613 results match your criteria: "Presurgical Evaluation of Medically Intractable Epilepsy"

Epilepsy, a neurological disorder characterised by recurrent seizures, poses significant challenges in diagnosis, treatment, and management. Understanding the underlying causes and identifying precise anatomical locations of epileptogenic foci are critical for effective management strategies, particularly in drug-resistant patients. Neuroimaging techniques, particularly magnetic resonance (MR), play a pivotal role in the evaluation of epilepsy patients, offering insights into structural abnormalities, epileptogenic lesions, and functional alterations within the brain.

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Multiple intracerebral hematomas during SEEG recording and intradural hemorrhage after spinal tap: A case report prompting more research on collagen IV gene mutation and oral nicotine consumption as risk factors.

Epilepsia Open

November 2024

Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.

Article Synopsis
  • - A 20-year-old man with drug-resistant epilepsy developed multiple intracerebral hemorrhages after receiving stereo-EEG electrodes and experiencing a lumbar spinal tap, with a history of heavy use of nicotine pouches.
  • - Genetic testing revealed a mutation in the COL4A2 gene, which is linked to collagen production and has previously been associated with hemorrhage risks, raising concerns about its role in the patient's complication.
  • - The study suggests that the combination of the COL4A2 mutation and high nicotine use could significantly increase the likelihood of bleeding during neurosurgical procedures, calling for more research into this connection.
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In drug-resistant focal epilepsy, planning surgical resection may involve presurgical intracranial EEG recordings (iEEG) to detect seizures and other iEEG patterns to improve postsurgical seizure outcome. We hypothesized that resection of tissue generating interictal high frequency oscillations (HFOs, 80-500 Hz) in the iEEG predicts surgical outcome. Eight international epilepsy centres recorded iEEG during the patients' pre-surgical evaluation.

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Article Synopsis
  • The study investigates the relationship between comorbid psychiatric disorders and pharmacoresistant temporal lobe epilepsy (TLE) associated with mesial temporal sclerosis (MTS), focusing on pre-surgical factors that could influence post-surgical psychiatric outcomes.
  • A retrospective analysis was conducted on 106 patients, with 51 having psychiatric disorders (PD) and 55 without, to identify predictors for post-surgical PD two years after cortico-amygdalohippocampectomy (CAH).
  • Results indicated that previous psychiatric treatment was linked to the development of PD post-surgery, with 35% of patients experiencing remission of PD and 14.5% developing new PD after CAH, underscoring the complexity of
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Intracranial EEG is used for two main purposes: to determine (i) if epileptic networks are amenable to focal treatment and (ii) where to intervene. Currently, these questions are answered qualitatively and differently across centres. There is a need to quantify the focality of epileptic networks systematically, which may guide surgical decision-making, enable large-scale data analysis and facilitate multi-centre prospective clinical trials.

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Brain PET Imaging in the Presurgical Evaluation of Drug-Resistant Focal Epilepsy.

PET Clin

January 2025

King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, Office Suite 6, 4th Floor Lambeth Wing, London, UK; St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.

Presurgical evaluation aims to localize the seizure onset zone (SOZ) for a tailored resection. Interictal [F]fluorodeoxyglucose PET is now an established test to lateralize and/or localize the SOZ, particularly if MR imaging is negative or if the noninvasive assessment shows discrepancies. PET can show hypometabolic areas associated with SOZ and the potential altered metabolic brain networks.

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Article Synopsis
  • The study investigated how to manage patients with medically resistant epilepsy caused by temporal encephaloceles, focusing on the importance of ancillary testing before surgery to improve surgical outcomes.
  • Researchers analyzed medical records from the Cleveland Clinic over two decades, specifically looking at patients who had surgery for drug-resistant temporal lobe epilepsy linked to encephaloceles.
  • Results showed that 63% of the 19 patients had successful seizure control one year post-surgery, with detailed patterns of seizure activity revealed through advanced EEG evaluations, indicating a need for personalized surgical strategies.
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: Epilepsy disproportionally affects children from Hispanic/Latino backgrounds, particularly among those born outside the U.S. Longstanding health-related disparities associated with ethnicity (e.

