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Wang Z, Guo J, van 't Klooster M, Hoogteijling S, Jacobs J, Zijlmans M. Prognostic Value of Complete Resection of the High-Frequency Oscillation Area in Intracranial EEG: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209216. [PMID: 38560817 PMCID: PMC11175645 DOI: 10.1212/wnl.0000000000209216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES High-frequency oscillations (HFOs; ripples 80-250 Hz; fast ripples [FRs] 250-500 Hz) recorded with intracranial electrodes generated excitement and debate about their potential to localize epileptogenic foci. We performed a systematic review and meta-analysis on the prognostic value of complete resection of the HFOs-area (crHFOs-area) for epilepsy surgical outcome in intracranial EEG (iEEG) accessing multiple subgroups. METHODS We searched PubMed, Embase, and Web of Science for original research from inception to October 27, 2022. We defined favorable surgical outcome (FSO) as Engel class I, International League Against Epilepsy class 1, or seizure-free status. The prognostic value of crHFOs-area for FSO was assessed by (1) the pooled FSO proportion after crHFOs-area; (2) FSO for crHFOs-area vs without crHFOs-area; and (3) the predictive performance. We defined high combined prognostic value as FSO proportion >80% + FSO crHFOs-area >without crHFOs-area + area under the curve (AUC) >0.75 and examined this for the clinical subgroups (study design, age, diagnostic type, HFOs-identification method, HFOs-rate thresholding, and iEEG state). Temporal lobe epilepsy (TLE) was compared with extra-TLE through dichotomous variable analysis. Individual patient analysis was performed for sex, affected hemisphere, MRI findings, surgery location, and pathology. RESULTS Of 1,387 studies screened, 31 studies (703 patients) met our eligibility criteria. Twenty-seven studies (602 patients) analyzed FRs and 20 studies (424 patients) ripples. Pooled FSO proportion after crHFOs-area was 81% (95% CI 76%-86%) for FRs and 82% (73%-89%) for ripples. Patients with crHFOs-area achieved more often FSO than those without crHFOs-area (FRs odds ratio [OR] 6.38, 4.03-10.09, p < 0.001; ripples 4.04, 2.32-7.04, p < 0.001). The pooled AUCs were 0.81 (0.77-0.84) for FRs and 0.76 (0.72-0.79) for ripples. Combined prognostic value was high in 10 subgroups: retrospective, children, long-term iEEG, threshold (FRs and ripples) and automated detection and interictal (FRs). FSO after complete resection of FRs-area (crFRs-area) was achieved less often in people with TLE than extra-TLE (OR 0.37, 0.15-0.89, p = 0.006). Individual patient analyses showed that crFRs-area was seen more in patients with FSO with than without MRI lesions (p = 0.02 after multiple correction). DISCUSSION Complete resection of the brain area with HFOs is associated with good postsurgical outcome. Its prognostic value holds, especially for FRs, for various subgroups. The use of HFOs for extra-TLE patients requires further evidence.
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Affiliation(s)
- Ziyi Wang
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Jiaojiao Guo
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maryse van 't Klooster
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Sem Hoogteijling
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Julia Jacobs
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maeike Zijlmans
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
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Tobochnik S, Regan MS, Dorotan MKC, Reich D, Lapinskas E, Hossain MA, Stopka S, Santagata S, Murphy MM, Arnaout O, Bi WL, Antonio Chiocca E, Golby AJ, Mooney MA, Smith TR, Ligon KL, Wen PY, Agar NYR, Lee JW. Pilot trial of perampanel on peritumoral hyperexcitability and clinical outcomes in newly diagnosed high-grade glioma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.11.24305666. [PMID: 38645003 PMCID: PMC11030478 DOI: 10.1101/2024.04.11.24305666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Glutamatergic neuron-glioma synaptogenesis and peritumoral hyperexcitability promote glioma growth in a positive feedback loop. The objective of this study was to evaluate the feasibility and estimated effect sizes of the AMPA-R antagonist, perampanel, on intraoperative electrophysiologic hyperexcitability and clinical outcomes. Methods An open-label trial was performed comparing perampanel to standard of care (SOC) in patients undergoing resection of newly-diagnosed radiologic high-grade glioma. Perampanel was administered as a pre-operative loading dose followed by maintenance therapy until progressive disease or up to 12-months. SOC treatment involved levetiracetam for 7-days or as clinically indicated. The primary outcome of hyperexcitability was defined by intra-operative electrocorticography high frequency oscillation (HFO) rates. Seizure-freedom and overall survival (OS) were estimated by the Kaplan-Meier method. Tissue concentrations of perampanel, levetiracetam, and metabolites were measured by mass spectrometry. Results HFO rates were similar between perampanel-treated and SOC cohorts. The trial was terminated early after interim analysis for futility, and outcomes assessed in 11 patients (7 perampanel-treated, 4 SOC). Over a median 281 days of post-enrollment follow-up, 27% of patients had seizures, including 14% treated with perampanel and 50% treated with SOC. OS in perampanel-treated patients was similar to a glioblastoma reference cohort (p=0.81). Glutamate concentrations in surface biopsies were positively correlated with HFO rates in adjacent electrode contacts and were not significantly associated with treatment assignment or drug concentrations. Conclusions A peri-operative loading regimen of perampanel was safe and well-tolerated, with similar peritumoral hyperexcitability as in levetiracetam-treated patients. Maintenance anti-glutamatergic therapy was not observed to impact survival outcomes.
