Long-term outcome of vagus nerve stimulation for drug-resistant epilepsy using continuous assessment, with a note on mortality.

Purpose: To examine the outcome of vagus nerve stimulation (VNS) for drug-resistant epilepsy using data from a National Health Service VNS clinic.

Methods: Clinical records of patients implanted with VNS for epilepsy between1995 and 2010 were examined. Patients were selected for study who had at least one year of therapeutic stimulation (minimum 1 mA stimulator current) and follow-up by our service with analysable electronic records, providing continuous assessment of seizure control during available follow-up.

Mortality and SUDEP in epilepsy patients treated with vagus nerve stimulation.

Objective: The risk of premature death is increased in patients with intractable epilepsy. The effect of vagus nerve stimulation (VNS) on mortality remains unclear. In a previous study by Annegers et al.

Preoperative estimation of seizure control after resective surgery for the treatment of epilepsy.

Purpose: Predicting seizure control after epilepsy surgery is difficult. The objectives of this work are: (a) to estimate the value of surgical procedure, presence of neuroimaging abnormalities, need for intracranial recordings, resection lobe, pathology, durations of epilepsy and follow-up period to predict postsurgical seizure control after epilepsy surgery and (b) to provide empirical estimates of successful outcome after different combinations of the above factors in order to aid clinicians in advising patients presurgically about the likelihood of success under their patients' individual circumstances.

Methods: We report postsurgical seizure control from all 243 patients who underwent resective surgery for epilepsy at King's College Hospital between 1999 and 2011.

Mortality after temporal lobe epilepsy surgery.

Purpose: To report mortality, after a longer interval, in a cohort of patients with drug-resistant epilepsy treated by temporal lobe surgery between 1975 and 1995. A previous audit of these patients ending December 1, 1997 observed a standardized mortality ratio (SMR) of 4.5.

Value of scalp delayed rhythmic ictal transformation (DRIT) in presurgical assessment of temporal lobe epilepsy.

Objectives: To estimate the localising and lateralising value of delayed rhythmic ictal transformation (DRIT) on the scalp EEG during presurgical assessment for temporal lobe epilepsy.

Methods: Two hundred and eighty eight seizures recorded simultaneously with scalp and foramen ovale (FO) electrodes were studied retrospectively in 110 patients. DRIT was defined as sustained regular rhythmic waveforms seen on scalp recordings after scalp seizure onset.

EEG latency analysis for hemispheric lateralisation in Landau-Kleffner syndrome.

Objective: To determine the reliability of latency analysis in lateralising the origin of epileptiform discharges in pre-surgical assessment of Landau-Kleffner syndrome (LKS).

Methods: A computer aided-method was developed to identify leading regions and measure inter-hemispheric latencies before and after averaging discharges. Scalp and intracranial EEG recordings were studied from seven patients undergoing surgical treatment.

Single pulse electrical stimulation for identification of structural abnormalities and prediction of seizure outcome after epilepsy surgery: a prospective study.

Background: Abnormal late responses to single pulse electrical stimulation (SPES) in patients with intracranial recordings can identify epileptogenic cortex. We aimed to investigate the presence of neuropathological abnormalities in abnormal SPES areas and to establish if removal of these areas improved postsurgical seizure control.

Methods: We studied abnormal responses to SPES during chronic intracranial recordings in 40 consecutive patients who were thereafter operated on because of refractory epilepsy and had a follow-up period of at least 12 months.

Brain stimulation in the treatment of epilepsy.

Stimulation of the brain for the treatment of epilepsy, indirectly via the vagus nerve and directly through intracranial targets, is feasible and has increased in use and complexity over the past 10 years. Vagus nerve stimulation is widely applied and the present indications and outcomes together with possible ways in which the treatment could be refined are reviewed. The application of stimulation to deep-brain targets is also reviewed along with present practice and results.

Interictal temporal delta activity in temporal lobe epilepsy: correlations with pathology and outcome.

Purpose: To determine the characteristics and the clinical significance of focal slow activity and its association with focal epileptogenesis in patients with temporal lobe epilepsy (TLE).

Methods: We analyzed the interictal EEGs of 141 patients who had temporal lobe resections for intractable focal seizures and correlated the findings with pathologic changes and outcome. The pathologic changes were categorized into medial temporal sclerosis, tumors, and nonspecific changes.

Registered computed tomography images as an alternative to postimplantation magnetic resonance imaging in the assessment of subthalamic electrode placement.

