1
|
Orr C, Fisher H, Elliott I, Yu X, Glennie M, White A, Pearson A, Essex J, Cragg M, Tews I. Conformational regulation in anti-CD40 antibodies. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322096358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
|
2
|
Vivekanantham A, Kesavan M, Evans J, Matin RN, Elliott I, Luqmani R. POS1453 OVERLAPPING FEATURES OF RELAPSING POLYCHONDRITIS AND SWEET’S SYNDROME: COULD THIS BE VEXAS (VACUOLES, UBIQUITIN A1E MUTATION, X-LINKED, AUTOINFLAMMATORY, SOMATIC) SYNDROME? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:An 83-year-old male presented to the infectious diseases team with intermittent fevers associated with tension headaches, malaise and fatigue for two years, with recent worsening. He had noted a progressive decline in his mobility over the past year following replacement of his right knee for osteoarthritis. His past medical history included atopic eczema, malaria and bilateral cataract extractions.On examination, he had a widespread non-scaly annular urticated rash. He had persistently raised inflammatory markers (CRP 40mg/L, ESR 82mm/hour), normocytic anaemia (Hb 102 g/L, MCV 101.9 fL), lymphopenia (0.70 x10^9/L), fluctuating eosinophilia (0.88-1.25 x10^9/L) and a mildly elevated lactate dehydrogenase (243IU/L). A thorough work up for pyrexia of unknown origin showed no evidence of infection/ vasculitis/ immune pathology. The only positive finding was prior exposure to schistosomiasis, treated with a single dose of praziquantel. An echocardiogram and serial PET-CT scans were normal. Given the deterioration in mobility since the right knee replacement, an MRI knee was performed, and cobalt/ chromium levels to look for allergic responses to the prosthesis, but these tests did not reveal any findings of significance.An initial haematology work-up did not identify an abnormality of concern (screening for a myeloproliferative neoplasm including BCR-ABL studies were negative and mast cell tryptase was not elevated). Due to a worsening skin rash, he was reviewed by dermatology where a skin biopsy showed features of superficial neutrophilic dermatosis which can be observed with Sweet’s syndrome. However, it was felt that this was an unlikely explanation for the persistent systemic symptoms. He proceeded to a bone marrow biopsy which showed reactive features including vacuolation of myeloid precursors with normal cytogenics.During follow up appointments, the patient described new recurrent violaceous patches with episodes of inflammation of the pinna of the ear, suggesting a diagnosis of relapsing polychondritis and so the patient was started on high dose prednisolone (80mg per day [1mg per kg]) and referred for rheumatological assessment. He had an excellent response to prednisolone (fever, ear swelling and rash subsided). The overlapping features of relapsing polychondritis and Sweet’s syndrome in an elderly man suggested a diagnosis of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic) syndrome. The prednisolone dose was rapidly reduced to 10mg per day and the patient was commenced on methotrexate, as a steroid-sparing agent. Further blood tests have been sent for genetic analysis for VEXAS syndrome but results are pending.Objectives:N/AMethods:N/AResults:N/AConclusion:VEXAS syndrome is a newly identified genetically defined syndrome, described by Beck et al in October 2020 consisting of somatic mutations in the UBA1 gene, affecting bone marrow stem cells. In a study of 25 patients with this mutation, diagnostic/ classification criteria for relapsing polychondritis (n=15), Sweet’s syndrome (n=8), polyarteritis nodosa (n=3) or giant cell arteritis (n=1) were met and patients often had severe refractory disease with overlapping systemic inflammatory and haematologic features. Features of VEXAS include the presence of vacuoles in myeloid cells, somatic mutations in the UBA1 (ubiquitin-activating enzyme) gene, X-linkage (therefore only occurring in males), in older people with autoinflammatory syndromes. Although VEXAS syndrome is a relatively rare condition, it was a relevant consideration in this case.References:[1]Beck et al. Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med 2020; 383:2628-2638. DOI: 10.1056/NEJMoa2026834Disclosure of Interests:None declared
Collapse
|
3
|
Caldwell A, Elliott I, Konadu P, Awariyah D, Ativor V. Process improvement: A valuable tool for health-system strengthening in
developing countries. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
4
|
Smith ML, Olds J, Snyder T, Elliott I, Lach L, Whiting S. A follow-up study of cognitive function in young adults who had resective epilepsy surgery in childhood. Epilepsy Behav 2014; 32:79-83. [PMID: 24508594 DOI: 10.1016/j.yebeh.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
Abstract
This study examined cognitive function in young adults who had epilepsy surgery in childhood. Thirty-seven individuals with medically intractable epilepsy with onset at 16 years or younger who had resective epilepsy surgery at least two years in the past (mean follow-up duration of 8.5 years) were assessed; of these, 13 had seizures within the year prior to the study, and the remainder had none. A comparison group of 16 individuals with childhood-onset intractable epilepsy who had not had surgery, all of whom had experienced at least one seizure in the past 12 months, was also included. The cognitive tests included measures of vocabulary, visuoconstructive ability, memory, and concept formation. Group differences were found only for the vocabulary and verbal memory tests, with the surgical group with seizures having the lowest performance. A subset of the surgical patients had preoperative data available on comparable tests, allowing for an examination of performance over time. Vocabulary scores were higher at follow-up, a finding which was present irrespective of seizure status. The results suggest that after epilepsy surgery in childhood or adolescence, few improvements in cognitive skills related to surgery or seizure outcome are to be expected.