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Affiliation(s)
- Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Neurology, VA Boston Healthcare System, Boston, MA, USA
| | - Michael S. Regan
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Emily Lapinskas
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Md Amin Hossain
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sylwia Stopka
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Melissa M. Murphy
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - E. Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexandra J. Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael A. Mooney
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Keith L. Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick Y. Wen
- Department of Medical Oncology, Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nathalie Y. R. Agar
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
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Nandoliya KR, Thirunavu V, Ellis E, Dixit K, Tate MC, Drumm MR, Templer JW. Pre-operative predictors of post-operative seizure control in low-grade glioma: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:94. [PMID: 38411788 DOI: 10.1007/s10143-024-02329-9] [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: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
As many as 80% of low-grade gliomas (LGGs) present with seizures, negatively impacting quality of life. While seizures are associated with gliomas regardless of grade, the importance of minimizing impact of seizures for patients with low grade tumors cannot be understated given the prolonged survival period in this population. The objective of this systematic review and meta-analysis was to summarize existing literature and identify factors associated with post-operative seizure control (defined as Engel I classification) in patients with LGGs, with a focus on pre-operative factors. Patient data extracted include tumor location and histology, pre-operative anti-seizure medication use, extent of resection (EOR), adjuvant treatment, pre-operative seizure type, duration, and frequency, and post-operative Engel classification. A random-effects model was used to calculate the effects of EOR, pre-operative seizure duration, adjuvant radiation, and adjuvant chemotherapy on post-operative seizure control. The effect of tumor location and histology on post-operative Engel I classification was determined using contingency analyses. Thirteen studies including 1628 patients with seizures were included in the systematic review. On meta-analyses, Engel I classification was associated with pre-operative seizure type (OR = 0.79 (0.63-0.99), p = 0.0385, focal versus generalized), frontal lobe LGGs (OR = 1.5 (1.1-2.0), p = 0.0195), and EOR (OR (95% CI) = 4.5 (2.3-6.7), p < 0.0001 gross-total versus subtotal). Pre-operative seizure duration less than one year, adjuvant radiation, adjuvant chemotherapy, and tumor histology were not associated with achieving Engel I classification. In addition to the known effects of EOR, Engel I classification is less likely to be achieved in patients with focal pre-operative seizures and more likely to be achieved in patients with frontal lobe LGGs.
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Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erin Ellis
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Michael R Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica W Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA.
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Avila EK, Tobochnik S, Inati SK, Koekkoek JAF, McKhann GM, Riviello JJ, Rudà R, Schiff D, Tatum WO, Templer JW, Weller M, Wen PY. Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management. Neuro Oncol 2024; 26:7-24. [PMID: 37699031 PMCID: PMC10768995 DOI: 10.1093/neuonc/noad154] [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] [Indexed: 09/14/2023] Open
Abstract
Tumor-related epilepsy (TRE) is a frequent and major consequence of brain tumors. Management of TRE is required throughout the course of disease and a deep understanding of diagnosis and treatment is key to improving quality of life. Gross total resection is favored from both an oncologic and epilepsy perspective. Shared mechanisms of tumor growth and epilepsy exist, and emerging data will provide better targeted therapy options. Initial treatment with antiseizure medications (ASM) in conjunction with surgery and/or chemoradiotherapy is typical. The first choice of ASM is critical to optimize seizure control and tolerability considering the effects of the tumor itself. These agents carry a potential for drug-drug interactions and therefore knowledge of mechanisms of action and interactions is needed. A review of adverse effects is necessary to guide ASM adjustments and decision-making. This review highlights the essential aspects of diagnosis and treatment of TRE with ASMs, surgery, chemotherapy, and radiotherapy while indicating areas of uncertainty. Future studies should consider the use of a standardized method of seizure tracking and incorporating seizure outcomes as a primary endpoint of tumor treatment trials.
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Affiliation(s)
- Edward K Avila
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Neurology, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sara K Inati
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Guy M McKhann
- Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - James J Riviello
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Italy
| | - David Schiff
- Department of Neurology, Division of Neuro-Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jessica W Templer
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Centre, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Center, and Division of Neuro-Oncology, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Youshani AS, Heal C, Lee JX, Younis M, Mohanraj R, Maye H, Bailey M, Coope D, D’Urso PI, Karabatsou K. Glioma-related epilepsy following low-grade glioma surgery. Neurooncol Adv 2024; 6:vdae127. [PMID: 39220245 PMCID: PMC11362847 DOI: 10.1093/noajnl/vdae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Background Epileptic seizures commonly burden low-grade glioma (LGG) patients and negatively impact quality of life, neurocognition, and general patient health. Anti-seizure medications (ASMs) are used to manage seizures but can result in undesired side effects. Our aim was to report our experience in epilepsy in one of the largest case series of LGG patients (reclassified in accordance with the WHO 2021 classification). Furthermore, we evaluate our postoperative seizure frequency difference between LGG patients who use preoperative ASMs and ones with no ASMs. Methods Data were retrospectively collected from Salford Royal Hospital electronic records and Neuro-Oncology database from 2006 to 2022. Descriptive statistics were performed for demographic analysis, while multivariable analysis was used to determine postoperative seizure-free outcomes. Results In total, 257 operations were performed on 206 patients. Postoperatively, 114 patients suffered from seizures, and approximately 45.2% of patients developed seizures at 3-12 months postsurgery, with the odds higher in patients on preoperative ASMs. There was no evidence to suggest a higher postoperative seizure rate in patients undergoing awake craniotomy versus general anesthetic. The extent of resection (EOR) was inversely related to seizure failure, with gross-total resection showing a statistically significant reduction in seizures in comparison to all other surgical resections. Conclusions In our experience, there is no evidence to suggest a reduced postoperative seizure outcome when prescribing preoperative ASMs. EOR is an independent prognosticator for postoperative seizure failure with all other variables demonstrating nonsignificance. Overall, a larger study can investigate the role of ASMs in LGG in greater detail.
