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Wang SH, Siebenhühner F, Arnulfo G, Myrov V, Nobili L, Breakspear M, Palva S, Palva JM. Critical-like Brain Dynamics in a Continuum from Second- to First-Order Phase Transition. J Neurosci 2023; 43:7642-7656. [PMID: 37816599 PMCID: PMC10634584 DOI: 10.1523/jneurosci.1889-22.2023] [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: 10/05/2022] [Revised: 06/07/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
The classic brain criticality hypothesis postulates that the brain benefits from operating near a continuous second-order phase transition. Slow feedback regulation of neuronal activity could, however, lead to a discontinuous first-order transition and thereby bistable activity. Observations of bistability in awake brain activity have nonetheless remained scarce and its functional significance unclear. Moreover, there is no empirical evidence to support the hypothesis that the human brain could flexibly operate near either a first- or second-order phase transition despite such a continuum being common in models. Here, using computational modeling, we found bistable synchronization dynamics to emerge through elevated positive feedback and occur exclusively in a regimen of critical-like dynamics. We then assessed bistability in vivo with resting-state MEG in healthy adults (7 females, 11 males) and stereo-electroencephalography in epilepsy patients (28 females, 36 males). This analysis revealed that a large fraction of the neocortices exhibited varying degrees of bistability in neuronal oscillations from 3 to 200 Hz. In line with our modeling results, the neuronal bistability was positively correlated with classic assessment of brain criticality across narrow-band frequencies. Excessive bistability was predictive of epileptic pathophysiology in the patients, whereas moderate bistability was positively correlated with task performance in the healthy subjects. These empirical findings thus reveal the human brain as a one-of-a-kind complex system that exhibits critical-like dynamics in a continuum between continuous and discontinuous phase transitions.SIGNIFICANCE STATEMENT In the model, while synchrony per se was controlled by connectivity, increasing positive local feedback led to gradually emerging bistable synchrony with scale-free dynamics, suggesting a continuum between second- and first-order phase transitions in synchrony dynamics inside a critical-like regimen. In resting-state MEG and SEEG, bistability of ongoing neuronal oscillations was pervasive across brain areas and frequency bands and was observed only with concurring critical-like dynamics as the modeling predicted. As evidence for functional relevance, moderate bistability was positively correlated with executive functioning in the healthy subjects, and excessive bistability was associated with epileptic pathophysiology. These findings show that critical-like neuronal dynamics in vivo involves both continuous and discontinuous phase transitions in a frequency-, neuroanatomy-, and state-dependent manner.
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Affiliation(s)
- Sheng H Wang
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- Doctoral Programme Brain & Mind, University of Helsinki, 00014 Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Center, 00290 Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, 00076 Espoo, Finland
| | - Felix Siebenhühner
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Center, 00290 Helsinki, Finland
| | - Gabriele Arnulfo
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, 16136 Genoa, Italy
| | - Vladislav Myrov
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, 00076 Espoo, Finland
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children's Sciences, University of Genoa, 16136 Genoa, Italy
- Child Neuropsychiatry Unit, Istituto Di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, 16147 Genoa, Italy
- Centre of Epilepsy Surgery "C. Munari," Department of Neuroscience, Niguarda Hospital, 20162 Milan, Italy
| | - Michael Breakspear
- College of Engineering, Science and Environment, College of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
| | - Satu Palva
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience & Psychology, University of Glasgow, Glasgow G12 8QB, United Kingdom
| | - J Matias Palva
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, 00076 Espoo, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience & Psychology, University of Glasgow, Glasgow G12 8QB, United Kingdom
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Ricci L, Matarrese M, Peters JM, Tamilia E, Madsen JR, Pearl PL, Papadelis C. Virtual implantation using conventional scalp EEG delineates seizure onset and predicts surgical outcome in children with epilepsy. Clin Neurophysiol 2022; 139:49-57. [PMID: 35526353 PMCID: PMC10026594 DOI: 10.1016/j.clinph.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delineation of the seizure onset zone (SOZ) is required in children with drug resistant epilepsy (DRE) undergoing neurosurgery. Intracranial EEG (icEEG) serves as gold standard but has limitations. Here, we examine the utility of virtual implantation with electrical source imaging (ESI) on ictal scalp EEG for mapping the SOZ and predict surgical outcome. METHODS We retrospectively analyzed EEG data from 35 children with DRE who underwent surgery and dichotomized into seizure-free (SF) and non-seizure-free (NSF). We estimated virtual sensors (VSs) at brain locations that matched icEEG implantation and compared ictal patterns at VSs vs icEEG. We calculated the agreement between VSs SOZ and clinically defined SOZ and built receiver operating characteristic (ROC) curves to test whether it predicted outcome. RESULTS Twenty-one patients were SF after surgery. Moderate agreement between virtual and icEEG patterns was observed (kappa = 0.45, p < 0.001). Virtual SOZ agreement with clinically defined SOZ was higher in SF vs NSF patients (66.6% vs 41.6%, p = 0.01). Anatomical concordance of virtual SOZ with clinically defined SOZ predicted outcome (AUC = 0.73; 95% CI: 0.57-0.89; sensitivity = 66.7%; specificity = 78.6%; accuracy = 71.4%). CONCLUSIONS Virtual implantation on ictal scalp EEG can approximate the SOZ and predict outcome. SIGNIFICANCE SOZ mapping with VSs may contribute to tailoring icEEG implantation and predict outcome.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Margherita Matarrese
- Unit of Non-Linear Physics and Mathematical Modelling, Engineering Department, University Campus Bio-Medico of Rome, Rome, Italy; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University, Fort Worth, TX, USA.