Collapse
Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, ON L5L 1C6, Canada; Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Janet Olds
- Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Thomas Snyder
- Department of Psychiatry, University of Alberta Hospital, Edmonton, AB T5J 2J7, Canada
| | - Irene Elliott
- Division of Neurology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Lucyna Lach
- School of Social Work, McGill University, Montreal, QC H3A 2A7, Canada
| | - Sharon Whiting
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| |
Collapse
|
5
|
Elliott I, Dittrich S, Paris D, Sengduanphachanh A, Phoumin P, Newton PN. The use of dried cerebrospinal fluid filter paper spots as a substrate for PCR diagnosis of the aetiology of bacterial meningitis in the Lao PDR. Clin Microbiol Infect 2013; 19:E466-72. [PMID: 23738720 PMCID: PMC4285853 DOI: 10.1111/1469-0691.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/24/2013] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
Abstract
We investigated whether dried cerebrospinal fluid (CSF) conserved on filter paper can be used as a substrate for accurate PCR diagnosis of important causes of bacterial meningitis in the Lao PDR. Using mock CSF, we investigated and optimized filter paper varieties, paper punch sizes, elution volumes and quantities of DNA template to achieve sensitive and reliable detection of bacterial DNA from filter paper specimens. FTA Elute Micro Card™ (Whatman, Maidstone, UK) was the most sensitive, consistent and practical variety of filter paper. Following optimization, the lower limit of detection for Streptococcus pneumoniae from dried mock CSF spots was 14 genomic equivalents (GE)/μL (interquartile range 5.5 GE/μL) or 230 (IQR 65) colony forming units/mL. A prospective clinical evaluation for S. pneumoniae, S. suis and Neisseria meningitidis was performed. Culture and PCR performed on fresh liquid CSF from patients admitted with a clinical diagnosis of meningitis (n = 73) were compared with results derived from dried CSF spots. Four of five fresh PCR-positive CSF samples also tested PCR positive from dried CSF spots, with one patient under the limit of detection. In a retrospective study of S. pneumoniae samples (n = 20), the median (IQR; range) CSF S. pneumoniae bacterial load was 1.1 × 10(4) GE/μL (1.2 × 10(5) ; 1 to 6.1 × 10(6) DNA GE/μL). Utilizing the optimized methodology, we estimate an extrapolated sensitivity of 90%, based on the range of CSF genome counts found in Laos. Dried CSF filter paper spots could potentially help us to better understand the epidemiology of bacterial meningitis in resource-poor settings and guide empirical treatments and vaccination policies.
Collapse
Affiliation(s)
- I Elliott
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | | | | | | | | | | |
Collapse
|
6
|
Mohamed IS, Otsubo H, Ferrari P, Sharma R, Ochi A, Elliott I, Go C, Chuang S, Rutka J, Snead C, Cheyne D. Source localization of interictal spike-locked neuromagnetic oscillations in pediatric neocortical epilepsy. Clin Neurophysiol 2013; 124:1517-27. [PMID: 23523111 DOI: 10.1016/j.clinph.2013.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the utility of an event-related beamforming (ERB) algorithm in source localization of interictal discharges. METHODS We analyzed interictal magnetoencephalography data in 35 children with intractable neocortical epilepsy. We used a spatiotemporal beamforming method to estimate the spatial distribution of source power in individual interictal spikes. We compared ERB results to source localization using the equivalent current dipole model and to the seizure onset zones on intracranial EEG. RESULTS Focal beamformer localization was observed in 66% of patients and multifocal in the remaining 34%. ERB localized within 2 cm of the equivalent current dipole cluster centroid in 77% of the patients. ERB localization was concordant with the seizure onset zone on intracranial EEG at the gyral level in 69% of patients. Focal ERB localization area was included in the resection margin in 22/23 patients. However, focal ERB localization was not statistically associated with better surgical outcome. CONCLUSIONS ERB can be used for source localization of interictal spikes and can be predictive of the ictal onset zone in a subset of patients with neocortical epilepsy. SIGNIFICANCE These results support the utility of beamformer source localization as a fast semi-automated method for source localization of interictal spikes and planning the surgical strategy.
Collapse
Affiliation(s)
- Ismail S Mohamed
- Department of Pediatrics, IWK Health Center, Dalhousie University, Halifax, NS, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Elliott I, Jerome A, Angwafor SA, Smith ML, Takougang I, Noh J, Tsang V, Wilkins P, Cockburn L, Keystone J, Njamnshi AK, Snead OC. Epilepsy and cysticercosis in Northwest Cameroon: a serological study. Seizure 2013; 22:283-6. [PMID: 23428421 DOI: 10.1016/j.seizure.2013.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/18/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The prevalence of epilepsy in Cameroon is higher than that of the industrialized world and other developing countries. Neurocysticercosis due to Taenia solium infestation has been reported as a major cause of epilepsy in some parts of Cameroon although there are some conflicting data. The prevalence of epilepsy is especially high in the Momo division of the North-West Province of Cameroon. We hypothesized that individuals with epilepsy in this region have a higher percentage of seropositivity to T. solium than matched controls. METHODS We conducted a case-control study in the Momo subdivision of Ngie. Individuals with epilepsy were recruited from the health centers in Ngie. Control subjects were selected from 19 Ngie villages. Potential cases of people with epilepsy (PWE) were identified through a questionnaire applied by trained field workers, using history of epileptic seizures as a key indicator. Blood samples were taken from all consenting individuals by finger prick, stored in StabilZyme Select, and assayed for antibodies to T. solium in an Atlanta based reference laboratory. RESULTS We accrued 249 patients with epilepsy, of whom 237 met the inclusion criteria, and 245 age-matched controls. There was no significant difference in seropositivity to T. solium between those individuals with epilepsy (5%) and controls (4.9%). CONCLUSIONS Our data do not support the hypothesis that epilepsy is associated with seropositivity to T. solium. It is highly unlikely that cysticercosis plays a causative role in the high prevalence of epilepsy in this region of Cameroon.