Magnetic resonance imaging (MRI) after implantation of electrodes in the subthalamic nuclei is currently performed at a number of sites, but a recent adverse incident and changes in MRI technology may heighten safety concerns. In this report, it is demonstrated that given whole-head image data, registration of postimplantation computed tomography to preimplantation MRI can enable verification of the position of electrodes to an accuracy of 2 mm. This registration technique can remove the need for potentially risky postoperative MRI.

Characteristics of scalp electrical fields associated with deep medial temporal epileptiform discharges.

Objective: To determine scalp characteristics of epileptiform discharges arising from medial temporal structures (MT).

Methods: Signal-to-noise ratio was increased by averaging simultaneous recordings from intracranial and scalp electrodes synchronised on discharges recorded by foramen ovale (FO) electrodes. The topography, amplitude and distribution of averaged scalp signals were analysed.

Clinical outcome of epilepsy surgery.

Purpose Of Review: The outcome from current surgical methods of treating drug-resistant epilepsy will be considered, looking at changes in classical resective surgery and new methodology being introduced in the functional treatment of these patients.

Recent Findings: There is now class I evidence that temporal lobe surgery is effective. Sophisticated and appropriate magnetic resonance imaging sequences, together with an assessment of the electroclinical syndrome, allow patients to be assessed for resective surgery.

Resective surgery for hypothalamic hamartoma.

Hypothalamic hamartoma presents with precocious puberty, epilepsy or both. There are two epileptic syndromes, one presenting initially in infancy with gelastic seizures evolving rapidly into a syndrome with multiple seizures, developmental delay and a moderate to severe behaviour disorder. The other presents later with a milder epileptic syndrome, again usually including gelastic seizures, but with normal intellect and behaviour.

Material-specific recognition memory deficits elicited by unilateral hippocampal electrical stimulation.

Although the medial temporal lobe is thought to be critical for recognition memory (RM), the specific role of the hippocampus in RM remains uncertain. We investigated the effects of transient unilateral hippocampal electrical stimulation (ES), subthreshold for afterdischarge, on delayed item RM in epilepsy patients implanted with bilateral hippocampal depth electrodes. RM was assessed using a novel computer-controlled test paradigm in which ES to left or right hippocampus was either absent (baseline) or synchronized with item presentation.

Alternative surgical procedures to help drug-resistant epilepsy - a review.

The concepts of pathophysiology of epilepsy which underly the non-resective surgical treatment of epilepsy are reviewed. The available techniques, lesioning, disconnection and stimulation are described and reviewed critically. Stereotactic lesioning, popular in the 1950's has been largely abandoned but stereotactic radiosurgery emerges as a useful technique, especially in the treatment of mesial temporal sclerosis.

Lateralising value of neuropsychological protocols for presurgical assessment of temporal lobe epilepsy.

Purpose: To estimate the value of neuropsychological measurements in determining the side of seizure onset for presurgical assessment in patients with temporal lobe epilepsy. The lateralising value of neuropsychological protocols was evaluated for all patients and in subpopulations depending on surgical outcome with regard to seizure control, speech dominance, neuropathology, and need for intracranial EEG recordings.

Methods: A battery of neuropsychological procedures was carried out preoperatively in 125 patients who underwent left (n = 66) or right (n = 59) temporal lobectomies.

Neuropsychological Outcome and the Extent of Resection in the Unilateral Temporal Lobectomy.

Thirty-eight patients who had undergone either a right (RTL, n = 19) or left (RTL, n = 19) en bloc unilateral temporal lobectomy were scanned using magnetic resonance imaging, and the extent of removal of the superior lateral (SL), inferolateral (IL), basal, parahippocampal, and hippocampal regions was rated using semiautomated analysis. Brain regional ratings were correlated against pre- versus postoperative changes in memory functioning. The results showed overall significant postoperative decline in verbal memory only in the LTL group.

Quantitative magnetic resonance imaging of the amygdala in temporal lobe epilepsy-clinico-pathological correlations (a pilot study).

Purpose: We carried out a pilot study of quantitative volumetric MRI of the amygdala in patients undergoing surgery for intractable temporal lobe epilepsy. We wished to explore whether amygdala volume correlated with pre-operative clinical variables and post-operative outcome.

Methods: Ten patients had detailed volumetric measurements of their amygdala and hippocampus according to operationalised anatomical criteria from an optimised MRI imaging sequence.

Internal carotid-inferior petrosal sinus fistula complicating foramen ovale telemetry: successful treatment with detachable coils: case report and review.

Objective And Importance: Iatrogenic internal carotid artery-cavernous sinus fistula complicating percutaneous foramen ovale (FO) instrumentation (e.g., retrogasserian rhizotomy for trigeminal neuralgia) has been reported in only four patients to date.