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3
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Pelliccia V, Avanzini P, Rizzi M, Caruana F, Tassi L, Francione S, Gozzo F, Mariani V, d'Orio P, Castana L, Mai R, Terzaghi M, Nobili L, Sartori I. Association Between Semiology and Anatomo-Functional Localization in Patients With Cingulate Epilepsy: A Cohort Study. Neurology 2022; 98:e2211-e2223. [PMID: 35190463 DOI: 10.1212/wnl.0000000000200145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cingulate epilepsy (CE) is a rare and challenging type of focal epilepsy, due to the polymorphic semiology of the seizures, mimicking other types of epilepsy, and the limited utility of scalp-EEG. METHODS We selected consecutive drug-resistant subjects with CE who were seizure-free after surgery, with seizure onset zone (SOZ) confirmed in the CC (cingulate cortex) by histology and/or SEEG. We analysed subjective and objective ictal manifestations using video recordings and correlated semeiology with anatomical CC subregions (anterior, anterior middle, posterior middle and posterior) localization of SOZ. RESULTS We analysed 122 seizures in 57 patients. Seizures were globally characterized by complex behaviors, typically natural seeming and often accompanied by emotional components.All objective ictal variables considered (pronation of the body or getting up from a lying/sitting position, tonic/dystonic posturing, hand movements, asymmetry, vocalizations, fluidity and repetitiveness of motor manifestations, awareness and emotional and autonomic components) were differently distributed among CC subregions (p<.05) Along the rostro-caudal axis fluidity and repetitiveness of movement, vocalizations, body pronation and emotional components decrease anterior-posteriorly, while tonic/dystonic postures, signs of lateralization and awareness increase.Vestibular and asymmetric somatosensory, somatosensory and epigastric and enteroceptive/autonomic symptoms were distributed differently among CC subregions (p<.05). Along the rostro-caudal axis vestibular, somatosensory and somatosensory asymmetric symptoms increase anterior-posterior. DISCUSSION CE is characterized by a spectrum of semeiological manifestations with a topographic distribution. CE semiology could indicate which cingulate sector is mainly involved.
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Affiliation(s)
- Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Michele Rizzi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,CNR Institute of Neuroscience, Parma, Italy
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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Boop S, Barkley A, Emerson S, Prolo LM, Goldstein H, Ojemann JG, Hauptman JS. Robot-assisted stereoelectroencephalography in young children: technical challenges and considerations. Childs Nerv Syst 2022; 38:263-267. [PMID: 34716458 DOI: 10.1007/s00381-021-05384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Robot-assisted stereoelectroencephalography (sEEG) is frequently employed to localize epileptogenic zones in patients with medically refractory epilepsy (MRE). Its methodology is well described in adults, but less so in children. Given the limited information available on pediatric applications, the objective is to describe the unique technical challenges and considerations of sEEG in the pediatric population. In this report, we describe our institutional experience with the technical aspects of robot-assisted sEEG in an exclusively pediatric epilepsy surgery unit, focusing on pre-, intra-, and post-operative nuances that are particular to the pediatric population. The pediatric population presents several unique challenges in sEEG, including reduced skull thickness relative to adults, incomplete neurologic development, and often special behavioral considerations. Pre-operative selection of putative epileptogenic zones requires careful multidisciplinary decision-making. Intraoperative attention to nuances in positioning, clamp selection, registration, and electrode placement are necessary. Activity considerations and electrode migration and removal are key post-operative considerations. Robot-assisted sEEG is a valuable tool in the armamentarium of techniques to characterize MRE. However, special considerations must be given to the pediatric population to optimize safety and efficacy.
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Affiliation(s)
- Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Ariana Barkley
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Samuel Emerson
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Hannah Goldstein
- Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.,Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA. .,Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA.
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5
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Lee CC, Chou CC, Hsiao FJ, Chen YH, Lin CF, Chen CJ, Peng SJ, Liu HL, Yu HY. Pilot study of focused ultrasound for drug-resistant epilepsy. Epilepsia 2021; 63:162-175. [PMID: 34729772 PMCID: PMC9297900 DOI: 10.1111/epi.17105] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 02/04/2023]
Abstract
Objective The neuromodulatory effects of focused ultrasound (FUS) have been demonstrated in animal epilepsy models; however, the safety and efficacy of FUS in humans with epilepsy have not been well established. Patients with drug‐resistant epilepsy (DRE) undergoing stereo‐electroencephalography (SEEG) provide an opportunity to investigate the neuromodulatory effects of FUS in humans. Methods Patients with DRE undergoing SEEG for localization of the seizure onset zone (SOZ) were prospectively enrolled. FUS was delivered to the SOZ using a neuronavigation‐guided FUS system (ceiling spatial‐peak temporal‐average intensity level = 2.8 W/cm2, duty cycle = 30%, modulating duration = 10 min). Simultaneous SEEG recordings were obtained during sonication and for 3 days after treatment. Seizures, interictal epileptiform discharges, and adverse events after FUS were monitored. Results Six patients met the eligibility criteria and completed FUS treatment. A decrease in seizure frequency was observed in two patients within the 3‐day follow‐up; however, one patient presented an increase in the frequency of subclinical seizures. Posttreatment magnetic resonance imaging revealed neither lesion nor brain edema. Significant changes in spectral power of SEEG were noted at the targeted electrodes during FUS treatment. One patient reported subjective scalp heating during FUS, and one patient developed transient naming and memory impairment that resolved within 3 weeks after FUS. Significance FUS can be safely delivered to the SOZ of patients with DRE, resulting in significant changes in spectral power of SEEG. A larger sample cohort and pursuing optimal sonication parameters will be required to elucidate the neuromodulatory effects of FUS when used for seizure control.
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Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chen Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsiu Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hao-Li Liu
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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6
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Yazdani M, Reagan J, Kocher M, Antonucci M, Taylor J, Edwards J, Vandergrift WA, Spampinato MV. Safety of MRI in the localization of implanted intracranial electrodes for refractory epilepsy. J Neuroimaging 2021; 31:551-559. [PMID: 33783916 DOI: 10.1111/jon.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/27/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE This is an observational study to evaluate the safety of magnetic resonance imaging (MRI) to localize subdural grids and depth electrodes in patients with refractory epilepsy using a 1.5 Tesla MR scanner. METHODS We implemented an optimized MRI protocol providing adequate image quality for the assessment of subdural grids and depth electrodes, while minimizing the specific absorption rate (SAR). We reviewed all MRI studies performed in patients with subdural grids and depth electrodes between January 2010 and October 2018. Image quality was graded as acceptable or nonacceptable for the assessment of intracranial device positioning. We reviewed the medical record and any imaging obtained after intracranial implant removal for adverse event or complication occurring during and after the procedure. RESULTS Ninety-nine patients with refractory epilepsy underwent MRI scans using a magnetization-prepared rapid acquisition of gradient echo sequence and a transmit-receive head coil with depth electrodes and subdural grids in place. Two patients underwent two separate depth electrode implantations for a total of 101 procedures and MRI scans. No clinical adverse events were reported during or immediately after imaging. Image quality was graded as acceptable for 97 MRI scans. Review of follow-up CT and MRI studies after implant removal, available for 70 patients, did not demonstrate unexpected complications in 69 patients. CONCLUSION In our experience, a low SAR MRI protocol can be used to safely localize intracranial subdural grids and depth electrode in patients with refractory epilepsy.