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Affiliation(s)
- Amir Saam Youshani
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neurosciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Calvin Heal
- Division of Population Health, Health Services and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jing X Lee
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Michael Younis
- Manchester Medical School, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Matthew Bailey
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - David Coope
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neurosciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Pietro I D’Urso
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
| | - Konstantina Karabatsou
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
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Bushara O, Zhou G, Sharma A, Zelano C, Schuele SU, Tate MC, Gavvala JR, Templer JW. High-Frequency Oscillations in Tumor-Related Epilepsy. J Clin Neurophysiol 2023; 40:567-573. [PMID: 35344517 DOI: 10.1097/wnp.0000000000000930] [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] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To define the patient characteristics, tumor characteristics, and clinical course of patients with primary brain tumors with high-frequency oscillations (HFOs) recorded on electrocorticography. Furthermore, we evaluated whether the presence of HFOs portends a greater risk of postoperative tumor-related epilepsy and whether the resection of HFO-generating tissue reduces likelihood of postoperative tumor-related epilepsy. METHODS This was a retrospective study of 35 patients undergoing awake craniotomy for tumor resection, all of whom underwent intraoperative electrocorticography. Electrocorticography data were reviewed to assess the presence of HFOs and determine their contact locations. The data were analyzed to determine whether HFO-generating tissue was included in the resection and relationship to postoperative seizure outcome. RESULTS Seventeen patients (48.5%) were found to have HFOs. Very few patients (4 of 35, 11.4%) had sharp waves. Patients with and without HFOs did not significantly differ in demographics, presentation, tumor characteristics, or tumor molecular genetics. A history of seizures prior to resection was not associated with the presence of HFOs ( P = 0.62), although when patients had seizures during the same hospitalization as the resection, HFOs were more likely to be present ( P = 0.045). Extent of HFO resection was not associated with the likelihood of postoperative seizure freedom. CONCLUSIONS Approximately half (48.5%) of patients undergoing resection for a primary brain tumor had HFOs. Although HFO resection was not shown to lead to improved seizure freedom, this study was limited by a small sample size, and further investigation into HFO resection and patient outcomes in this population is warranted.
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Affiliation(s)
- Omar Bushara
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Guangyu Zhou
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Arjun Sharma
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Christina Zelano
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Stephan U Schuele
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Matthew C Tate
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A. ; and
| | - Jay R Gavvala
- Department of Neurology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jessica W Templer
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Freund BE, Feyissa AM, Khan A, Sirven JI, Grewal SS, Sabsevitz D, Moniz-Garcia D, Quinones-Hinojosa A, Tatum WO. Enhanced sensitivity of electrocorticography during awake craniotomy using a novel circular grid electrode. J Neurooncol 2023; 165:313-320. [PMID: 37932608 DOI: 10.1007/s11060-023-04495-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Awake craniotomy with intraoperative functional brain mapping (FBM) bedside neurological testing is an important technique used to optimize resective brain surgeries near eloquent cortex. Awake craniotomy performed with electrocorticography (ECoG) and direct electrical stimulation (DES) for FBM can delineate eloquent cortex from lesions and epileptogenic regions. However, current electrode technology demonstrates spatial limitations. Our group has developed a novel circular grid with the goal of improving spatial recording of ECoG to enhance detection of ictal and interictal activity. METHODS This retrospective study was approved by the institutional review board at Mayo Clinic Florida. We analyzed patients undergoing awake craniotomy with ECoG and DES and compared ECoG data obtained using the 22 contact circular grid to standard 6 contact strip electrode. RESULTS We included 144 cases of awake craniotomy with ECoG, 73 using circular grid and 71 with strip electrode. No significant differences were seen regarding preoperative clinical and demographic data, duration of ECoG recording (p = 0.676) and use of DES (p = 0.926). Circular grid was more sensitive in detecting periodic focal epileptiform discharges (PFEDs) (p = 0.004), PFEDs plus (p = 0.032), afterdischarges (ADs) per case (p = 0.022) at lower minimum (p = 0.012) and maximum (p < 0.0012) intensity stimulation, and seizures (p = 0.048). PFEDs (p < 0.001), PFEDs plus (p < 0.001), and HFOs (p < 0.001) but not ADs (p = 0.255) predicted electrographic seizures. CONCLUSION We demonstrate higher sensitivity in detecting ictal and interictal activity on ECoG during awake craniotomy with a novel circular grid compared to strip electrode, likely due to better spatial sampling during ECoG. We also found association between PFEDs and intraoperative seizures.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Aafreen Khan
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - David Sabsevitz
- Department of Psychiatry and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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Boerger TF, Pahapill P, Butts AM, Arocho-Quinones E, Raghavan M, Krucoff MO. Large-scale brain networks and intra-axial tumor surgery: a narrative review of functional mapping techniques, critical needs, and scientific opportunities. Front Hum Neurosci 2023; 17:1170419. [PMID: 37520929 PMCID: PMC10372448 DOI: 10.3389/fnhum.2023.1170419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 08/01/2023] Open
Abstract
In recent years, a paradigm shift in neuroscience has been occurring from "localizationism," or the idea that the brain is organized into separately functioning modules, toward "connectomics," or the idea that interconnected nodes form networks as the underlying substrates of behavior and thought. Accordingly, our understanding of mechanisms of neurological function, dysfunction, and recovery has evolved to include connections, disconnections, and reconnections. Brain tumors provide a unique opportunity to probe large-scale neural networks with focal and sometimes reversible lesions, allowing neuroscientists the unique opportunity to directly test newly formed hypotheses about underlying brain structural-functional relationships and network properties. Moreover, if a more complete model of neurological dysfunction is to be defined as a "disconnectome," potential avenues for recovery might be mapped through a "reconnectome." Such insight may open the door to novel therapeutic approaches where previous attempts have failed. In this review, we briefly delve into the most clinically relevant neural networks and brain mapping techniques, and we examine how they are being applied to modern neurosurgical brain tumor practices. We then explore how brain tumors might teach us more about mechanisms of global brain dysfunction and recovery through pre- and postoperative longitudinal connectomic and behavioral analyses.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Alissa M. Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
- Mayo Clinic, Rochester, MN, United States
| | - Elsa Arocho-Quinones
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
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Feyissa AM, Rosenfeld SS, Quiñones-Hinojosa A. Altered glutamatergic and inflammatory pathways promote glioblastoma growth, invasion, and seizures: An overview. J Neurol Sci 2022; 443:120488. [PMID: 36368135 DOI: 10.1016/j.jns.2022.120488] [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: 07/14/2022] [Revised: 10/03/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive malignant primary brain cancer. Drug-resistant seizures and cognitive impairments often accompany the invasion of the neocortex by the GBM cells. Recent studies suggest that seizures and glioma share common pathogenic mechanisms and may influence each other. One explanation for the close link between the two conditions is elevated glutamate in the tumor microenvironment (TME) due to an increased expression of the cystine-glutamate transporter with ensuing overactivity of glutamatergic signaling. Excess glutamate in the TME also encourages the polarization of pro-inflammatory tumor-associated macrophages to an anti-inflammatory state causing TME immunosuppression and facilitating tumor invasion. Besides, the recently discovered glutamatergic neurogliomal synapses, partially via their influence on calcium communication in microtube-connected tumor cell networks, drive the progression of GBM by stimulating glioma invasion and growth. Moreover, neuroinflammatory pathways have been shown to have several points of intersection with glutamatergic signaling in the TME, further promoting both epileptogenesis and oncogenesis. Future studies identifying pharmacotherapeutics targeting these elements is an extremely attractive therapeutic strategy for GBM, for which very little therapeutic progress has been made in the past two decades.