Collapse
Affiliation(s)
- Irene Elliott
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Elliott I, Kadis DS, Lach L, Olds J, McCleary L, Whiting S, Snyder T, Smith ML. Quality of life in young adults who underwent resective surgery for epilepsy in childhood. Epilepsia 2012; 53:1577-86. [PMID: 22812675 DOI: 10.1111/j.1528-1167.2012.03594.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study investigated quality of life (QOL) in young adults who had undergone epilepsy surgery before the age of 16 years. The contribution to QOL of seizure status in the prior year, sex, number of antiepileptic drugs, and mood were evaluated. METHODS Sixty-nine young adults who had undergone surgery were subdivided into those who were seizure-free in the past year (n = 38) and those who had seizures (n = 31) in that time. A nonsurgical comparison group of young adults (n = 29) with childhood-onset medically intractable epilepsy was also studied. All groups completed measures of QOL and mood. KEY FINDINGS After accounting for mood, sex, and number of antiepileptic drugs, the seizure-free group reported better cognitive and physical function and overall QOL, experienced less seizure worry, and had better self-perception. Mood was the most consistently predictive covariate, and was independently predictive of many aspects of QOL. SIGNIFICANCE Seizure freedom associated with surgery in childhood is associated with improved QOL in certain domains. Findings highlight the importance of mood in determining self-perception of QOL.
Collapse
Affiliation(s)
- Irene Elliott
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Webb BD, Barrera M, Beyene J, Carcao M, Daneman D, Elliott I, Gong GWK, Halperin IJ, Lord S, Melville H, Narayanan UG, Ota S, Solomon M, Sung L, Young NL, Zachos M, Feldman BM. Determinants of quality of life in children with chronic somatic disease: pilot data from the GapS Questionnaire. Qual Life Res 2012; 22:339-49. [PMID: 22461136 DOI: 10.1007/s11136-012-0159-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
|
10
|
Ibrahim GM, Fallah A, Snead OC, Elliott I, Drake JM, Bernstein M, Rutka JT. Ethical issues in surgical decision making concerning children with medically intractable epilepsy. Epilepsy Behav 2011; 22:154-7. [PMID: 21856238 DOI: 10.1016/j.yebeh.2011.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/06/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
Abstract
The widespread inclusion of surgical strategies in the treatment of medically intractable epilepsy is largely justified by the medical and psychosocial burden of the illness. Performing these procedures in pediatric populations is associated with distinct challenges ranging from unique seizure etiologies to issues surrounding brain development and functional plasticity. As the trend toward more aggressive surgical intervention continues, the ethical foundation of current and emerging practices must be increasingly scrutinized. Here, we present the first article discussing ethical issues in the surgical management of medically intractable epilepsies in children. We discuss principles of informed consent, harm reduction, and justice in this vulnerable patient population. We also highlight the unique ethical challenge of surgical decision making concerning developmentally delayed children. The recognition of these issues is essential to providing patient-centered, responsible, and ethical care.
Collapse
Affiliation(s)
- George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children and Toronto Western Hospital, Toronto, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|
11
|
Lach LM, Elliott I, Giecko T, Olds J, Snyder T, McCleary L, Whiting S, Lowe A, Nimigon J, Smith ML. Patient-reported outcome of pediatric epilepsy surgery: social inclusion or exclusion as young adults? Epilepsia 2010; 51:2089-97. [PMID: 20477845 DOI: 10.1111/j.1528-1167.2010.02584.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to examine the social relationships and participation in educational, vocational, and community life in young adults who had undergone epilepsy surgery during childhood or adolescence. METHODS This was a retrospective, cross-sectional, case-controlled, and multisite design study. Findings were compared between young adults who had undergone epilepsy surgery and were seizure-free in the previous 12 months (n = 38), those who had undergone epilepsy surgery and were not seizure-free (n = 33), and a group of individuals with epilepsy who had not undergone surgery (n = 31). RESULTS The surgical seizure-free group had significantly better general social well-being than the other two groups. Specifically, these participants were employed for more months over the past year, were less likely to report that epilepsy had affected their employment, and were more likely to belong to at least one community organization. However, these participants were not any more likely to be involved in a relationship than those in the other two groups. In addition, there were no group differences in the reported number of friends or the frequency of visits with friends, or in what participants described as their principal activity (i.e., student, employed or unemployed). DISCUSSION There are a number of benefits to social functioning associated with having had epilepsy surgery and being seizure-free in the past year. Further research is recommended to increase our understanding of the mechanisms involved in the social and personal challenges that these individuals face.
Collapse
Affiliation(s)
- Lucyna M Lach
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Smith ML, Elliott I, Naguiat A. Sex differences in episodic memory among children with intractable epilepsy. Epilepsy Behav 2009; 14:247-9. [PMID: 18765300 DOI: 10.1016/j.yebeh.2008.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 08/18/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
Abstract
This study investigated whether children with epilepsy exhibit sex differences in episodic memory. Fifty-one children and adolescents (26 boys and 25 girls) with intractable epilepsy were administered two verbal-auditory tasks (learning and recall of a word list and story recall) and two visual tasks (design recall and face recognition). Girls exhibited an advantage on the delayed recall of stories and on the learning phase of the word list task. No significant differences were observed on the delayed recall of words or the visual tasks. These results identify a particular risk for cognitive impairment in boys that could have an important impact on their academic performance.
Collapse
Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.