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Affiliation(s)
- Milad Yazdani
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Justin Reagan
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Madison Kocher
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Michael Antonucci
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - James Taylor
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Jonathan Edwards
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC
| | | | - Maria Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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Sokolov E, Sisterson ND, Hussein H, Plummer C, Corson D, Antony AR, Mettenburg JM, Ghearing GR, Pan JW, Urban A, Bagić A, Richardson RM, Kokkinos V. Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data. Epilepsia Open 2021; 7:36-45. [PMID: 34786887 PMCID: PMC8886064 DOI: 10.1002/epi4.12483] [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: 12/25/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The question of whether a patient with presumed temporal lobe seizures should proceed directly to temporal lobectomy surgery versus undergo intracranial monitoring arises commonly. We evaluate the effect of intracranial monitoring on seizure outcome in a retrospective cohort of consecutive subjects who specifically underwent an anterior temporal lobectomy (ATL) for refractory temporal lobe epilepsy (TLE). Methods We performed a retrospective analysis of 85 patients with focal refractory TLE who underwent ATL following: (a) intracranial monitoring via craniotomy and subdural/depth electrodes (SDE/DE), (b) intracranial monitoring via stereotactic electroencephalography (sEEG), or (c) no intracranial monitoring (direct ATL—dATL). For each subject, the presurgical primary hypothesis for epileptogenic zone localization was characterized as unilateral TLE, unilateral TLE plus (TLE+), or TLE with bilateral/poor lateralization. Results At one‐year and most recent follow‐up, Engel Class I and combined I/II outcomes did not differ significantly between the groups. Outcomes were better in the dATL group compared to the intracranial monitoring groups for lesional cases but were similar in nonlesional cases. Those requiring intracranial monitoring for a hypothesis of TLE+had similar outcomes with either intracranial monitoring approach. sEEG was the only approach used in patients with bilateral or poorly lateralized TLE, resulting in 77.8% of patients seizure‐free at last follow‐up. Importantly, for 85% of patients undergoing SEEG, recommendation for ATL resulted from modifying the primary hypothesis based on iEEG data. Significance Our study highlights the value of intracranial monitoring in equalizing seizure outcomes in difficult‐to‐treat TLE patients undergoing ATL.
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Affiliation(s)
- Elisaveta Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Helweh Hussein
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheryl Plummer
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Danielle Corson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Arun R Antony
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Gena R Ghearing
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jullie W Pan
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Urban
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anto Bagić
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Vasileios Kokkinos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
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8
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Sarasso S, Zubler F, Pigorini A, Sartori I, Castana L, Nobili L. Thalamic and neocortical differences in the relationship between the time course of delta and sigma power during NREM sleep in humans. J Sleep Res 2020; 30:e13166. [PMID: 32830381 DOI: 10.1111/jsr.13166] [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: 04/11/2020] [Revised: 06/14/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
Sleep spindles and slow waves are the hallmarks of non-rapid eye movement (NREM) sleep and are produced by the dynamic interplay between thalamic and cortical regions. Several studies in both human and animal models have focused their attention on the relationship between electroencephalographic (EEG) spindles and slow waves during NREM, using the power in the sigma and delta bands as a surrogate for the production of spindles and slow waves. A typical report is an overall inverse relationship between the time course of sigma and delta power as measured by a single correlation coefficient both within and across NREM episodes. Here we analysed stereotactically implanted intracerebral electrode (Stereo-EEG [SEEG]) recordings during NREM simultaneously acquired from thalamic and from several neocortical sites in six neurosurgical patients. We investigated the relationship between the time course of delta and sigma power and found that, although at the cortical level it shows the expected inverse relationship, these two frequency bands follow a parallel time course at the thalamic level. Both these observations were consistent across patients and across different cortical as well as thalamic regions. These different temporal dynamics at the neocortical and thalamic level are discussed, considering classical as well as more recent interpretations of the neurophysiological determinants of sleep spindles and slow waves. These findings may also help understanding the regulatory mechanisms of these fundamental sleep EEG graphoelements across different brain compartments.
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Affiliation(s)
- Simone Sarasso
- Dipartimento di Scienze Biomediche e Cliniche ''L. Sacco'', Università degli Studi di Milano, Milan, Italy
| | - Frederic Zubler
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Pigorini
- Dipartimento di Scienze Biomediche e Cliniche ''L. Sacco'', Università degli Studi di Milano, Milan, Italy
| | - Ivana Sartori
- Claudio Munari" Centre for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Laura Castana
- Claudio Munari" Centre for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
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9
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Peedicail JS, Almohawes A, Hader W, Starreveld Y, Singh S, Josephson CB, Murphy W, Federico P, Wiebe S, Pillay N, Agha‐Khani Y, Jette N, Avendano R, Hanna S. Outcomes of stereoelectroencephalography exploration at an epilepsy surgery center. Acta Neurol Scand 2020; 141:463-472. [PMID: 32057089 DOI: 10.1111/ane.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/13/2019] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Epilepsy surgery is offered in resistant focal epilepsy. Non-invasive investigations like scalp video EEG monitoring (SVEM) help delineate epileptogenic zone. Complex cases may require intracranial video EEG monitoring (IVEM). Stereoelectroencephalography (SEEG)-based intracerebral electrode implantation has better spatial resolution, lower morbidity, better tolerance, and superiority in sampling deep structures. Our objectives were to assess IVEM using SEEG with regard to reasoning behind implantation, course, surgical interventions, and outcomes. MATERIALS AND METHODS Seventy-two admissions for SEEG from January 2014 to December 2018 were included in the study. Demographic and clinical data were retrospectively collected. RESULTS The cohort comprised of 69 adults of which 34 (47%) had lesional MRI. Reasons for SEEG considering all cases included non-localizing ictal onset (76%), ictal-interictal discordance (21%), discordant semiology (17%), proximity to eloquent cortex (33%), nuclear imaging discordance (34%), and discordance with neuropsychology (19%). Among lesional cases, additional reasons included SVEM discordance (68%) and dual or multiple pathology (47%). Forty-eight patients (67%) were offered resective surgery, and 41 underwent it. Twenty-three (56%) had at least one year post-surgical follow-up of which 14 (61%) had Engels class I outcome. Of the remaining 23 who were continued on medical management, 4 (17%) became seizure-free and 12 (51%) had reduction in seizure frequency. CONCLUSION SEEG monitoring is an important and safe tool for presurgical evaluation with good surgical and non-surgical outcomes. Whether seizure freedom following non-surgical management could be related to SEEG implantation, medication change, or natural course needs to be determined.
