference in the angle between the left and right eyes was significantly widened (p = 0.025). Nine (56%) of 16 patients exhibited post-operative chronic strabismus as evaluated with the Hirschberg test. Intermittent strabismus was noticed by family members or caregivers in 10 (63%) of 16 patients. Patients older than 12 years did not show post-operative strabismus as evaluated by the Hirschberg test. CONCLUSION Hemispherotomy can cause or worsen post-operative strabismus in pediatric patients.
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Berg AT, Kaiser K, Dixon‐Salazar T, Elliot A, McNamara N, Meskis MA, Golbeck E, Tatachar P, Laux L, Raia C, Stanley J, Luna A, Rozek C. Seizure burden in severe early-life epilepsy: Perspectives from parents. Epilepsia Open 2019; 4:293-301. [PMID: 31168496 PMCID: PMC6546015 DOI: 10.1002/epi4.12319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/18/2019] [Accepted: 03/31/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Seizure burden is typically measured by seizure frequency yet it entails more than seizure counts, especially for people with severe epilepsies and their caregivers. We aimed to characterize the multi-faceted nature of seizure burden in young people and their parents who are living with severe early-life epilepsies. METHODS A one-day workshop and a series of teleconferences were held with parents of children with severe, refractory epilepsy of early-life origin and providers for children with epilepsy. The workshop sessions were structured as focus groups and aimed to identify components of seizure burden and their impact from the perspective of parents and providers. Data were gathered, organized, and refined during the workshop using an iterative 4-step process that drew upon grounded theory. RESULTS Three primary components of seizure burden were identified: frequency, severity, and unpredictability, which was as important if not more important at times than frequency and severity. Caregivers noted that the impacts of seizures were experienced as acute-immediate consequences, longer-term consequences, and as chronic effects that develop and evolve over time. The severity of the child's neurological and medical status as well as where in the disease journey a family was represented additional contextual factors that influenced the experience of seizure burden. SIGNIFICANCE Patient-reported and patient-centered outcomes are increasingly incorporated into the evaluation of treatment effectiveness. Without understanding how the disease creates burden for the patient (or family), it is difficult to know how to assess the impact of treatment. Our preliminary findings indicate seizure burden is a complex construct and unpredictability can be as important as frequency and severity.
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Affiliation(s)
- Anne T. Berg
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
- Department of PediatricsNorthwestern UniversityFeinberg School of MedicineChicagoIllinois
| | - Karen Kaiser
- Department of Medical Social SciencesNorthwestern UniversityFeinberg School of MedicineChicagoIllinois
| | | | | | - Nancy McNamara
- Department of PediatricsCS Mott Children's HospitalAnn ArborMichigan
- Department of PediatricsUniversity of Michigan School of MedicineAnn ArborMichigan
| | | | - Emily Golbeck
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
| | - Priya Tatachar
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
- Department of PediatricsNorthwestern UniversityFeinberg School of MedicineChicagoIllinois
| | - Linda Laux
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
- Department of PediatricsNorthwestern UniversityFeinberg School of MedicineChicagoIllinois
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Watila MM, Xiao F, Keezer MR, Miserocchi A, Winkler AS, McEvoy AW, Sander JW. Epilepsy surgery in low- and middle-income countries: A scoping review. Epilepsy Behav 2019; 92:311-326. [PMID: 30738248 DOI: 10.1016/j.yebeh.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC and discuss some challenges and priority. METHODS We used an accepted six-stage methodological framework for scoping reviews as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature. RESULTS We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The postoperative seizure-free rates and quality of life (QOL) are comparable with those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resource-limited setting through collaboration with international partners and through the use of information and communications technology (ICT). The cost of surgery is a fraction of what is available in HIC. CONCLUSION This review has demonstrated the availability of epilepsy surgery in a few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.
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Affiliation(s)
- Musa M Watila
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Magnetic Resonance Imaging Unit, Epilepsy Society, Gerrards Cross, UK
| | - Mark R Keezer
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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Singh G, Sander JW. Neurocysticercosis as a probable risk factor for hippocampal sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:783-790. [DOI: 10.1590/0004-282x20180130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Neurocysticercosis is one of the most common risk factors for epilepsy but its association with drug-resistant epilepsy remains uncertain. Conjectures of an association with drug-resistant epilepsy have been fueled by reports of an association between calcific neurocysticercosis lesions (CNL) and hippocampal sclerosis (HS) from specialized epilepsy centers in Taenia solium-endemic regions. The debate arising from these reports is whether the association is causal. Evidence for the association is not high quality but sufficiently persuasive to merit further investigation with longitudinal imaging studies in population-based samples from geographically-diverse regions. The other controversial point is the choice of a surgical approach for drug-resistant epilepsy associated with CNL-HS. Three approaches have been described: standard anteromesial temporal lobectomy, lesionectomy involving a CNL alone and lesionectomy with anteromesial temporal lobectomy (for dual pathology); reports of the latter two approaches are limited. Presurgical evaluation should consider possibilities of delineating the epileptogenic zone/s in accordance with all three approaches.