| | | | | |
Collapse
|
13
|
Benifla M, Rutka JT, Otsubo H, Lamberti-Pasculli M, Elliott I, Sell E, RamachandranNair R, Ochi A, Weiss SK, Snead OC, Donner EJ. Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood. Epilepsy Res 2008; 82:133-8. [DOI: 10.1016/j.eplepsyres.2008.07.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 07/09/2008] [Accepted: 07/20/2008] [Indexed: 11/25/2022]
|
14
|
Mohamed IS, Otsubo H, Ochi A, Elliott I, Donner E, Chuang S, Sharma R, Holowka S, Rutka J, Snead OC. Utility of Magnetoencephalography in the Evaluation of Recurrent Seizures after Epilepsy Surgery. Epilepsia 2007; 48:2150-9. [PMID: 17727666 DOI: 10.1111/j.1528-1167.2007.01271.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To study the role of magnetoencephalography (MEG) in the surgical evaluation of children with recurrent seizures after epilepsy surgery. METHODS We studied 17 children with recurrent seizures after epilepsy surgery using interictal and ictal scalp EEG, intracranial video EEG (IVEEG), MRI, and MEG. We analyzed the location and distribution of MEG spike sources (MEGSSs) and the relationship of MEGSSs to the margins of previous resections and surgical outcome. RESULTS Clustered MEGSSs occurred at the margins of previous resections within two contiguous gyri in 10 patients (group A), extended spatially from a margin by < or =3 cm in three patients (group B), and were remote from a resection margin by >3 cm in six patients (group C). Two patients had concomitant group A and C clusters. Thirteen patients underwent second surgeries. IVEEG was used in four patients. Six of seven patients with group A MEGSS clusters did not require IVEEG for second surgeries. Follow-up periods ranged from 0.6 to 4.3 years (mean: 2.6 years). Eleven children, including eight who became seizure-free, achieved Engel class I or II. CONCLUSION Our data demonstrate the utility of MEG for evaluating patients with recurrent seizures after epilepsy surgery. Specific MEGSS cluster patterns delineate epileptogenic zones. Removing cluster regions adjacent to the margins of previous resections, in addition to removing recurrent lesions, achieves favorable surgical outcome. Cluster location and extent identify which patients require IVEEG, potentially eliminating IVEEG for some. Patients with remotely located clusters require IVEEG for accurate assessment and localization of the entire epileptogenic zone.
Collapse
Affiliation(s)
- Ismail S Mohamed
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Unviersity of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ochi A, Otsubo H, Donner EJ, Elliott I, Iwata R, Funaki T, Akizuki Y, Akiyama T, Imai K, Rutka JT, Snead OC. Dynamic changes of ictal high-frequency oscillations in neocortical epilepsy: using multiple band frequency analysis. Epilepsia 2007; 48:286-96. [PMID: 17295622 DOI: 10.1111/j.1528-1167.2007.00923.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To characterize the spatial and temporal course of ictal high-frequency oscillations (HFOs) recorded by subdural EEG in children with intractable neocortical epilepsy. METHODS We retrospectively studied nine children (four girls, five boys; 4-17 yr) who presented with intractable extrahippocampal localization-related epilepsy and who underwent extraoperative video subdural EEG (1000 Hz sampling rate) and cortical resection. We performed multiple band frequency analysis (MBFA) to evaluate the frequency, time course, and distribution of ictal HFOs. We compared ictal HFO changes before and after clinical onset and postsurgical seizure outcomes. RESULTS Seventy-eight of 79 seizures showed HFOs. We observed wide-band HFOs ( approximately 250 Hz, approximately 120 electrodes) in six patients either with partial seizures alone (three patients) or with epileptic spasms (three patients). Three patients with partial seizures that secondarily generalized had wide-band HFOs ( approximately 170 Hz) before clinical onset and sustained narrow-band HFOs (60-164 Hz) with electrodecremental events after clinical onset ( approximately 28 electrodes). In four postoperatively seizure-free patients, more electrodes recorded higher-frequency HFOs inside the resection area than outside before and after clinical seizure onset. In five patients with residual seizures, electrodes recorded more HFOs that were of higher or equal frequency outside the surgical area than inside after clinical onset. CONCLUSION For partial seizures alone and epileptic spasms, more electrodes recorded only wide-band HFOs; for partial seizures that secondarily generalized, fewer electrodes recorded wide-band HFOs, but in these seizures electrodes also recorded subsequent sustained narrow-band ictal HFOs. Resection of those brain regions having electrodes with ictal, higher HFOs resulted in postsurgical seizure-free outcomes.
Collapse
Affiliation(s)
- Ayako Ochi
- The Divisions of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Benifla M, Otsubo H, Ochi A, Weiss SK, Donner EJ, Shroff M, Chuang S, Hawkins C, Drake JM, Elliott I, Smith ML, Snead OC, Rutka JT. Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children. Neurosurgery 2007; 59:1203-13; discussion 1213-4. [PMID: 17277683 DOI: 10.1227/01.neu.0000245615.32226.83] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe epilepsy. In this study, we conducted a retrospective review of children with drug-resistant temporal lobe epilepsy to evaluate seizure outcome after temporal lobe surgery. METHODS We reviewed the medical records of 126 children who had surgery for temporal lobe epilepsy at The Hospital for Sick Children between 1983 and 2003. The records were examined for preoperative and intraoperative factors that could predict patient outcome after surgery. RESULTS The mean age at seizure onset was 5.9 years. The mean seizure duration before surgery was 5.6 years. All patients had preoperative computed tomographic scans, magnetic resonance imaging scans, or both. The mean age at the time of surgery was 13.5 years. Sixty-two patients underwent left temporal resections and 64 patients underwent right temporal resections. The histopathology of the temporal resections revealed low-grade brain tumors in 65 children (52%) and cavernous malformations in four children. Ganglioglioma and astrocytoma were the most common tumors encountered. Mesial temporal sclerosis was found in 16 patients (13%), astrogliosis in 15 patients (12%), and cortical dysplasia in eight patients (7%). Postoperative follow-up of at least 2 years was available for 106 patients and ranged up to 13.0 years. Seventy-four percent of patients had an Engel Class I or II outcome. Patients with temporal lobe lesions had better outcomes compared with those without lesions (P < 0.05). Patients without a history of secondary generalization of seizures also had a better outcome when compared with those with secondary generalization. Complications in the form of contralateral homonymous hemianopsia, dysphasia, and infection were found in 5% of patients. Twelve patients had a second temporal lobe procedure for intractable recurrent seizures. After a second procedure, seven patients returned to a seizure-free state. CONCLUSION Temporal lobe resections for epilepsy in children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to children.