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Affiliation(s)
- Joseph Samuel Peedicail
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Amal Almohawes
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Walter Hader
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Yves Starreveld
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Shaily Singh
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Colin Bruce Josephson
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - William Murphy
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Paolo Federico
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Samuel Wiebe
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Neelan Pillay
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Yahya Agha‐Khani
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Nathalie Jette
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Rey Avendano
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
| | - Salma Hanna
- Calgary Comprehensive Epilepsy Program Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Canada
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Artoni F, d'Orio P, Catricalà E, Conca F, Bottoni F, Pelliccia V, Sartori I, Russo GL, Cappa SF, Micera S, Moro A. High gamma response tracks different syntactic structures in homophonous phrases. Sci Rep 2020; 10:7537. [PMID: 32372065 PMCID: PMC7200802 DOI: 10.1038/s41598-020-64375-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/13/2020] [Indexed: 11/08/2022] Open
Abstract
Syntax is a species-specific component of human language combining a finite set of words in a potentially infinite number of sentences. Since words are by definition expressed by sound, factoring out syntactic information is normally impossible. Here, we circumvented this problem in a novel way by designing phrases with exactly the same acoustic content but different syntactic structures depending on the other words they occur with. In particular, we used phrases merging an article with a noun yielding a Noun Phrase (NP) or a clitic with a verb yielding a Verb Phrase (VP). We performed stereo-electroencephalographic (SEEG) recordings in epileptic patients. We measured a different electrophysiological correlates of verb phrases vs. noun phrases in multiple cortical areas in both hemispheres, including language areas and their homologous in the non-dominant hemisphere. The high gamma band activity (150-300 Hz frequency), which plays a crucial role in inter-regional cortical communications, showed a significant difference during the presentation of the homophonous phrases, depending on whether the phrase was a verb phrase or a noun phrase. Our findings contribute to the ultimate goal of a complete neural decoding of linguistic structures from the brain.
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Affiliation(s)
- Fiorenzo Artoni
- The Biorobotics Institute and Department of Excellence in AI and Robotics, Scuola Superiore Sant'Anna, Pisa, Italy
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, EPFL - Campus Biotech, Geneve, Switzerland
| | - Piergiorgio d'Orio
- "Claudio Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Institute of Neuroscience, CNR, Parma, Italy
| | - Eleonora Catricalà
- Neurocognition Epistemology and theoretical Syntax Research Center (NEtS), Scuola Universitaria Superiore IUSS, Pavia, Italy
| | - Francesca Conca
- Neurocognition Epistemology and theoretical Syntax Research Center (NEtS), Scuola Universitaria Superiore IUSS, Pavia, Italy
| | | | - Veronica Pelliccia
- "Claudio Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Institute of Neuroscience, CNR, Parma, Italy
| | - Ivana Sartori
- "Claudio Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano F Cappa
- Neurocognition Epistemology and theoretical Syntax Research Center (NEtS), Scuola Universitaria Superiore IUSS, Pavia, Italy
- IRCCS Mondino Foundation National Institute of Neurology, Pavia, Italy
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in AI and Robotics, Scuola Superiore Sant'Anna, Pisa, Italy.
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, EPFL - Campus Biotech, Geneve, Switzerland.
| | - Andrea Moro
- Neurocognition Epistemology and theoretical Syntax Research Center (NEtS), Scuola Universitaria Superiore IUSS, Pavia, Italy.
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Yan H, Katz JS, Anderson M, Mansouri A, Remick M, Ibrahim GM, Abel TJ. Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review. Epilepsia 2019; 60:1960-1972. [PMID: 31423575 DOI: 10.1111/epi.16315] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). METHODS We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords "electroencephalography," "intracranial grid," and "epilepsy." Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow-up or complication rates of SEEG- or SDE-monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. RESULTS Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7-6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = -10.6%, 95% CI = -11.6 to -9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = -0.2%, 95% CI = -0.3 to -0.1%, P = .001). SIGNIFICANCE In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.
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Affiliation(s)
- Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel S Katz
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melanie Anderson
- Library and Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Diagnostic evaluation and surgical management of pediatric insular epilepsy utilizing magnetoencephalography and invasive EEG monitoring. Epilepsy Res 2018; 140:72-81. [DOI: 10.1016/j.eplepsyres.2017.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 11/28/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
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van der Loo LE, Schijns OEMG, Hoogland G, Colon AJ, Wagner GL, Dings JTA, Kubben PL. Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography. Acta Neurochir (Wien) 2017; 159:1733-1746. [PMID: 28676892 PMCID: PMC5557874 DOI: 10.1007/s00701-017-3242-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Background Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications. Objective To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations. Methods All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported. Results Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%). Conclusions This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
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Rossini L, Garbelli R, Gnatkovsky V, Didato G, Villani F, Spreafico R, Deleo F, Lo Russo G, Tringali G, Gozzo F, Tassi L, de Curtis M. Seizure activity per se does not induce tissue damage markers in human neocortical focal epilepsy. Ann Neurol 2017; 82:331-341. [PMID: 28749594 DOI: 10.1002/ana.25005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The contribution of recurring seizures to the progression of epileptogenesis is debated. Seizure-induced brain damage is not conclusively demonstrated either in humans or in animal models of epilepsy. We evaluated the expression of brain injury biomarkers on postsurgical brain tissue obtained from 20 patients with frequent seizures and a long history of drug-resistant focal epilepsy. METHODS The expression patterns of specific glial, neuronal, and inflammatory molecules were evaluated by immunohistochemistry in the core of type II focal cortical dysplasias (FCD-II), at the FCD boundary (perilesion), and in the adjacent normal-appearing area included in the epileptogenic region. We also analyzed surgical specimens from cryptogenic patients not presenting structural alterations at imaging. RESULTS Astroglial and microglial activation, reduced neuronal density, perivascular CD3-positive T-lymphocyte clustering, and fibrinogen extravasation were demonstrated in the core of FCD-II lesions. No pathological immunoreactivity was observed outside the FCD-II or in cryptogenetic specimens, where the occurrence of interictal and ictal epileptiform activity was confirmed by either stereo-electroencephalography or intraoperative electrocorticography. INTERPRETATION Recurrent seizures do not induce the expression of brain damage markers in nonlesional epileptogenic cortex studied in postsurgical tissue from cryptogenic and FCD patients. This evidence argues against the hypothesis that epileptiform activity per se contributes to focal brain injury, at least in the neocortical epilepsies considered here. Ann Neurol 2017;82:331-341.