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Affiliation(s)
| | - Steven S Rosenfeld
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
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10
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Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes. Cancers (Basel) 2022; 14:cancers14225705. [PMID: 36428797 PMCID: PMC9688206 DOI: 10.3390/cancers14225705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Maximal safe resection is the mainstay of treatment in the neurosurgical management of gliomas, and preserving functional integrity is linked to favorable outcomes. How these modalities differ in their effectiveness on the extent of resection (EOR), survival, and complications remains unknown. A systematic literature search was performed with the following inclusion criteria: published between 2005 and 2022, involving brain glioma surgery, and including one or a combination of intraoperative modalities: intraoperative magnetic resonance imaging (iMRI), awake/general anesthesia craniotomy mapping (AC/GA), fluorescence-guided imaging, or combined modalities. Of 525 articles, 464 were excluded and 61 articles were included, involving 5221 glioma patients, 7(11.4%) articles used iMRI, 21(36.8%) used cortical mapping, 15(24.5%) used 5-aminolevulinic acid (5-ALA) or fluorescein sodium, and 18(29.5%) used combined modalities. The heterogeneity in reporting the amount of surgical resection prevented further analysis. Progression-free survival/overall survival (PFS/OS) were reported in 18/61(29.5%) articles, while complications and permanent disability were reported in 38/61(62.2%) articles. The reviewed studies demonstrate that intraoperative adjuncts such as iMRI, AC/GA mapping, fluorescence-guided imaging, and a combination of these modalities improve EOR. However, PFS/OS were underreported. Combining multiple intraoperative modalities seems to have the highest effect compared to each adjunct alone.
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11
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Zweiphenning W, Klooster MAV', van Klink NEC, Leijten FSS, Ferrier CH, Gebbink T, Huiskamp G, van Zandvoort MJE, van Schooneveld MMJ, Bourez M, Goemans S, Straumann S, van Rijen PC, Gosselaar PH, van Eijsden P, Otte WM, van Diessen E, Braun KPJ, Zijlmans M. Intraoperative electrocorticography using high-frequency oscillations or spikes to tailor epilepsy surgery in the Netherlands (the HFO trial): a randomised, single-blind, adaptive non-inferiority trial. Lancet Neurol 2022; 21:982-993. [PMID: 36270309 PMCID: PMC9579052 DOI: 10.1016/s1474-4422(22)00311-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Background Intraoperative electrocorticography is used to tailor epilepsy surgery by analysing interictal spikes or spike patterns that can delineate epileptogenic tissue. High-frequency oscillations (HFOs) on intraoperative electrocorticography have been proposed as a new biomarker of epileptogenic tissue, with higher specificity than spikes. We prospectively tested the non-inferiority of HFO-guided tailoring of epilepsy surgery to spike-guided tailoring on seizure freedom at 1 year. Methods The HFO trial was a randomised, single-blind, adaptive non-inferiority trial at an epilepsy surgery centre (UMC Utrecht) in the Netherlands. We recruited children and adults (no age limits) who had been referred for intraoperative electrocorticography-tailored epilepsy surgery. Participants were randomly allocated (1:1) to either HFO-guided or spike-guided tailoring, using an online randomisation scheme with permuted blocks generated by an independent data manager, stratified by epilepsy type. Treatment allocation was masked to participants and clinicians who documented seizure outcome, but not to the study team or neurosurgeon. Ictiform spike patterns were always considered in surgical decision making. The primary endpoint was seizure outcome after 1 year (dichotomised as seizure freedom [defined as Engel 1A–B] vs seizure recurrence [Engel 1C–4]). We predefined a non-inferiority margin of 10% risk difference. Analysis was by intention to treat, with prespecified subgroup analyses by epilepsy type and for confounders. This completed trial is registered with the Dutch Trial Register, Toetsingonline ABR.NL44527.041.13, and ClinicalTrials.gov, NCT02207673. Findings Between Oct 10, 2014, and Jan 31, 2020, 78 individuals were enrolled to the study and randomly assigned (39 to HFO-guided tailoring and 39 to spike-guided tailoring). There was no loss to follow-up. Seizure freedom at 1 year occurred in 26 (67%) of 39 participants in the HFO-guided group and 35 (90%) of 39 in the spike-guided group (risk difference –23·5%, 90% CI –39·1 to –7·9; for the 48 patients with temporal lobe epilepsy, the risk difference was –25·5%, –45·1 to –6·0, and for the 30 patients with extratemporal lobe epilepsy it was –20·3%, –46·0 to 5·4). Pathology associated with poor prognosis was identified as a confounding factor, with an adjusted risk difference of –7·9% (90% CI –20·7 to 4·9; adjusted risk difference –12·5%, –31·0 to 5·9, for temporal lobe epilepsy and 5·8%, –7·7 to 19·5, for extratemporal lobe epilepsy). We recorded eight serious adverse events (five in the HFO-guided group and three in the spike-guided group) requiring hospitalisation. No patients died. Interpretation HFO-guided tailoring of epilepsy surgery was not non-inferior to spike-guided tailoring on intraoperative electrocorticography. After adjustment for confounders, HFOs show non-inferiority in extratemporal lobe epilepsy. This trial challenges the clinical value of HFOs as an epilepsy biomarker, especially in temporal lobe epilepsy. Further research is needed to establish whether HFO-guided intraoperative electrocorticography holds promise in extratemporal lobe epilepsy. Funding UMCU Alexandre Suerman, EpilepsieNL, RMI Talent Fellowship, European Research Council, and MING Fund.