Collapse
Affiliation(s)
- Mony Benifla
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Araki T, Otsubo H, Makino Y, Elliott I, Iida K, Ochi A, Weiss SK, Chuang SH, Rutka JT, Snead OC. Efficacy of Dexamathasone on Cerebral Swelling and Seizures during Subdural Grid EEG Recording in Children. Epilepsia 2006; 47:176-80. [PMID: 16417546 DOI: 10.1111/j.1528-1167.2006.00384.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the impact of steroid treatment on cerebral swelling and seizures during subdural grid EEG (SGEEG) monitoring. METHODS We reviewed data from 37 pediatric patients with intractable epilepsy who underwent SGEEG monitoring and divided the patients into those who received dexamethasone and those who did not. We then correlated administration of steroids to incidence of cerebral swelling on computed tomography (CT) scans and to frequency of seizures during SGEEG. RESULTS Twenty-three patients received dexamethasone prophylactically every 6 hours (dosage range, 1-7.5 mg; mean, 3.2 mg) from the first day of SGEEG placement (group A); 14 patients received no dexamethasone (group B). Eight (21.6%) of 37 patients experienced cerebral swelling on CT: two (9%) were in group A, and six (42.9%) were in group B (p < 0.05). SGEEG monitoring time for recording habitual seizures that localized cortical areas for surgical excision was longer in group A (1-6 days; mean, 3.0) than it was in group B (1-3 days; mean, 2.2), (p < 0.05). Habitual seizures were recorded in 36 patients. One group A patient experienced obtundation due to cerebral swelling, and monitoring in this patient was discontinued. CONCLUSIONS The prophylactic administration of steroids to pediatric patients during SGEEG monitoring is efficacious for reducing cerebral swelling. Although it decreases the frequency of habitual seizures and increases seizure-monitoring time, dexamethasone reduces the risk of complications from cerebral swelling during the SGEEG procedure.
Collapse
Affiliation(s)
- Takashi Araki
- Division of Neurosurgery, Department of Pediatrics, The Hospital for Sick Children and University of Toront, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ochi A, Otsubo H, Iida K, Oishi M, Elliott I, Weiss SK, Kutomi T, Nakayama T, Sharma R, Chuang SH, Rutka JT, Snead OC. Identifying the primary epileptogenic hemisphere from electroencephalographic (EEG) and magnetoencephalographic dipole lateralizations in children with intractable epilepsy. J Child Neurol 2005; 20:885-92. [PMID: 16417858 DOI: 10.1177/08830738050200110501] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We used electroencephalographic (EEG) and magnetoencephalographic dipole lateralizations to identify the primary epileptogenic hemisphere in 41 children with intractable localization-related epilepsy. We compared EEG and magnetoencephalographic dipole lateralizations, EEG ictal onsets, and magnetic resonance images (MRIs). Concordant lateralization of EEG and magnetoencephalographic dipoles (> 50% of each lateralizing to the same hemisphere) occurred in 34 patients, with EEG ictal onsets in the same hemisphere in 23 (68%) and concordant MRI lesions in 23 (68%). Focal resection in 16 of 20 patients resulted in a good surgical outcome. Of the seven children with nonconcordant magnetoencephalographic and EEG lateralizations, one (14%) had EEG ictal onset and one (14%) had MRI lesions that lateralized; none had surgery. The relationship between lateralized EEG and magnetoencephalographic dipoles forecasts surgical candidacy. Concordant lateralizations predict good seizure control after surgery by identifying the primary epileptogenic hemisphere. Discordant lateralizations signify an undetermined epileptogenic hemisphere and contraindicate surgery without further testing.
Collapse
Affiliation(s)
- Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVES Linezolid, the first available agent in the new class of oxazolidinone antibiotics, represents a significant advance in the management options available for combating methicillin-resistant Staphylococcus aureus (MRSA) infections. In the UK it was launched for clinical use in 2001. The aim of this study was to audit the clinical use of linezolid and compliance with the guidelines of the hospital antibiotic committee. METHODS Our hospital antibiotic committee agreed clinical indications for linezolid use. We undertook an audit of compliance with these recommendations and also reviewed its use in terms of the source of infection, microbiology, duration of therapy, side-effects and choice of previous treatment. RESULTS Seventy-seven inpatients prescribed linezolid in Ninewells Hospital in the 3 years between March 2001 and September 2003 were audited. Overall compliance with our local recommendations appears to be very good. The main justification for using linezolid is the presence of existing or worsening renal dysfunction or poor venous access (34%) or lack of tolerance or clinical failure following glycopeptide monotherapy or combination therapy (32%). Skin and soft tissue infections (26%) were the most frequently diagnosed infections, although an increasing number of patients appear to receive linezolid for the treatment of lower respiratory tract infections, primarily in the ICU for nosocomial or ventilator-associated pneumonia. MRSA organisms were the most common cause of microbiologically proven treated infections [n = 43 (56%)]. Disappointingly, only 34 out of 77 patients had case record documentation of prior approval by an infection specialist. CONCLUSIONS The use of linezolid in our hospital appears to follow local guidelines, but the quality of information recorded in the notes could be optimized. Consequently, a linezolid mandatory order form to be completed by the attending prescribing clinician has been introduced, and will be subject to future evaluation. We recommend such specific antibiotic utilization reviews or audits of new agents introduced into clinical infection practice.