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Affiliation(s)
- Laura Rossini
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | - Rita Garbelli
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | | | | | - Flavio Villani
- Epilepsy Unit, C. Besta Neurological Institute Foundation
| | | | | | | | - Giovanni Tringali
- Neurosurgery Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | | | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital
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Freri E, Matricardi S, Gozzo F, Cossu M, Granata T, Tassi L. Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome. Epilepsia 2017. [DOI: 10.1111/epi.13816] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Freri
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Sara Matricardi
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Francesca Gozzo
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - Massimo Cossu
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience; Foundation I.R.C.C.S. Neurological Institute “C. Besta”; Milan Italy
| | - Laura Tassi
- “C. Munari” Epilepsy Surgery Centre; Niguarda Hospital; Milan Italy
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Donos C, Mîndruţă I, Malîia MD, Raşină A, Ciurea J, Barborica A. Co-occurrence of high-frequency oscillations and delayed responses evoked by intracranial electrical stimulation in stereo-EEG studies. Clin Neurophysiol 2017; 128:1043-1052. [DOI: 10.1016/j.clinph.2016.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Bhattacharyya PK, Mullin J, Lee BS, Gonzalez-Martinez JA, Jones SE. Safety of externally stimulated intracranial electrodes during functional MRI at 1.5 T. Magn Reson Imaging 2017; 38:182-188. [DOI: 10.1016/j.mri.2017.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 11/16/2022]
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Cossu M, Cardinale F, Casaceli G, Castana L, Consales A, D'Orio P, Lo Russo G. Stereo-EEG-guided radiofrequency thermocoagulations. Epilepsia 2017; 58 Suppl 1:66-72. [DOI: 10.1111/epi.13687] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo Cossu
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Francesco Cardinale
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giuseppe Casaceli
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Laura Castana
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | | | - Piergiorgio D'Orio
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giorgio Lo Russo
- “Claudio Munari” Center for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
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Narizzano M, Arnulfo G, Ricci S, Toselli B, Tisdall M, Canessa A, Fato MM, Cardinale F. SEEG assistant: a 3DSlicer extension to support epilepsy surgery. BMC Bioinformatics 2017; 18:124. [PMID: 28231759 PMCID: PMC5324222 DOI: 10.1186/s12859-017-1545-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 02/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background In the evaluation of Stereo-Electroencephalography (SEEG) signals, the physicist’s workflow involves several operations, including determining the position of individual electrode contacts in terms of both relationship to grey or white matter and location in specific brain regions. These operations are (i) generally carried out manually by experts with limited computer support, (ii) hugely time consuming, and (iii) often inaccurate, incomplete, and prone to errors. Results In this paper we present SEEG Assistant, a set of tools integrated in a single 3DSlicer extension, which aims to assist neurosurgeons in the analysis of post-implant structural data and hence aid the neurophysiologist in the interpretation of SEEG data. SEEG Assistant consists of (i) a module to localize the electrode contact positions using imaging data from a thresholded post-implant CT, (ii) a module to determine the most probable cerebral location of the recorded activity, and (iii) a module to compute the Grey Matter Proximity Index, i.e. the distance of each contact from the cerebral cortex, in order to discriminate between white and grey matter location of contacts. Finally, exploiting 3DSlicer capabilities, SEEG Assistant offers a Graphical User Interface that simplifies the interaction between the user and the tools. SEEG Assistant has been tested on 40 patients segmenting 555 electrodes, and it has been used to identify the neuroanatomical loci and to compute the distance to the nearest cerebral cortex for 9626 contacts. We also performed manual segmentation and compared the results between the proposed tool and gold-standard clinical practice. As a result, the use of SEEG Assistant decreases the post implant processing time by more than 2 orders of magnitude, improves the quality of results and decreases, if not eliminates, errors in post implant processing. Conclusions The SEEG Assistant Framework for the first time supports physicists by providing a set of open-source tools for post-implant processing of SEEG data. Furthermore, SEEG Assistant has been integrated into 3D Slicer, a software platform for the analysis and visualization of medical images, overcoming limitations of command-line tools.
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Affiliation(s)
- Massimo Narizzano
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Gabriele Arnulfo
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy.
| | - Serena Ricci
- Departement of Physiology Pharmacology and Neuroscience, CUNY Medical School, New York, New York, USA
| | - Benedetta Toselli
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Martin Tisdall
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, WC1N 3JH, London, UK
| | - Andrea Canessa
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Marco Massimo Fato
- Department of Informatics, Bioengineering Robotics and System engineering (DIBRIS), University of Genoa, Viale Causa 13, Genova, 16143, Italy
| | - Francesco Cardinale
- "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
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Park JT, Baca Vaca GF, Avery J, Miller JP. Utility of Stereoelectroencephalography in Children with Dysembryoplastic Neuroepithelial Tumor and Cortical Malformation. Neurodiagn J 2017; 57:191-210. [PMID: 28898173 DOI: 10.1080/21646821.2017.1326270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Uncontrolled seizures in children can contribute to irreversible cognitive impairment and developmental delay, in addition to placing them at risk for sudden unexplained death in epileptic patients (SUDEP). Since its introduction at Saint Ann Hospital in Paris in the 1960s, stereoelectroencephalography (SEEG) is increasingly being utilized at epilepsy centers in the United States as an invasive tool to help localize the seizure focus in drug-resistant focal epilepsy. INDICATIONS Children with symptomatic epilepsy, commonly due to cortical dysplasia and dysembryoplastic neuroepithelial tumor (DNET), may benefit from SEEG investigation. The arrangement of SEEG electrodes is individually tailored based on the suspected location of the epileptogenic zone (EZ). The implanted depth electrodes are used to electrically stimulate the corresponding cortices to obtain information about the topography of eloquent cortex and EZ. Morbidity: Surgical morbidity in these children undergoing SEEG investigation is low, but not negligible. The number of electrodes directly correlates with the risk of intraoperative complication. Thus a risk and benefit analysis needs to be carefully considered for each patient. Neurodiagnostic technology: Both during and after the SEEG electrode implantation, the intraoperative monitoring and EEG technologists play a vital role in the successful monitoring of the patient. CONCLUSION SEEG is an important tool in the process of epilepsy surgery in children with symptomatic epilepsy, commonly due to cortical dysplasia and DNET.