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Affiliation(s)
- Willemiek Zweiphenning
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Tineke Gebbink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Geertjan Huiskamp
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Monique M J van Schooneveld
- Department of Pediatric Psychology, Wilhelmina's Children Hospital, University Medical Center Utrecht, Netherlands
| | - M Bourez
- Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Sophie Goemans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Sven Straumann
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Willem M Otte
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Eric van Diessen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
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12
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Tobochnik S, Bateman LM, Akman CI, Anbarasan D, Bazil CW, Bell M, Choi H, Feldstein NA, Kent PF, McBrian D, McKhann GM, Mendiratta A, Pack AM, Sands TT, Sheth SA, Srinivasan S, Schevon CA. Tracking Multisite Seizure Propagation Using Ictal High-Gamma Activity. J Clin Neurophysiol 2022; 39:592-601. [PMID: 34812578 PMCID: PMC8611231 DOI: 10.1097/wnp.0000000000000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Spatial patterns of long-range seizure propagation in epileptic networks have not been well characterized. Here, we use ictal high-gamma activity (HGA) as a proxy of intense neuronal population firing to map the spatial evolution of seizure recruitment. METHODS Ictal HGA (80-150 Hz) was analyzed in 13 patients with 72 seizures recorded by stereotactic depth electrodes, using previously validated methods. Distinct spatial clusters of channels with the ictal high-gamma signature were identified, and seizure hubs were defined as stereotypically recruited nonoverlapping clusters. Clusters correlated with asynchronous seizure terminations to provide supportive evidence for independent seizure activity at these sites. The spatial overlap between seizure hubs and interictal ripples was compared. RESULTS Ictal HGA was detected in 71% of seizures and 10% of implanted contacts, enabling tracking of contiguous and noncontiguous seizure recruitment. Multiple seizure hubs were identified in 54% of cases, including 43% of patients thought preoperatively to have unifocal epilepsy. Noncontiguous recruitment was associated with asynchronous seizure termination (odds ratio = 19.7; p = 0.029). Interictal ripples demonstrated greater spatial overlap with ictal HGA in cases with single seizure hubs compared with those with multiple hubs (100% vs. 66% per patient; p = 0.03). CONCLUSIONS Ictal HGA may serve as a useful adjunctive biomarker to distinguish contiguous seizure spread from propagation to remote seizure sites. High-gamma sites were found to cluster in stereotyped seizure hubs rather than being broadly distributed. Multiple hubs were common even in cases that were considered unifocal.
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Affiliation(s)
- Steven Tobochnik
- Brigham and Women’s Hospital, Department of Neurology, Boston, MA
| | - Lisa M. Bateman
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Cigdem I. Akman
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | | | - Carl W. Bazil
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Michelle Bell
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Hyunmi Choi
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Neil A. Feldstein
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Paul F. Kent
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Danielle McBrian
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Guy M. McKhann
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Anil Mendiratta
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Alison M. Pack
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Tristan T. Sands
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Sameer A. Sheth
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX
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13
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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Affiliation(s)
- Andrea Cometa
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Antonio Falasconi
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Marco Biasizzo
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Jacopo Carpaneto
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Andreas Horn
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology, 10117 Berlin, Germany
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Translational Neural Engineering Lab, School of Engineering, École Polytechnique Fèdèrale de Lausanne, 1015 Lausanne, Switzerland
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14
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Tripathi S, Vivas-Buitrago T, Domingo RA, Biase GD, Brown D, Akinduro OO, Ramos-Fresnedo A, Sherman W, Gupta V, Middlebrooks EH, Sabsevitz DS, Porter AB, Uhm JH, Bendok BR, Parney I, Meyer FB, Chaichana KL, Swanson KR, Quiñones-Hinojosa A. IDH-wild-type glioblastoma cell density and infiltration distribution influence on supramarginal resection and its impact on overall survival: a mathematical model. J Neurosurg 2022; 136:1567-1575. [PMID: 34715662 PMCID: PMC9248269 DOI: 10.3171/2021.6.jns21925] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Recent studies have proposed resection of the T2 FLAIR hyperintensity beyond the T1 contrast enhancement (supramarginal resection [SMR]) for IDH-wild-type glioblastoma (GBM) to further improve patients' overall survival (OS). GBMs have significant variability in tumor cell density, distribution, and infiltration. Advanced mathematical models based on patient-specific radiographic features have provided new insights into GBM growth kinetics on two important parameters of tumor aggressiveness: proliferation rate (ρ) and diffusion rate (D). The aim of this study was to investigate OS of patients with IDH-wild-type GBM who underwent SMR based on a mathematical model of cell distribution and infiltration profile (tumor invasiveness profile). METHODS Volumetric measurements were obtained from the selected regions of interest from pre- and postoperative MRI studies of included patients. The tumor invasiveness profile (proliferation/diffusion [ρ/D] ratio) was calculated using the following formula: ρ/D ratio = (4π/3)2/3 × (6.106/[VT21/1 - VT11/1])2, where VT2 and VT1 are the preoperative FLAIR and contrast-enhancing volumes, respectively. Patients were split into subgroups based on their tumor invasiveness profiles. In this analysis, tumors were classified as nodular, moderately diffuse, or highly diffuse. RESULTS A total of 101 patients were included. Tumors were classified as nodular (n = 34), moderately diffuse (n = 34), and highly diffuse (n = 33). On multivariate analysis, increasing SMR had a significant positive correlation with OS for moderately and highly diffuse tumors (HR 0.99, 95% CI 0.98-0.99; p = 0.02; and HR 0.98, 95% CI 0.96-0.99; p = 0.04, respectively). On threshold analysis, OS benefit was seen with SMR from 10% to 29%, 10% to 59%, and 30% to 90%, for nodular, moderately diffuse, and highly diffuse, respectively. CONCLUSIONS The impact of SMR on OS for patients with IDH-wild-type GBM is influenced by the degree of tumor invasiveness. The authors' results show that increasing SMR is associated with increased OS in patients with moderate and highly diffuse IDH-wild-type GBMs. When grouping SMR into 10% intervals, this benefit was seen for all tumor subgroups, although for nodular tumors, the maximum beneficial SMR percentage was considerably lower than in moderate and highly diffuse tumors.