Collapse
Affiliation(s)
- H M Ziglam
- Department of Infection, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
| | | | | | | | | |
Collapse
|
20
|
Iida K, Otsubo H, Matsumoto Y, Ochi A, Oishi M, Holowka S, Pang E, Elliott I, Weiss SK, Chuang SH, Snead OC, Rutka JT. Characterizing magnetic spike sources by using magnetoencephalography-guided neuronavigation in epilepsy surgery in pediatric patients. J Neurosurg 2005; 102:187-96. [PMID: 16156229 DOI: 10.3171/jns.2005.102.2.0187] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECT The authors sought to validate magnetoencephalography spike sources (MEGSSs) in neuronavigation during epilepsy surgery in pediatric patients. METHODS The distributions of MEGSSs in 16 children were defined and classified as clusters (Class I), greater than or equal to 20 MEGSSs with 1 cm or less between MEGSSs; small clusters (Class II), 6 to 19 with 1 cm or less between; and scatters (Class III), less than 6 or greater than 1 cm between spike sources. Using neuronavigation, the MEGSSs were correlated to epileptic zones from intra- and extraoperative electrocorticography (ECoG), surgical procedures, disease entities, and seizure outcomes. Thirteen patients underwent MEGSSs: nine had clusters; two had small clusters, one with and one without clusters; and three had scatters alone. All 13 had scatters. Clusters localized within and extended from areas of cortical dysplasia and at margins of tumors or cystic lesions. All clusters were colocalized to ECoG-defined epileptic zones. Four of 10 patients with clusters and/or small clusters underwent complete excisions, and six underwent partial excision with or without multiple subpial transections. In the three patients with scatters alone, ECoG revealed epileptic zones buried within MEGSS areas; these regions of scatters were completely excised and treated with multiple subpial transections. Coexisting scatters were left untreated in nine of 10 patients. Postoperatively, nine of 13 patients were seizure free; the four patients with residual seizures had clusters in unresected eloquent cortex. Three patients in whom no MEGSSs were demonstrated underwent lesionectomies and were seizure free. CONCLUSIONS Magnetoencephalography spike source clusters indicate an epileptic zone requiring complete excision. Coexisting scatters remote from clusters are nonepileptogenic and do not require excision. Scatters alone, however, should be examined by ECoG; an epileptic zone may exist within these distributions.
Collapse
Affiliation(s)
- Koji Iida
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Children with epilepsy have known deficits on objective measures of learning and memory. Parents and children report that memory deficits have a negative impact on everyday functioning. In adults with epilepsy, self-report of memory is more strongly associated with depression than performance on memory tests. We investigated the cognitive and psychological predictors of everyday memory in 37 children with medically intractable epilepsy, using children's self-report and parent ratings of everyday memory performance and standard tests of attention, intelligence, visual and verbal memory, working memory, and mood/emotional state. Standard multiple regressions demonstrated that only a parent report measure of attention uniquely and significantly (P< or =0.05) predicted estimates of everyday memory performance, accounting for 33% of variance in children's own ratings and 27% of variance in parents' ratings. Findings suggest that everyday memory in children with intractable epilepsy differs from that of adults; attentional problems may underlie everyday memory problems in these children.
Collapse
|
22
|
Onal C, Otsubo H, Araki T, Chitoku S, Ochi A, Weiss S, Elliott I, Snead OC, Rutka JT, Logan W. Complications of invasive subdural grid monitoring in children with epilepsy. J Neurosurg 2003; 98:1017-26. [PMID: 12744361 DOI: 10.3171/jns.2003.98.5.1017] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was performed to evaluate the complications of invasive subdural grid monitoring during epilepsy surgery in children. METHODS The authors retrospectively reviewed the records of 35 consecutive children with intractable localization-related epilepsy who underwent invasive video electroencephalography (EEG) with subdural grid electrodes at The Hospital for Sick Children between 1996 and 2001. After subdural grid monitoring and identification of the epileptic regions, cortical excisions and/or multiple subpial transections (MSTs) were performed. Complications after these procedures were then categorized as either surgical or neurological. There were 17 male and 18 female patients whose mean age was 11.7 years. The duration of epilepsy before surgery ranged from 2 to 17 years (mean 8.3 years). Fifteen children (43%) had previously undergone surgical procedures for epilepsy. The number of electrodes on the grids ranged from 40 to 117 (mean 95). During invasive video EEG, cerebrospinal fluid leaks occurred in seven patients. Also, cerebral edema (five patients), subdural hematoma (five patients), and intracerebral hematoma (three patients) were observed on postprocedural imaging studies but did not require surgical intervention. Hypertrophic scars on the scalp were observed in nine patients. There were three infections, including one case of osteomyelitis and two superficial wound infections. Blood loss and the amounts of subsequent transfusions correlated directly with the size and number of electrodes on the grids (p < 0.001). Twenty-eight children derived significant benefit from cortical resections and MSTs, with a more than 50% reduction of seizures and a mean follow-up period of 30 months. CONCLUSIONS The results of this study indicate that carefully selected pediatric patients with intractable epilepsy can benefit from subdural invasive monitoring procedures that entail definite but acceptable risks.
Collapse
MESH Headings
- Adolescent
- Cerebral Cortex/abnormalities
- Cerebral Cortex/physiopathology
- Cerebral Cortex/surgery
- Child
- Child, Preschool
- Craniotomy
- Dominance, Cerebral/physiology
- Electrodes, Implanted/adverse effects
- Electroencephalography/instrumentation
- Epilepsies, Partial/diagnosis
- Epilepsies, Partial/physiopathology
- Epilepsies, Partial/surgery
- Epilepsy, Temporal Lobe/diagnosis
- Epilepsy, Temporal Lobe/physiopathology
- Epilepsy, Temporal Lobe/surgery
- Female
- Humans
- Imaging, Three-Dimensional
- Magnetic Resonance Imaging
- Male
- Monitoring, Physiologic/instrumentation
- Neurologic Examination
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Psychosurgery
- Reoperation
- Risk Factors
- Tomography, X-Ray Computed
- Video Recording/instrumentation
Collapse
Affiliation(s)
- Cagatay Onal
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Chitoku S, Otsubo H, Harada Y, Jay V, Rutka JT, Weiss SK, Elliott I, Ochi A, Kitayama M, Snead OC. Characteristics of prolonged afterdischarges in children with malformations of cortical development. J Child Neurol 2003; 18:247-53. [PMID: 12760426 DOI: 10.1177/08830738030180041101] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated aberrant cortical excitability in malformations of cortical development From subdural electrodes, we recorded afterdischarges lasting > or = 6 seconds in 12 of 13 patients with malformations of cortical development and 6 of 10 pediatric patients with nonmalformations of cortical development and reviewed amperage thresholds, distribution of afterdischarges, and motor responses. In patients with malformation of cortical development, motor response thresholds were high; afterdischarge and motor response thresholds, which essentially overlapped, inversely correlated with age (P < .01); afterdischarge thresholds declined with age; and 8 patients showed afterdischarges in remote sites. In nonmalformation of cortical development, afterdischarge thresholds did not significantly correlate with age; motor response thresholds tended to decline with age; and 2 patients had remote afterdischarges. Adolescent patients with malformations of cortical development had lower afterdischarge thresholds than adolescents with nonmalformation of cortical development (P < .05). From their high afterdischarge (and motor response) thresholds, we concluded that preadolescent patients with malformation of cortical development have less excitable, immature cortices, whereas adolescent patients with malformation of cortical development with low afterdischarge thresholds have hyperexcitable cortices. Remote afterdischarges over focal dysplastic cortex suggest aberrant cortical excitability and neural circuits.