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Affiliation(s)
- Gagandeep Singh
- Dayanand Medical College, India; NIHR University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Netherlands
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Guo J, Yang K, Liu H, Yin C, Xiang J, Li H, Ji R, Gao Y. A Stacked Sparse Autoencoder-Based Detector for Automatic Identification of Neuromagnetic High Frequency Oscillations in Epilepsy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:2474-2482. [PMID: 29994761 PMCID: PMC6299455 DOI: 10.1109/tmi.2018.2836965] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
High-frequency oscillations (HFOs) are spontaneous magnetoencephalography (MEG) patterns that have been acknowledged as a putative biomarker to identify epileptic foci. Correct detection of HFOs in the MEG signals is crucial for the accurate and timely clinical evaluation. Since the visual examination of HFOs is time-consuming, error-prone, and with poor inter-reviewer reliability, an automatic HFOs detector is highly desirable in clinical practice. However, the existing approaches for HFOs detection may not be applicable for MEG signals with noisy background activity. Therefore, we employ the stacked sparse autoencoder (SSAE) and propose an SSAE-based MEG HFOs (SMO) detector to facilitate the clinical detection of HFOs. To the best of our knowledge, this is the first attempt to conduct HFOs detection in MEG using deep learning methods. After configuration optimization, our proposed SMO detector is outperformed other classic peer models by achieving 89.9% in accuracy, 88.2% in sensitivity, and 91.6% in specificity. Furthermore, we have tested the performance consistency of our model using various validation schemes. The distribution of performance metrics demonstrates that our model can achieve steady performance.
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Elliott CA, Broad A, Narvacan K, Steve TA, Snyder T, Urlacher J, Wheatley BM, Sinclair DB. Seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery: selective amygdalohippocampectomy versus anterior temporal lobectomy. J Neurosurg Pediatr 2018; 22:276-282. [PMID: 29932370 DOI: 10.3171/2018.4.peds17607] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE). METHODS The authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing. RESULTS A total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1-16 years). The patients' average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher's exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up. CONCLUSIONS SelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - D Barry Sinclair
- 4Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
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44
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Conway L, Widjaja E, Smith ML. Single-item measure for assessing quality of life in children with drug-resistant epilepsy. Epilepsia Open 2018; 3:46-54. [PMID: 29588987 PMCID: PMC5839315 DOI: 10.1002/epi4.12088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The current study investigated the psychometric properties of a single-item quality of life (QOL) measure, the Global Quality of Life in Childhood Epilepsy question (G-QOLCE), in children with drug-resistant epilepsy. Method Data came from the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life Study (PESQOL), a multicenter prospective cohort study (n = 118) with observations collected at baseline and at 6 months of follow-up on children aged 4-18 years. QOL was measured with the QOLCE-76 and KIDSCREEN-27. The G-QOLCE was an overall QOL question derived from the QOLCE-76. Construct validity and reliability were assessed with Spearman's correlation and intraclass correlation coefficient (ICC). Responsiveness was examined through distribution-based and anchor-based methods. Results The G-QOLCE showed moderate (r ≥ 0.30) to strong (r ≥ 0.50) correlations with composite scores, and most subscales of the QOLCE-76 and KIDSCREEN-27 at baseline and 6-month follow-up. The G-QOLCE had moderate test-retest reliability (ICC range: 0.49-0.72) and was able to detect clinically important change in patients' QOL (standardized response mean: 0.38; probability of change: 0.65; Guyatt's responsiveness statistics: 0.62 and 0.78). Caregiver anxiety and family functioning contributed most strongly to G-QOLCE scores over time. Significance Results offer promising preliminary evidence regarding the validity, reliability, and responsiveness of the proposed single-item QOL measure. The G-QOLCE is a potentially useful tool that can be feasibly administered in a busy clinical setting to evaluate clinical status and impact of treatment outcomes in pediatric epilepsy.