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Affiliation(s)
- Shashwat Tripathi
- 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 10Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Tito Vivas-Buitrago
- 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 11Department of Health Sciences, School of Medicine, Universidad de Santander UDES, Bucaramanga, Colombia
| | | | | | - Desmond Brown
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Wendy Sherman
- 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 7Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Jacksonville
| | - Vivek Gupta
- 8Department of Radiology, Mayo Clinic, Jacksonville
| | - Erik H Middlebrooks
- 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 8Department of Radiology, Mayo Clinic, Jacksonville
| | - David S Sabsevitz
- 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 9Department of Psychology, Mayo Clinic, Jacksonville, Florida
| | - Alyx B Porter
- 5Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Phoenix, Arizona
| | - Joon H Uhm
- 6Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Ian Parney
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kristin R Swanson
- 3Department of Neurosurgery, Mayo Clinic, Phoenix
- 4Mathematical Neuro-Oncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix
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15
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Feyissa AM, Carrano A, Wang X, Allen M, Ertekin-Taner N, Dickson DW, Jentoft ME, Rosenfeld SS, Tatum WO, Ritaccio AL, Guerrero-Cázares H, Quiñones-Hinojosa A. Analysis of intraoperative human brain tissue transcriptome reveals putative risk genes and altered molecular pathways in glioma-related seizures. Epilepsy Res 2021; 173:106618. [PMID: 33765507 PMCID: PMC9356713 DOI: 10.1016/j.eplepsyres.2021.106618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pathogenesis of glioma-related seizures (GRS) is poorly understood. Here in, we aim to identify putative molecular pathways that lead to the development of GRS. METHODS We determined brain transcriptome from intraoperative human brain tissue of patients with either GRS, glioma without seizures (non-GRS), or with idiopathic temporal lobe epilepsy (iTLE). We performed transcriptome-wide comparisons between disease groups tissue from non-epileptic controls (non-EC) to identify differentially-expressed genes (DEG). We compared DEGs to identify those that are specific or common to the groups. Through a gene ontology analysis, we identified molecular pathways enriched for genes with a Log-fold change ≥1.5 or ≤-1.5 and p-value <0.05 compared to non-EC. RESULTS We identified 110 DEGs that are associated with GRS vs. non-GRS: 80 genes showed high and 30 low expression in GRS. There was significant overexpression of genes involved in cell-to-cell and glutamatergic signaling (CELF4, SLC17A7, and CAMK2A) and down-regulation of genes involved immune-trafficking (CXCL8, H19, and VEGFA). In the iTLE vs GRS analysis, there were 1098 DEGs: 786 genes were overexpressed and 312 genes were underexpressed in the GRS samples. There was significant enrichment for genes considered markers of oncogenesis (GSC, MYBL2, and TOP2A). Further, there was down-regulation of genes involved in the glutamatergic neurotransmission (vesicular glutamate transporter-2) in the GRS vs. iTLE samples. CONCLUSIONS We identified a number of altered processes such as cell-to-cell signaling and interaction, inflammation-related, and glutamatergic neurotransmission in the pathogenesis of GRS. Our findings offer a new landscape of targets to further study in the fields of brain tumors and seizures.