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Affiliation(s)
- Jun T Park
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Guadalupe Fernandez Baca Vaca
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Jennifer Avery
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
| | - Jonathan P Miller
- a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio
- b Case Western Reserve University School of Medicine , Cleveland , Ohio
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Stereotactic Electroencephalography Is a Safe Procedure, Including for Insular Implantations. World Neurosurg 2016; 99:353-361. [PMID: 28003163 DOI: 10.1016/j.wneu.2016.12.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In some cases of drug-resistant focal epilepsy, noninvasive presurgical investigation may be insufficient to identify the ictal onset zone and the eloquent cortical areas. In such situations, invasive investigations are proposed using either stereotactic electroencephalography (SEEG) or subdural grid electrodes. Meta-analysis suggests that SEEG is safer than subdural grid electrodes, but insular implantation of SEEG electrodes has been thought to carry an additional risk of intraparenchymal hemorrhagic complications. Our objectives were to determine whether an insular SEEG trajectory is a risk factor for intracranial hematoma and to report the global safety of the procedure and provide some guidelines to prevent and detect complications. METHODS In a retrospective analysis of a surgical series of 525 consecutive procedures between 1995 and 2015, all electrodes were classified according to their insular or extrainsular trajectory. All complications were classified as major or minor according to their potential consequences regarding patient neurologic status. RESULTS Four intraparenchymal hematomas, all related to extrainsular electrodes (4/4974; 0.08%) were reported; no hematoma was found along insular electrodes (0/1042; 0%). There were 8 major complications (1.52%): 7 intracranial hematomas (1.33%) and 1 case of meningitis. Two patients had long-term neurologic impairment (0.38%), and 1 death (not directly related to the procedure) occurred (0.19%). Eleven minor complications (2.09%) were encountered, including broken electrode (1.52%), acute pneumocephalus (0.38%), and local cutaneous infection (0.19%). CONCLUSIONS SEEG is a safe procedure. Insular trajectories cannot be considered an additional risk of intracranial bleeding.
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Epilepsy surgery in the posterior part of the brain. Epilepsy Behav 2016; 64:273-282. [PMID: 27788449 DOI: 10.1016/j.yebeh.2016.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
Posterior cortex epilepsy surgery is rarely performed and is associated with a high number of surgical failures, partly because accurate localization of the epileptogenic zone in the posterior part of the brain is extremely difficult. We present the characteristics as well as the surgical outcome and its determinants of a cohort of 208 consecutive patients (adults/children: 125/83) operated on for drug-resistant posterior cortex epilepsy at the "Claudio Munari" Epilepsy Surgery Centre, Milan between May 1996 and May 2013 (mean postsurgical follow-up: 9.6years). In addition, we highlight the differences in anatomoelectroclinical features and outcome between (i) patients who necessitated an invasive preoperative evaluation and those who proceeded directly to surgery and (ii) adults and children. Mean age at epilepsy onset was 6.8years (91.4% with onset before 14years of age). A high seizure frequency was reported by 51% of subjects, interictal and ictal EEG features were localizing in 16% and 28% of cases, and 86% of patients had a positive, judged as more or less informative, MRI. Invasive presurgical evaluation by stereoelectroencephalography was performed in 54% of patients; explorations may schematically be grouped in three main implantation patterns. Globally, 70% of subjects achieved seizure freedom, and further, 10% achieved Engel class II, with the patients operated on in childhood achieving significantly better postsurgical results in terms of seizure freedom and drug discontinuation. Duration of epilepsy represented the most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success. Therefore, we recommend an early surgical referral in cases of pharmacoresistant posterior cortex seizures. Furthermore, we suggest that surgical failure might be predicted very early, namely within the first 6 postoperative months. We conclude that surgical management of posterior cortex epilepsy may attain excellent results.
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Roessler K, Sommer B, Merkel A, Rampp S, Gollwitzer S, Hamer HM, Buchfelder M. A Frameless Stereotactic Implantation Technique for Depth Electrodes in Refractory Epilepsy Using Intraoperative Magnetic Resonance Imaging. World Neurosurg 2016; 94:206-210. [PMID: 27389940 DOI: 10.1016/j.wneu.2016.06.114] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Various complex techniques for depth electrode insertion in refractory epilepsy using preoperative imaging have been investigated. We evaluated a simple, accurate, cost-effective, and timesaving method using intraoperative magnetic resonance imaging (MRI). METHODS A neuronavigation-guided insertion tube attached to bone facilitated the placement of stereotactic percutaneous drill holes, bolt implantation, and frameless stereotactic insertion of depth electrodes. Image registration was carried out by head coil fiducials with trajectory planning and intraoperative electrode correction. RESULTS In 6 patients with refractory epilepsy (3 women and 3 men; mean age, 30.0 years; range, 20-37 years), 58 depth electrodes (9-11 per patient) were placed. The mean length of the inserted electrodes was 37.3 mm ± 8.8 (mean ± SD) (range, 22.1-84.4 mm). The overall target point accuracy was 3.2 mm ± 2.2 (range, 0-8.6 mm), which was significantly different from the overall entry point accuracy of 1.4 mm ± 1.2 (P < 0.0001). All electrodes functioned perfectly, enabling high-quality stereo-electroencephalography recordings over a period of 7.3 days ± 0.5 (range, 7-8 days). The mean implantation time for 9-11 electrodes per patient was 115 minutes ± 36.3 (range, 75-160 minutes; 12 minutes for 1 electrode on average) including the intraoperative MRI (T1 three-dimensional magnetization-prepared rapid acquisition gradient echo, T2, and diffusion tensor imaging). There was no hemorrhage, infection, or neurologic deficit related to the procedure. CONCLUSIONS Our frameless technique of depth electrode insertion using intraoperative MRI guidance is an accurate, reliable, cost-effective, and timesaving method for stereo-electroencephalography.