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Affiliation(s)
- Lauryn Conway
- Department of PsychologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PsychologyUniversity of Toronto MississaugaMississaugaOntarioCanada
| | - Elysa Widjaja
- Division of NeurologyHospital for Sick ChildrenTorontoOntarioCanada
- Diagnostic ImagingHospital for Sick ChildrenTorontoOntarioCanada
| | - Mary Lou Smith
- Department of PsychologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PsychologyUniversity of Toronto MississaugaMississaugaOntarioCanada
- Division of NeurologyHospital for Sick ChildrenTorontoOntarioCanada
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Yee AS, Tharakan J, Idris Z, Bhaskar S, Halim SA, Razak SA, Hussin ZAM, Kandasamy R, Hassan WMNW, Mukmin L, Hassan MH, Chin TY, Idris B, Ghani ARI, Pal HK, George J, Sayuthi S, Awang MS, Abdullah JM. Epilepsy Surgery in Hospital Universiti Sains Malaysia: Our Experiences since 2004. Malays J Med Sci 2018; 24:97-102. [PMID: 29379392 DOI: 10.21315/mjms2017.24.6.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022] Open
Abstract
Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.
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Affiliation(s)
- Ang Song Yee
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - John Tharakan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Shalini Bhaskar
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Salmi Abd Razak
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zabidi Azhar Mohd Hussin
- Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Regunath Kandasamy
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Laila Mukmin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohamad Hasyizan Hassan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Tan Yew Chin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Badrisyah Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hillol Kanti Pal
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Jain George
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sani Sayuthi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohamed Saufi Awang
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Sultanah Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia
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46
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Quitadamo LR, Mai R, Gozzo F, Pelliccia V, Cardinale F, Seri S. Kurtosis-Based Detection of Intracranial High-Frequency Oscillations for the Identification of the Seizure Onset Zone. Int J Neural Syst 2018; 28:1850001. [PMID: 29577781 DOI: 10.1142/s0129065718500016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pathological High-Frequency Oscillations (HFOs) have been recently proposed as potential biomarker of the seizure onset zone (SOZ) and have shown superior accuracy to interictal epileptiform discharges in delineating its anatomical boundaries. Characterization of HFOs is still in its infancy and this is reflected in the heterogeneity of analysis and reporting methods across studies and in clinical practice. The clinical approach to HFOs identification and quantification usually still relies on visual inspection of EEG data. In this study, we developed a pipeline for the detection and analysis of HFOs. This includes preliminary selection of the most informative channels exploiting statistical properties of the pre-ictal and ictal intracranial EEG (iEEG) time series based on spectral kurtosis, followed by wavelet-based characterization of the time-frequency properties of the signal. We performed a preliminary validation analyzing EEG data in the ripple frequency band (80-250 Hz) from six patients with drug-resistant epilepsy who underwent pre-surgical evaluation with stereo-EEG (SEEG) followed by surgical resection of pathologic brain areas, who had at least two-year positive post-surgical outcome. In this series, kurtosis-driven selection and wavelet-based detection of HFOs had average sensitivity of 81.94% and average specificity of 96.03% in identifying the HFO area which overlapped with the SOZ as defined by clinical presurgical workup. Furthermore, the kurtosis-based channel selection resulted in an average reduction in computational time of 66.60%.
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Affiliation(s)
- Lucia Rita Quitadamo
- 1 School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, B4 7ET, UK
| | - Roberto Mai
- 2 Centro per la Chirurgia dell'Epilessia "Claudio Munari", Ospedale Ca' Granda-Niguarda, 20162 Milan, Italy
| | - Francesca Gozzo
- 2 Centro per la Chirurgia dell'Epilessia "Claudio Munari", Ospedale Ca' Granda-Niguarda, 20162 Milan, Italy
| | - Veronica Pelliccia
- 2 Centro per la Chirurgia dell'Epilessia "Claudio Munari", Ospedale Ca' Granda-Niguarda, 20162 Milan, Italy
| | - Francesco Cardinale
- 2 Centro per la Chirurgia dell'Epilessia "Claudio Munari", Ospedale Ca' Granda-Niguarda, 20162 Milan, Italy
| | - Stefano Seri
- 1 School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, B4 7ET, UK.,3 Department of Clinical Neurophysiology, The Birmingham Children's Hospital NHS, F. Trust, Birmingham, UK
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47
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Olivares-Granados G, Ríos-Pelegrina RM, Ruiz-Giménez J, Galdón-Castillo A, Escobar-Delgado T, García del Moral R. Definición clínico-patológica de los subtipos de epilepsia temporal medial con esclerosis del hipocampo. Neurocirugia (Astur) 2018; 29:9-17. [DOI: 10.1016/j.neucir.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 01/02/2023]
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48