Collapse
Affiliation(s)
- Shiro Chitoku
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Ochi A, Otsubo H, Honda Y, Hara Y, Sharma R, Elliott I, Rutka JT, Chuang SH, Kamijo KI, Kiyuna T, Yamazaki T, Snead OC. Electroencephalographic dipoles of spikes with and without myoclonic jerks caused by epilepsia partialis continua. J Child Neurol 2002; 17:127-31. [PMID: 11952073 DOI: 10.1177/088307380201700207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We used electroencephalographic (EEG) dipole analysis to investigate the generators of spikes with and without myoclonic jerks in a 12-year-old patient with epilepsia partialis continua secondary to left parietal cortical dysplasia. We recorded EEG and right wrist extensor electromyography (EMG) and collected 42 spikes with jerks (jerking spikes) and 42 spikes without jerks (nonjerking spikes). We applied a single moving dipole model to the individual and averaged spikes. Dipoles at the negative peak of individual jerking and nonjerking spikes were localized in the dysplastic area. At the onset of the averaged jerking spike that preceded the EMG discharges by 20 ms, the dipole was in the motor cortex, whereas for the averaged nonjerking spike, the dipole was in the sensory cortex. The dipole moment at averaged jerking spike onset was twice that of the averaged nonjerking spike. Electroencephalographic dipole analysis of averaged spikes differentiated the generator of jerking and nonjerking spikes in epilepsia partialis continua. Individual dipoles demonstrated the area of epileptogenic cortical dysplasia.
Collapse
MESH Headings
- Child
- Electroencephalography
- Electromyography
- Epilepsies, Myoclonic/diagnosis
- Epilepsies, Myoclonic/pathology
- Epilepsies, Myoclonic/physiopathology
- Epilepsies, Myoclonic/surgery
- Epilepsy, Partial, Motor/diagnosis
- Epilepsy, Partial, Motor/pathology
- Epilepsy, Partial, Motor/physiopathology
- Epilepsy, Partial, Motor/surgery
- Evoked Potentials/physiology
- Humans
- Magnetic Resonance Imaging
- Male
- Monitoring, Physiologic
- Motor Cortex/pathology
- Motor Cortex/physiopathology
- Parietal Lobe/abnormalities
- Parietal Lobe/pathology
- Parietal Lobe/physiopathology
- Postoperative Complications/diagnosis
- Postoperative Complications/physiopathology
- Treatment Outcome
- Video Recording
Collapse
Affiliation(s)
- Ayako Ochi
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Otsubo H, Ochi A, Elliott I, Chuang SH, Rutka JT, Jay V, Aung M, Sobel DF, Snead OC. MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases. Epilepsia 2001; 42:1523-30. [PMID: 11879362 DOI: 10.1046/j.1528-1157.2001.16701.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To discover whether the spatial distribution of spike sources determined by magnetoencephalography (MEG) provides reliable information for planning surgery and predicting outcomes in pediatric patients with lesional extrahippocampal epilepsy. METHODS We retrospectively studied 12 children with extrahippocampal epilepsy secondary to cortical dysplasia (CD), tumor, or porencephalic cyst. We compared interictal MEG spike source locations and somatosensory evoked fields derived from equivalent-current dipole modeling with intraoperative or extraoperative electrocorticography (ECoG). RESULTS MEG spike sources were found in proximity to the lesion in all patients and extended from lesions in five patients with CD. Marginal spike sources were noted in three patients with tumors, one patient with a cyst, and one with CD, and extramarginal sources in three patients with tumors. Three patients with tumors underwent lesionectomy only; two had further cortical excisions. One patient with CD underwent lesionectomy only, three had lesionectomy and cortical excisions, and two had lesionectomy and multiple subpial transection. Asymmetric MEG spike sources correlated with ECoG findings in all patients. Residual epileptiform discharges on postexcisional ECoG corresponded to spike sources in three patients with tumors and one patient with a cyst. Eleven patients have been seizure free for 1-6 years (mean, 4 years). One patient had residual seizures after incomplete excision of right temporal CD. CONCLUSIONS MEG delineated asymmetric epileptogenicity surrounding lesions and the eloquent cortex. Complete tumor resection produced favorable outcomes despite residual postexcisional ECoG spikes and extramarginal MEG spike sources. CD characterized by clusters of MEG spike sources within and extending from lesions seen on magnetic resonance imaging (MRI) should be removed to prevent seizures.