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Affiliation(s)
- Karl Roessler
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany.
| | - Björn Sommer
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Merkel
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Gollwitzer
- Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Hajo M Hamer
- Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Epilepsy Centre, University Hospital Erlangen, Erlangen, Germany
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Murphy BA, Miller JP, Gunalan K, Ajiboye AB. Contributions of Subsurface Cortical Modulations to Discrimination of Executed and Imagined Grasp Forces through Stereoelectroencephalography. PLoS One 2016; 11:e0150359. [PMID: 26963246 PMCID: PMC4786254 DOI: 10.1371/journal.pone.0150359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/12/2016] [Indexed: 12/03/2022] Open
Abstract
Stereoelectroencephalographic (SEEG) depth electrodes have the potential to record neural activity from deep brain structures not easily reached with other intracranial recording technologies. SEEG electrodes were placed through deep cortical structures including central sulcus and insular cortex. In order to observe changes in frequency band modulation, participants performed force matching trials at three distinct force levels using two different grasp configurations: a power grasp and a lateral pinch. Signals from these deeper structures were found to contain information useful for distinguishing force from rest trials as well as different force levels in some participants. High frequency components along with alpha and beta bands recorded from electrodes located near the primary motor cortex wall of central sulcus and electrodes passing through sensory cortex were found to be the most useful for classification of force versus rest although one participant did have significant modulation in the insular cortex. This study electrophysiologically corroborates with previous imaging studies that show force-related modulation occurs inside of central sulcus and insular cortex. The results of this work suggest that depth electrodes could be useful tools for investigating the functions of deeper brain structures as well as showing that central sulcus and insular cortex may contain neural signals that could be used for control of a grasp force BMI.
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Affiliation(s)
- Brian A. Murphy
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States of America
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, United States of America
| | - Jonathan P. Miller
- Department of Neurosurgery, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, United States of America
| | - Kabilar Gunalan
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States of America
| | - A. Bolu Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States of America
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, United States of America
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Enatsu R, Mikuni N. Invasive Evaluations for Epilepsy Surgery: A Review of the Literature. Neurol Med Chir (Tokyo) 2016; 56:221-7. [PMID: 26948700 PMCID: PMC4870176 DOI: 10.2176/nmc.ra.2015-0319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive evaluations play important roles in identifying epileptogenic zones and functional areas in patients with intractable focal epilepsy. This article reviews the usefulness, methods, and limitations of invasive evaluations for epilepsy surgery. Invasive evaluations include various types of intracranial electrodes such as stereotactically implanted intracranial depth electrodes (stereo-EEG), chronic subdural electrodes, and intraoperative electrocorticography. Scalp EEG is distorted by the skull, meninges, and skin. On the other hand, intracranial electrodes provide spatial information with higher resolution than scalp electrodes, thereby enabling further delineation of epileptogenic zones and mapping of functional areas with electrical stimulation. In addition, intracranial electrodes record a wide frequency range of electrical activity, which is not possible with scalp electrodes. The very slow potentials in ictal recordings, known as ictal direct current (DC) shifts and ictal/interictal high frequency oscillations, such as ripples (100–200 Hz) and fast ripples (200–500 Hz), have been correlated with the ictal onset zone and are a sensitive and specific marker for epileptogenicity. Furthermore, several studies reported that the electrical stimulation of epileptogenic zones elicited enhanced cortical evoked potentials, abnormal delayed or repetitive responses, and fast ripples. These responses may assist in the delineation of the epileptogenic cortex as a potential new marker. There are definite risks of complications associated with the use of intracranial electrodes. However, when an invasive evaluation is selected based on careful consideration of the risks and benefits, it provides useful information for establishing a strategy for epilepsy surgery.
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Affiliation(s)
- Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University
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Usefulness of multidetector-row computerized tomographic angiography for the surgical planning in stereoelectroencephalography. Diagn Interv Imaging 2016; 97:333-7. [DOI: 10.1016/j.diii.2015.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
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Kajita Y, Nakatsubo D, Kataoka H, Nagai T, Nakura T, Wakabayashi T. Installation of a Neuromate Robot for Stereotactic Surgery: Efforts to Conform to Japanese Specifications and an Approach for Clinical Use-Technical Notes. Neurol Med Chir (Tokyo) 2015; 55:907-14. [PMID: 26511113 PMCID: PMC4686454 DOI: 10.2176/nmc.tn.2015-0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The neuromate is a commercially available, image-guided robotic system for use in stereotactic surgery and is employed in Europe and North America. In June 2015, this device was approved in accordance with the Pharmaceutical Affairs Law in Japan. The neuromate can be specified to a wide range of stereotactic procedures in Japan. The stereotactic X-ray system, developed by a Japanese manufacturer, is normally attached to the operating table that provides lateral and anteroposterior images to verify the positions of the recording electrodes. The neuromate is designed to be used with the patient in the supine position on a flat operating table. In Japan, deep brain stimulation surgery is widely performed with the patient's head positioned upward so as to minimize cerebrospinal fluid leakage. The robot base where the patient's head is fixed has an adaptation for a tilted head position (by 25 degrees) to accommodate the operating table at proper angle to hold the patient's upper body. After these modifications, the accuracy of neuromate localization was examined on a computed tomography phantom preparation, showing that the root mean square error was 0.12 ± 0.10 mm. In our hospital, robotic surgeries, such as those using the Da Vinci system or neuromate, require operative guidelines directed by the Medical Risk Management Office and Biomedical Research and Innovation Office. These guidelines include directions for use, procedural manuals, and training courses.
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Affiliation(s)
- Yasukazu Kajita
- Department of Neurosurgery, Nagoya University, Postgraduate School of Medicine
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Abstract
BACKGROUND Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to the age of the participants and which focal epilepsies are included, but have been reported as at least 20% and in some studies up to 70%. If the epileptogenic zone can be located surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.The secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence and to identify the factors that correlate to remission of seizures postoperatively. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 to 4 July 2013), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for relevant trials up to 4 July 2013. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), cohort studies or case series, with either a prospective and/or retrospective design, including at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportion of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RR) and 95% confidence intervals. MAIN RESULTS We identified 177 studies (16,253 participants) investigating the outcome of surgery for epilepsy. Four studies were RCTs (including one that randomised participants to surgery or medical treatment). The risk of bias in the RCTs was unclear or high, limiting our confidence in the evidence that addressed the primary review objective. Most of the remaining 173 non-randomised studies had a retrospective design; they were of variable size, were conducted in a range of countries, recruited a wide demographic range of participants, used a wide range of surgical techniques and used different scales used to measure outcomes. We performed quality assessment using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across the domains.In terms of freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy. We judged the evidence from the four RCTs to be of moderate to very low quality due to the lack of information reported about the randomised trial design and the restricted study populations.Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to the recording of adverse events to be very poor.In total, 118 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: an abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation or presence of postoperative discharges were prognostic factors of outcome. We observed variability between studies for many of our analyses, likely due to the small study sizes with unbalanced group sizes, variation in the definition of seizure outcome, definition of the prognostic factor and the influence of the site of surgery, all of which we observed to be related to postoperative seizure outcome. Twenty-nine studies reported multivariable models of prognostic factors and the direction of association of factors with outcome was generally the same as found in the univariate analyses. However, due to the different multivariable analysis approaches and selective reporting of results, meaningful comparison of multivariate analysis with univariate meta-analysis is difficult. AUTHORS' CONCLUSIONS The study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcome. Future research should be of high quality, have a prospective design, be appropriately powered and focus on specific issues related to diagnostic tools, the site-specific surgical approach and other issues such as the extent of resection. Prognostic factors related to the outcome of surgery should be investigated via multivariable statistical regression modelling, where variables are selected for modelling according to clinical relevance and all numerical results of the prognostic models are fully reported. Protocols should include pre- and postoperative measures of speech and language function, cognition and social functioning along with a mental state assessment. Journal editors should not accept papers where adverse events from a medical intervention are not recorded. Improvements in the development of cancer care over the past three to four decades have been achieved by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH
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Nowell M. In response: Talairach methodology in the era of 3D multimodal imaging: "The song remains the same," but catchier, and therefore more helpful for clinical decision making and surgical planning in epilepsy surgery. Epilepsia 2015; 56:977-8. [PMID: 26040534 DOI: 10.1111/epi.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Nowell
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.