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Seizure outcome in drug-resistant epilepsy in the setting of polymicrogyria.

Seizure

October 2024

Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S60, Cleveland, OH 44195, United States. Electronic address:

Article Synopsis
  • The study looked at patients with polymicrogyria (PMG) who had epilepsy that didn't get better with medicine, using a special procedure called ICEEG to see where the seizures started.
  • Out of 35 patients, those who had surgery to remove parts of the brain had a better chance of stopping seizures completely compared to those who didn’t have surgery.
  • The researchers found that knowing exactly where the seizures came from helped doctors decide how best to treat the patients, suggesting that just removing visible brain areas on scans doesn’t always mean the seizures will stop.
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Do germline genetic variants influence surgical outcomes in drug-resistant epilepsy?

Epilepsy Res

October 2024

Adult Genetic Epilepsy (AGE) Program, Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Objective: We retrospectively explored patients with drug-resistant epilepsy (DRE) who previously underwent presurgical evaluation to identify correlations between surgical outcomes and pathogenic variants in epilepsy genes.

Methods: Through an international collaboration, we evaluated adult DRE patients who were screened for surgical candidacy. Patients with pathogenic (P) or likely pathogenic (LP) germline variants in genes relevant to their epilepsy were included, regardless of whether the genetic diagnosis was made before or after the presurgical evaluation.

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Article Synopsis
  • The study aimed to assess cognitive changes after surgery that involved removing areas of the brain with significant high-gamma power modulations (HGM) during a visual naming task, even though these areas were not identified as language-critical during standard electrical stimulation mapping.
  • Researchers analyzed the cognitive outcomes of 37 drug-resistant epilepsy patients one year after surgery, highlighting the effects of lesioning HGM language sites on various neuropsychological assessments, specifically measuring reliable change indices (RCIs).
  • Results showed that lesioning even one HGM language site was associated with significant declines in scores for vocabulary, working memory, and verbal learning, indicating that these areas play an important role in cognitive function, despite being categorized as non-language sites through electrical mapping.
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Cenobamate has demonstrated efficacy in patients with treatment-resistant epilepsy, including patients who continued to have seizures after epilepsy surgery. This article provides recommendations for cenobamate use in patients referred for epilepsy surgery evaluation. A panel of six senior epileptologists from the United States and Europe with experience in presurgical evaluation of patients with epilepsy and in the use of antiseizure medications (ASMs) was convened to provide consensus recommendations for the use of cenobamate in patients referred for epilepsy surgery evaluation.

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Aim Of Study: Glutamate decarboxylase (GAD) enzyme can be a target intracellular antigen in autoimmune focal epilepsy. GAD65 antibody is in found patients diagnosed with drug-refractory temporal lobe epilepsy (TLE). We explore the clinical features of the disease and therapeutic options.

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Purpose: This study evaluates the efficacy of SISCOS (Subtraction ictal-interictal SPECT coregistered to SPECT) in localizing the epileptogenic zone (EZ) in focal cortical dysplasia (FCD), comparing its predictive performance with MRI and post-surgical outcomes based on ILAE classification.

Methods: 84 patients with drug refractory epilepsy (DRE) who were operated and had histopathology consistent with FCD, were included in the study. All patients had undergone a complete work-up including SISCOS and MRI for EZ localization, followed by discussion in the multidisciplinary epilepsy surgery meeting prior to surgery.

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Objective: Stereoelectroencephalography (SEEG) is increasingly being recognized as an important invasive modality for presurgical evaluation of epilepsy. This study focuses on the clinical and technical considerations of SEEG investigations when using conventional frame-based stereotaxy, drawing on institutional experience and a comprehensive review of relevant literature.

Methods: This retrospective observational study encompassed the surgical implantation of 201 SEEG electrodes in 16 epilepsy patients using a frame-based stereotactic instrument at a single tertiary-level center.

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Surgical outcomes of patients with genetically refractory epilepsy: A systematic review and meta-analysis.

Seizure

August 2024

Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Clinical Research on Epilepsy, Beijing, China; Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China. Electronic address:

Objective: To summarize the surgical outcomes of genetically refractory epilepsy and identify prognostic factors for these outcomes.