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Affiliation(s)
| | - Anna Carrano
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Xue Wang
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Mariet Allen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mark E Jentoft
- Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Steven S Rosenfeld
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA; Department of Pharmacology, Mayo Clinic, Jacksonville, FL, USA
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16
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Vivas-Buitrago T, Domingo RA, Tripathi S, De Biase G, Brown D, Akinduro OO, Ramos-Fresnedo A, Sabsevitz DS, Bendok BR, Sherman W, Parney IF, Jentoft ME, Middlebrooks EH, Meyer FB, Chaichana KL, Quinones-Hinojosa A. Influence of supramarginal resection on survival outcomes after gross-total resection of IDH-wild-type glioblastoma. J Neurosurg 2021; 136:1-8. [PMID: 34087795 DOI: 10.3171/2020.10.jns203366] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' goal was to use a multicenter, observational cohort study to determine whether supramarginal resection (SMR) of FLAIR-hyperintense tumor beyond the contrast-enhanced (CE) area influences the overall survival (OS) of patients with isocitrate dehydrogenase-wild-type (IDH-wt) glioblastoma after gross-total resection (GTR). METHODS The medical records of 888 patients aged ≥ 18 years who underwent resection of GBM between January 2011 and December 2017 were reviewed. Volumetric measurements of the CE tumor and surrounding FLAIR-hyperintense tumor were performed, clinical variables were obtained, and associations with OS were analyzed. RESULTS In total, 101 patients with newly diagnosed IDH-wt GBM who underwent GTR of the CE tumor met the inclusion criteria. In multivariate analysis, age ≥ 65 years (HR 1.97; 95% CI 1.01-2.56; p < 0.001) and contact with the lateral ventricles (HR 1.59; 95% CI 1.13-1.78; p = 0.025) were associated with shorter OS, but preoperative Karnofsky Performance Status ≥ 70 (HR 0.47; 95% CI 0.27-0.89; p = 0.006), MGMT promotor methylation (HR 0.63; 95% CI 0.52-0.99; p = 0.044), and increased percentage of SMR (HR 0.99; 95% CI 0.98-0.99; p = 0.02) were associated with longer OS. Finally, 20% SMR was the minimum percentage associated with beneficial OS (HR 0.56; 95% CI 0.35-0.89; p = 0.01), but > 60% SMR had no significant influence (HR 0.74; 95% CI 0.45-1.21; p = 0.234). CONCLUSIONS SMR is associated with improved OS in patients with IDH-wt GBM who undergo GTR of CE tumor. At least 20% SMR of the CE tumor was associated with beneficial OS, but greater than 60% SMR had no significant influence on OS.
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Affiliation(s)
| | | | | | | | - Desmond Brown
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | | | | | | | | | | | - Ian F Parney
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Fredric B Meyer
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
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17
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van Klink NEC, Zweiphenning WJEM, Ferrier CH, Gosselaar PH, Miller KJ, Aronica E, Braun KPJ, Zijlmans M. Can we use intraoperative high-frequency oscillations to guide tumor-related epilepsy surgery? Epilepsia 2021; 62:997-1004. [PMID: 33617688 PMCID: PMC8248094 DOI: 10.1111/epi.16845] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 02/05/2023]
Abstract
Objective In people with low‐grade intrinsic brain tumors, an epileptic focus is often located close to the lesion. High‐frequency oscillations (HFOs) in electrocorticography (ECoG) might help to delineate this focus. We investigated the relationship between HFOs and low‐grade brain tumors and their potential value for tumor‐related epilepsy surgery. Methods We analyzed pre‐ and postresection intraoperative ECoG in 41 patients with refractory epilepsy and a low‐grade lesion. Electrodes were designated as overlying the tumor, adjacent resected tissue (peritumoral), or outside the resection bed using magnetic resonance imaging (MRI) and intraoperative photographs. We then used a semiautomated approach to detect HFOs as either ripples (80–250 Hz) or fast ripples (250–500 Hz). Results The rate of fast ripples was higher in electrodes covering tumor and peritumoral tissue than outside the resection (p = .04). Mesiotemporal tumors showed more ripples (p = .002), but not more fast ripples (p = .07), than superficial tumors. Rates of fast ripples were higher in glioma and extraventricular neurocytoma than in ganglioglioma or dysembryoplastic neuroepithelial tumor (DNET). The rate of ripples and fast ripples in postresection ECoG was not higher in patients with residual tumor tissue on MRI than those without. The rate of ripples in postresection ECoG was higher in patients with good than bad seizure outcome (p = .03). Fast ripples outside the resection and in post‐ECoG seem related to seizure recurrence. Significance Fast ripples in intraoperative ECoG can be used to help guide resection in tumor‐related epilepsy surgery. Preresection fast ripples occur predominantly in epileptogenic tumor and peritumoral tissue. Fast ripple rates are higher in glioma and extraventricular neurocytoma than in ganglioglioma and DNET.
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Affiliation(s)
- Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Willemiek J E M Zweiphenning
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Kai J Miller
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation (SEIN), Heemstede, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation (SEIN), Heemstede, the Netherlands
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18
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A feasibility study of electrocorticography during routine craniotomy to predict tumor-related epilepsy. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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ReFaey K, Chaichana KL, Feyissa AM, Vivas-Buitrago T, Brinkmann BH, Middlebrooks EH, McKay JH, Lankford DJ, Tripathi S, Bojaxhi E, Roth GE, Tatum WO, Quiñones-Hinojosa A. A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy. J Neurosurg 2020; 133:443-450. [PMID: 31277069 DOI: 10.3171/2019.4.jns19261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is common among patients with supratentorial brain tumors; approximately 40%-70% of patients with glioma develop brain tumor-related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the "circular grid," that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface. METHODS The authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes. RESULTS Matched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80). CONCLUSIONS The circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.