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Boido D, Gnatkovsky V, Uva L, Francione S, de Curtis M. Simultaneous enhancement of excitation and postburst inhibition at the end of focal seizures. Ann Neurol 2014; 76:826-36. [PMID: 24916758 DOI: 10.1002/ana.24193] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Comprehension of the events that lead to seizure termination contributes to the development of strategies to confine propagation of ictal discharges. It is commonly assumed that the inhibitory control fails during seizures and recovers after the end of the ictal event. We examine the possibility that a progressive increase of inhibition that counters an increase in the strength of excitation contributes to terminating a focal seizure. METHODS We analyzed seizures acutely induced by pharmacological manipulations (bicuculline and 4-aminopyridine) in the entorhinal cortex and in the hippocampus of the in vitro isolated guinea pig brain. RESULTS As seizures ended, extracellular and intracellular recordings showed periodic bursting that progressively decreased in frequency. During the late bursting phase, the duration, number, and rate of occurrence of spikes within single bursts remained constant, whereas cumulative spike amplitude (index of excitation during a burst) and interburst interval (index of inhibition between bursts) progressively increased. The increment of average/cumulative burst excitation and interburst interval toward seizure end was confirmed in human focal seizures recorded with intracerebral electrodes in patients with drug-resistant partial epilepsies. A postburst refractory period of circa 2 seconds that increases with time toward the end of the seizure was confirmed in the experimental model by probing interburst epochs in the CA1 region with local dentate gyrus stimulation just suprathreshold for burst generation. INTERPRETATION Our findings support the concept that focal seizures are terminated by the simultaneous and opposing enhancement of excitation (burst activity) in addition to postburst inhibition. We hypothesize that a seizure stops when postburst inhibition becomes large enough to prevent reactivation of excitation.
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Affiliation(s)
- Davide Boido
- Unit of Epileptology and Experimental Neurophysiology, Carlo Besta Neurological Institute Foundation, Milan, Italy
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Intracranial Telemetry Recording of Intractable Epilepsy at London Health Sciences. Can J Neurol Sci 2012. [DOI: 10.1017/s0317167100018114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Routine EEG telemetry using scalp electrode recordings is carried out in all patients being considered for epilepsy surgery. However this, along with other testing, may not yield sufficient information about the location of seizure onset to allow a decision regarding surgery to be made. Various methods have been developed to implant electrodes for chronic recording closer to the cortical surface from which seizures arise including the use of sphenoidal, foramen ovale, epidural peg, subdural and depth electrodes. This is a review of the last two techniques particularly as utilized at London Health Sciences Centre.
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Besson P, Andermann F, Dubeau F, Bernasconi A. Small focal cortical dysplasia lesions are located at the bottom of a deep sulcus. ACTA ACUST UNITED AC 2008; 131:3246-55. [PMID: 18812443 DOI: 10.1093/brain/awn224] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Focal cortical dysplasia (FCD) is often characterized by minor structural changes that may go unrecognized by standard radiological analysis. Visual assessment of morphological characteristics of FCD and sulci harbouring them is difficult due to the complexity of brain convolutions. Our purpose was to elucidate and quantify the spatial relationship between FCD lesions and brain sulci using automated sulcal extraction and morphometry. We studied 43 consecutive FCD patients using high-resolution MRI. Lesions were classified into small and large using qualitative (detection on initial clinical assessment of conventional MRI) and quantitative (volume) criteria. Sulci were identified and labelled automatically using an algorithm based on a congregation of neural networks. Segmented FCD lesions and sulci were then simultaneously visualized in 3D. We measured mean and maximum depth of sulci related to each FCD and of the corresponding sulci in 21 healthy controls. In addition, we calculated sulcal depth within the FCD neighbourhood. Twenty-one (21/43 = 49%) patients had small FCD lesions (volume range: 128-3093 mm(3)). Among them, 17 (81%) had been overlooked during initial radiological evaluation and were subsequently identified using image processing. Eighteen (18/21 = 86%) small FCD lesions were located at the bottom of a sulcus. Two others were related to the walls of two sulci and one was located at the crown of a gyrus. Mean and maximum depth of sulci related to the FCD was higher than that of the corresponding sulci in controls (P < 0.008). Sulcal depth within lesional neighbourhood had larger mean depth than that of the entire sulcus (P < 0.0002). Evidence that small FCD lesions are preferentially located at the bottom of an abnormally deep sulcus may be used to direct the search for developmental abnormalities, particularly in patients in whom large-scale MRI features are only mildly abnormal or absent.
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Affiliation(s)
- Pierre Besson
- Department of Neurology and Neurosurgery and Brain Imaging Center, McGill University, Montreal Neurological Institute and Hospital, Montreal,Quebec, Canada
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Kahane P, Ryvlin P, Vercueil L, Hirsch E, Arzimanoglou A. À l’heure de l’évaluation économique des pratiques hospitalières : quelle place pour la chirurgie de l’épilepsie ? Rev Neurol (Paris) 2007; 163:1151-6. [DOI: 10.1016/s0035-3787(07)78399-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 03/20/2007] [Accepted: 04/17/2007] [Indexed: 10/22/2022]
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