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Sinclair G, Martin H, Shamikh A, Samadi A, Cooray G, Bartek J, Al-Saffar Y, Svensson M, Dodoo E. Salvage gamma knife radiosurgery in the management of dysembryoplastic neuroepithelial tumors: Long-term outcome in a single-institution case series. Surg Neurol Int 2017; 8:174. [PMID: 28868186 PMCID: PMC5569391 DOI: 10.4103/sni.sni_482_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/30/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNT/DNET) are rare epileptogenic tumors. Microsurgery remains the best treatment option, although case reports exist on the use of gamma knife radiosurgery (GKRS) in selected cases. We investigated the long-term outcome of GKRS-treated DNTs at our institution in the context of current diagnostic and treatment options. CASE DESCRIPTIONS We conducted a retrospective review of three consecutive adult patients (≥18 years) treated with salvage GKRS between 2002 and 2010 at Karolinska University Hospital, Stockholm, Sweden. The case series was supplemented by a review of current literature. A 20-year-old male underwent subtotal resection (STR) in 1997 and 2002 of DNT resulting in temporary control of intractable epilepsy despite antiepileptic drug treatment (AED). Long-term seizure control was obtained after GKRS of two separate residual DNT components along the surgical margin (2005 and 2010). A 27-year-old male undergoing gross total resection of the contrast-enhancing portion of a DNT (1999) resulted in temporary control of intractable epilepsy despite AEDs; lasting clinical control of seizures was achieved in 2002 after GKRS of a small, recurrent DNT component. A 28-year-old male underwent STR of DNT (1994 and 2004) resulting in temporary control of intractable epilepsy. Lasting seizure control was gained after GKRS of a residual tumor (2005). CONCLUSION GKRS as performed in our series was effective in terms of tumor and seizure control. No adverse radiation effects were recorded. Prospective studies are warranted to establish the role of GKRS in the treatment of DNTs.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Alia Shamikh
- Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Samadi
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gerald Cooray
- Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Yehya Al-Saffar
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ernest Dodoo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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49
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Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments. World Neurosurg 2017; 104:411-417. [DOI: 10.1016/j.wneu.2017.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
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50
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Avila EK, Chamberlain M, Schiff D, Reijneveld JC, Armstrong TS, Ruda R, Wen PY, Weller M, Koekkoek JAF, Mittal S, Arakawa Y, Choucair A, Gonzalez-Martinez J, MacDonald DR, Nishikawa R, Shah A, Vecht CJ, Warren P, van den Bent MJ, DeAngelis LM. Seizure control as a new metric in assessing efficacy of tumor treatment in low-grade glioma trials. Neuro Oncol 2016; 19:12-21. [PMID: 27651472 DOI: 10.1093/neuonc/now190] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patients with low-grade glioma frequently have brain tumor-related epilepsy, which is more common than in patients with high-grade glioma. Treatment for tumor-associated epilepsy usually comprises a combination of surgery, anti-epileptic drugs (AEDs), chemotherapy, and radiotherapy. Response to tumor-directed treatment is measured primarily by overall survival and progression-free survival. However, seizure frequency has been observed to respond to tumor-directed treatment with chemotherapy or radiotherapy. A review of the current literature regarding seizure assessment for low-grade glioma patients reveals a heterogeneous manner in which seizure response has been reported. There is a need for a systematic approach to seizure assessment and its influence on health-related quality-of-life outcomes in patients enrolled in low-grade glioma therapeutic trials. In view of the need to have an adjunctive metric of tumor response in these patients, a method of seizure assessment as a metric in brain tumor treatment trials is proposed.
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Affiliation(s)
- Edward K Avila
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Marc Chamberlain
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - David Schiff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Jaap C Reijneveld
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Terri S Armstrong
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Roberta Ruda
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Patrick Y Wen
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Michael Weller
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Johan A F Koekkoek
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Sandeep Mittal
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Yoshiki Arakawa
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Ali Choucair
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Jorge Gonzalez-Martinez
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - David R MacDonald
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Ryo Nishikawa
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Aashit Shah
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Charles J Vecht
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Paula Warren
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Martin J van den Bent
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (E.K.A., L.M.D.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurology, University of Virginia, Charlottesville, Virginia (D.S.); Department of Neurology, VUmc Cancer Center, Amsterdam, Netherlands (J.C.R.); Department of Family Health, University of Texas Health Science Center, Houston, Texas (T.S.A.); Department of Neuro-Oncology, City of Health and Science Hospital, Torino, Italy (R.R.); Center for Neuro-Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Center, Boston, Massachusetts (P.W.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurology, Leiden University Medical Center, The Hague, Netherlands (J.A.F.K.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (S.M.); Department of Neurosurgery, Kyoto University School of Graduate Medicine, Kyoto, Japan (Y.A.); Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois (A.C.); Department of Epilepsy and Surgery Center, Cleveland Clinic, Cleveland, Ohio (J.G.-M.); Department of Neurology, London Health Sciences Center, London, Ontario, Canada (D.R.M.); Department of Neurosurgery, Saitama Medical University, Saitama, Japan (R.N.); Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan (A.S.); Service Neurologie Mazarin, CHU Pitie-Salpetriere, Paris, France (C.J.V.); Department of Neurology, University of Alabama, Birmingham, Alabama (P.W.); Department of Neuro-Oncology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.)
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