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Affiliation(s)
| | | | | | | | - Benjamin H Brinkmann
- Departments of3Neurology and
- 4Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Shashwat Tripathi
- 6Department of Mathematics, University of Texas at Austin, Austin, Texas; and
| | - Elird Bojaxhi
- 7Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida
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20
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Correlation of preoperative seizures with a wide range of tumor molecular markers in gliomas: An analysis of 442 glioma patients from China. Epilepsy Res 2020; 166:106430. [PMID: 32712511 DOI: 10.1016/j.eplepsyres.2020.106430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Epileptic seizures often develop in 40-70 % of glioma patients and have a significant impact on patients' quality of life. Many biomarkers have been suggested to be associated with glioma-related preoperative seizures (GPS). The purpose of the present study was to investigate the possible correlation between GPS and clinicopathological factors and a wide range of glioma-associated molecular markers (GMMs). METHODS First, a retrospective cohort study of 442 patients with glioma was evaluated at the PLA General Hospital. Univariate and multivariate logistic analyses were used to identify basic factors associated with GPS. Second, 40 pairs of cases who underwent deep sequencing of 68 GMMs were selected from both groups for in-depth analysis. RESULTS Of the 442 patients examined in this study, 137 (31 %) had GPS. By analyzing the characteristics of these patients, the results showed that patient age (OR: 0.981, p = 0.037, 95 % CI: 0.964-0.999), WHO grade (OR: 0.678, p = 0.008, 95 % CI: 0.509-0.903) and IDH mutations (OR: 1.886, p = 0.013, 95 % CI: 1.143-3.11) in patients were associated with the occurrence of GPS. In our cohort, GPS did not differ by sex, tumor location, histopathological subtype, p53 expression, ARTX loss, MGMT gene promotor methylation, TERT promoter mutation, or 1p/19q co-deletion status. The results of the matching study showed that the paired groups had similar genetic expression profiles, and the mutation of these 68 GMMs was not correlated with the occurrence of GPS. CONCLUSION The current study updates existing information on GPS and genetic markers in gliomas and explores the correlation of a wide range of GMMs and GPS. These factors may provide insights for developing effective treatment strategies aimed at seizure control.
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21
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Gonzalez Castro LN, Milligan TA. Seizures in patients with cancer. Cancer 2020; 126:1379-1389. [PMID: 31967671 DOI: 10.1002/cncr.32708] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022]
Abstract
Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by systemic illness (metabolic derangements, infections). Evaluation should include a tailored history, neurologic examination, laboratory studies, neuroimaging, and electroencephalogram. In unprovoked seizures, antiepileptic drug (AED) treatment is required, and a nonenzyme-inducing AED is preferred. Treatment of the underlying cancer with surgery, chemotherapy, and radiation therapy also can help reduce seizures. Benzodiazepines are useful in the treatment of both provoked seizures and breakthrough epileptic seizures and as first-line treatment for status epilepticus. Counseling for safety is an important component in the care of a patient with cancer who has seizures. Good seizure management can be challenging but significantly improves the quality of life during all phases of care, including end-of-life care.
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Affiliation(s)
- L Nicolas Gonzalez Castro
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracey A Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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22
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Tatum WO, Feyissa AM, ReFaey K, Grewal SS, Alvi MA, Castro-Apolo R, Roth G, Segura-Duran I, Mahato D, Ruiz-Garcia H, Pamias-Portalatin E, Yelvington K, Chaichana K, Bechtle P, Quinones-Hinojosa A. Periodic focal epileptiform discharges. Clin Neurophysiol 2019; 130:1320-1328. [DOI: 10.1016/j.clinph.2019.04.718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/30/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022]
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23
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Feyissa AM, Worrell GA, Tatum WO, Chaichana KL, Jentoft ME, Guerrero Cazares H, Ertekin-Taner N, Rosenfeld SS, ReFaey K, Quinones-Hinojosa A. Potential influence of IDH1 mutation and MGMT gene promoter methylation on glioma-related preoperative seizures and postoperative seizure control. Seizure 2019; 69:283-289. [PMID: 31141785 DOI: 10.1016/j.seizure.2019.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/21/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To examine the occurrence of glioma-related preoperative seizures (GPS) and post-operative seizure control (PSC) with respect to patients characteristics including five commonly tested tumor molecular markers (TMMs). METHODS A single-center retrospective cohort study of patients with glioma evaluated at the Mayo Clinic, Florida between 2016 and 2018. RESULTS 68 adult patients (mean age = 51-years, 45-males) were included. 46 patients had GPS. 57 patients underwent intra-operative electrocorticography during awake craniotomy-assisted glioma resection. All patients underwent glioma resection (53, gross-total resection) with histologies of pilocytic astrocytoma (n = 2), diffuse astrocytoma (n = 4), oligodendroglioma (n = 14), anaplastic astrocytoma (n = 16), anaplastic oligodendroglioma (n = 1), and glioblastoma (n = 31). 31 (67%) patients had PSC (median follow-up = 14.5 months; IQR = 7-16.5 months). IDH1 mutation (IDH1mut) was present in 32, ARTX retention in 53, MGMT gene promotor methylation in 15, 1p/19q co-deletion in 15, and over-expression of p53 in 19 patients. Patients with IDH1mut were more likely to have GPS (p = 0.037) and PSC (p = 0.035) compared to patients with IDH1 wild-type. Patients with MGMT gene promoter methylation were also likely to have PSC (p = 0.032). GPS or PSC did not differ by age, sex, extent of surgery, glioma grade, location, and histopathological subtype, p53 expression, ARTX retention, or 1p/19q co-deletion status. CONCLUSIONS GPS and PSC may be associated with IDH1 mutation and MGMT gene promoter methylation status but not other glioma characteristics including tumor grade, location, or histopathology. Prospective studies with larger sample size are needed to clarify the exact mechanisms of GPS and PSC by the various TMMs to identify new treatment targets.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Kaisorn L Chaichana
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Mark E Jentoft
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Hugo Guerrero Cazares
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Nileufer Ertekin-Taner
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Steven S Rosenfeld
- Department of Hematology/Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Karim ReFaey
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
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Inhibition and oscillations in the human brain tissue in vitro. Neurobiol Dis 2019; 125:198-210. [DOI: 10.1016/j.nbd.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/22/2018] [Accepted: 02/07/2019] [Indexed: 01/22/2023] Open
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25
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Awake craniotomies for epileptic gliomas: intraoperative and postoperative seizure control and prognostic factors. J Neurooncol 2019; 142:577-586. [DOI: 10.1007/s11060-019-03131-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
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26
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Tatum WO, Quinones-Hinojosa A. Onco-Epilepsy: More Than Tumor and Seizures. Mayo Clin Proc 2018; 93:1181-1184. [PMID: 30104043 DOI: 10.1016/j.mayocp.2018.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 11/23/2022]
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