Collapse
Affiliation(s)
- H Otsubo
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Minassian BA, Otsubo H, Weiss S, Elliott I, Rutka JT, Snead OC. Magnetoencephalographic localization in pediatric epilepsy surgery: comparison with invasive intracranial electroencephalography. Ann Neurol 1999; 46:627-33. [PMID: 10514100 DOI: 10.1002/1531-8249(199910)46:4<627::aid-ana11>3.0.co;2-c] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The object of this study was to determine the concordance of the anatomical location of interictal magnetoencephalographic (MEG) spike foci with the location of ictal onset zones identified by invasive ictal intracranial electroencephalographic recordings in children undergoing evaluation for epilepsy surgery. MEG was performed in 11 children with intractable, nonlesional, extratemporal, localization-related epilepsy. Subsequently, chronic invasive intracranial electroencephalographic monitoring was performed by using subdural electrodes to localize the ictal onset zone and eloquent cortex. Based on the invasive monitoring data, all children had excision of, or multiple subpial transections through, ictal onset cortex and surrounding irritative zones. In 10 of 11 patients, the anatomical location of the epileptiform discharges as determined by MEG corresponded to the ictal onset zone established by ictal intracranial recordings. In all children, the anatomical location of the somatosensory hand area, determined by functional mapping through the subdural electrode array, was the same as that delineated by MEG. Nine of 11 patients became either seizure-free or had a greater than 90% reduction in seizures after surgery, with a mean follow-up of 24 months. MEG is a powerful and accurate tool in the presurgical evaluation of children with refractory nonlesional extratemporal epilepsy.
Collapse
Affiliation(s)
- B A Minassian
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
27
|
Otsubo H, Sharma R, Elliott I, Holowka S, Rutka JT, Snead OC. Confirmation of two magnetoencephalographic epileptic foci by invasive monitoring from subdural electrodes in an adolescent with right frontocentral epilepsy. Epilepsia 1999; 40:608-13. [PMID: 10386530 DOI: 10.1111/j.1528-1157.1999.tb05563.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To report our evaluation of interictal two epileptic spike fields on magnetoencephalography (MEG) by using invasive intracranial monitoring in a patient without lesion on magnetic resonance imaging (MRI). METHODS A 15-year-old left-handed boy with a 9-year history of refractory simple partial seizures, secondarily generalized, and a normal MRI, was studied with MEG to define magnetic spike sources, followed by invasive intracranial monitoring with subdural electrodes to delineate the epileptogenic zone and eloquent function pursuant to focal cortical excision. RESULTS MEG demonstrated two spike foci on the right middle frontal and inferior rolandic areas adjacent to the sensory area. Ictal recordings during prolonged invasive monitoring from subdural electrodes revealed two epileptogenic zones in the same locations as those defined by MEG. Focal cortical excision was performed of each epileptogenic zone. The patient has been seizure free for 24 months without neurologic deficit. CONCLUSIONS Magnetic source imaging is a valuable adjunct in the planning of subdural grid placement in epilepsy surgery, particularly in patients in whom conventional imaging fails to reveal a lesion.
Collapse
Affiliation(s)
- H Otsubo
- Division of Neurology, The Hospital for Sick Children, and University of Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE A recent rapid decrease in the duration of neonatal hospital stay in Ontario, Canada, enabled us to study the association between healthy infants' age at neonatal hospital discharge and subsequent readmission rates. DESIGN (1) Population-based and (2) single hospital-based retrospective studies. SETTING AND STUDY POPULATION (1) A total of 920,554 healthy infants with a birth weight of 2500 gm or more, born in Ontario from 1987 to 1994. (2) Infants with a birth weight of 2500 gm or more, born during the same period, and readmitted before 15 days from home to the Hospital for Sick Children for jaundice or dehydration. MEASUREMENT Duration of neonatal stay in the hospital and readmission rates were measured, and diagnostic codes were analyzed. Severity of illness was evaluated in infants readmitted to our hospital. RESULTS In Ontario the mean length of stay decreased from 4.5 days to 2.7 days (p = 0.000), and the readmission rate during the first 2 weeks of life increased from 12.9 to 20.7 per 1000 (p = 0.000). Increased rates of readmission were most marked for jaundice and dehydration. The infants readmitted to our hospital had evidence of increased severity of illness as indicated by higher serum bilirubin and sodium concentrations. Two deaths occurred in infants with hypernatremic dehydration, one in 1992-1993 and another in 1993-1994. CONCLUSIONS In Ontario, shorter neonatal hospital stay was associated with increased readmission rates for conditions that may not give rise to symptoms or signs on days 1 to 3 of life. In our hospital the severity of jaundice and dehydration in readmitted infants increased. The severity-of-illness data raise the question of whether shorter neonatal hospital stay of apparently healthy infants is always safe. Decisions to discharge infants should be based on rigorous evaluation of individual infants.
Collapse
Affiliation(s)
- K S Lee
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
29
|
Elliott I. Psychosocial functioning in adolescents with complex partial seizures. Axone 1992; 13:72-6. [PMID: 1540541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This pilot study examined psychosocial functioning in adolescents (age 12.5-18.5 years) with complex partial seizures. Twenty-five subjects were divided into three groups: Group I (N = 11), medically treated with uncontrolled seizures; Group II (N = 6), medically managed with controlled seizures; and Group III (N = 8), epilepsy refractory to medical management with seizure control following surgery. Psychosocial functioning was measured using the "Adolescent Psychosocial Inventory" of Batzel and Dodrill. Findings revealed significant differences (F 4.80. p less than 0.02) in psychosocial functioning between the three groups. Group I showed the poorest overall adjustment; Group II, the best adjustment; Group III was better adjusted than Group I, but less than Group II. Significant difficulties were evident in the areas of school, interpersonal, emotional, seizure adjustment and overall psychosocial functioning in Group III. No problems were evident in Group II. School, emotional and overall adjustment were moderately problematic in Group III. Analysis of biological and demographic data revealed a significant association between increased numbers of medications and poorer psychosocial functioning (r = 58, p less than 0.02). The study results provide direction for clinic and community nurse specialists to set priorities with regard to assessment and supportive interventions.
Collapse
|
30
|
Graor RA, de Wolfe VG, Elliott I. A clinical vignette: the clinical significance of systolic-diastolic bruits in the carotid arteries. Cleve Clin Q 1984; 51:155-8. [PMID: 6713671 DOI: 10.3949/ccjm.51.1.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|