Methods: A literature search of the PubMed, Web of Science, and Embase databases for relevant studies, published between January 1, 2002 and December 31, 2023, was performed using specific search terms. All studies addressing surgical outcomes and follow-up of genetically refractory epilepsy were included.

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Objective: Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a recently described, histopathologically and molecularly defined (SLC35A2-mutated) type of cortical malformation. Although increasingly recognized, the diagnosis of MOGHE remains a challenge. We present the characteristics of the first six patients diagnosed in Bulgaria, with the aim to facilitate identification, proper presurgical evaluation, and surgical treatment approach in this disease.

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Although the role of sleep in modulating epileptic activity is well established, many epileptologists overlook the significance of considering sleep during presurgical epilepsy evaluations in cases of drug-resistant epilepsy. Here, we conducted a comprehensive literature review from January 2000 to May 2023 using the PubMed electronic database and compiled evidence to highlight the need to revise the current clinical approach. All articles were assessed for eligibility by two independent reviewers.

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Application of HFO and scaling analysis of neuronal oscillations in the presurgical evaluation of focal epilepsy.

Brain Res Bull

September 2024

School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, Anhui, China. Electronic address:

Purpose: To explore the utility of high frequency oscillations (HFO) and long-range temporal correlations (LRTCs) in preoperative assessment of epilepsy.

Methods: MEG ripples were detected in 59 drug-resistant epilepsy patients, comprising 5 with parietal lobe epilepsy (PLE), 21 with frontal lobe epilepsy (FLE), 14 with lateral temporal lobe epilepsy (LTLE), and 19 with mesial temporal lobe epilepsy (MTLE) to identify the epileptogenic zone (EZ). The results were compared with clinical MEG reports and resection area.

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Background: Epilepsy surgery is an underutilized resource for children with drug-resistant epilepsy. Palliative and definitive surgical options can reduce seizure burden and improve quality of life. Palliative epilepsy surgery is often seen as a "last resort" compared to definitive surgical options.

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Although epilepsy is the most common comorbidity of brain tumors, epileptic spasms rarely occur. Brain tumors associated with epileptic spasms are mostly low-grade gliomas. To date, few studies in the literature have reported on malignant (Grades 3-4) brain tumors associated with epileptic spasms.

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Cortico-cortical evoked potentials (CCEPs) elicited by single-pulse electric stimulation (SPES) are widely used to assess effective connectivity between cortical areas and are also implemented in the presurgical evaluation of epileptic patients. Nevertheless, the cortical generators underlying the various components of CCEPs in humans have not yet been elucidated. Our aim was to describe the laminar pattern arising under SPES evoked CCEP components (P1, N1, P2, N2, P3) and to evaluate the similarities between N2 and the downstate of sleep slow waves.

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Successful surgical treatment of drug-resistant epilepsy traditionally relies on the identification of seizure onset zones (SOZs). Connectome-based analyses of electrographic data from stereo electroencephalography (SEEG) may empower improved detection of SOZs. Specifically, connectome-based analyses based on the interictal suppression hypothesis posit that when the patient is not having a seizure, SOZs are inhibited by non-SOZs through high inward connectivity and low outward connectivity.

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Objectives: The main goal of presurgical evaluation in drug-resistant focal epilepsy is to identify a seizure onset zone (SOZ). Of the noninvasive, yet resource-intensive tests available, ictal single-photon emission computed tomography (SPECT) aids SOZ localization by measuring focal increases in blood flow within the SOZ via intravenous peri-ictal radionuclide administration. Recent studies indicate that geographic and center-specific factors impact utilization of these diagnostic procedures.

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Objective: Epileptic Encephalopathy / Developmental Epileptic Encephalopathy with spike-and-wave activation during sleep (EE/DEE-SWAS) is a self-limiting childhood epilepsy syndrome but may cause permanent neurocognitive impairment. Surgical interventions have been controversial in the treatment of EE/DEE-SWAS. This systematic review aims to evaluate the efficacy of various surgical procedures on the outcomes of EE/DEE-SWAS.

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