613 results match your criteria: "Presurgical Evaluation of Medically Intractable Epilepsy"
Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and traditional open surgery (OS) are effective and safe options for patients with drug-resistant mesial temporal lobe epilepsy (DR-mTLE). However, their superiority in seizure control and preservation of functional abilities remains unclear. This study aimed to compare the surgical outcomes of MRgLITT and OS.
View Article and Find Full Text PDFEpilepsia
November 2023
Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
Objective: Rapid eye movement (REM) sleep reduces the rate and extent of interictal epileptiform discharges (IEDs). Breakthrough epileptic activity during REM sleep is therefore thought to best localize the seizure onset zone (SOZ). We utilized polysomnography combined with direct cortical recordings to investigate the influences of anatomical locations and the time of night on the suppressive effect of REM sleep on IEDs.
View Article and Find Full Text PDFEpilepsia
November 2023
Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
Despite progress in the development of anti-seizure medications (ASMs), one third of people with epilepsy have drug-resistant epilepsy (DRE). The working definition of DRE, proposed by the International League Against Epilepsy (ILAE) in 2010, helped identify individuals who might benefit from presurgical evaluation early on. As the incidence of DRE remains high, the TASK1 workgroup on DRE of the ILAE/American Epilepsy Society (AES) Joint Translational Task Force discussed the heterogeneity and complexity of its presentation and mechanisms, the confounders in drawing mechanistic insights when testing treatment responses, and barriers in modeling DRE across the lifespan and translating across species.
View Article and Find Full Text PDFNeurology
September 2023
From the Department of Neurology (N.S., K.A.D.), Penn Epilepsy Center, Perelman School of Medicine, and Center for Neuroengineering and Therapeutics (N.S., K.A.D.), University of Pennsylvania, Philadelphia; Translational and Clinical Research Institute (Y.W., P.N.T.), Faculty of Medical Sciences, and Computational Neuroscience, Neurology, and Psychiatry Lab (Y.W., P.N.T.), ICOS Group, School of Computing, Newcastle University; Department of Epilepsy (J.S.D., B.D., F.A.C., J.d.T., A.M., A.W.M., G.P.W., Y.W., P.N.T.), UCL Queen Square Institute of Neurology; UCL Centre for Medical Image Computing (S.B.V.); Neuroradiological Academic Unit (S.B.V.), UCL Queen Square Institute of Neurology, London; MRI Unit (J.S.D., G.P.W.), Chalfont Centre for Epilepsy, Bucks, United Kingdom; Centre for Microscopy, Characterisation, and Analysis (S.B.V.), The University of Western Australia, Nedlands; and Division of Neurology (G.P.W.), Department of Medicine, Queen's University, Kingston, Canada.
Background And Objectives: Surgery is an effective treatment for drug-resistant epilepsy, which modifies the brain's structure and networks to regulate seizure activity. Our objective was to examine the relationship between brain structure and function to determine the extent to which this relationship affects the success of the surgery in controlling seizures. We hypothesized that a stronger association between brain structure and function would lead to improved seizure control after surgery.
View Article and Find Full Text PDFArXiv
July 2023
Center for Neuroengineering and Therapeutics, University of Pennsylvania.
Introduction: Intracranial EEG (IEEG) is used for 2 main purposes, to determine: (1) if epileptic networks are amenable to focal treatment and (2) where to intervene. Currently these questions are answered qualitatively and sometimes differently across centers. There is a need for objective, standardized methods to guide surgical decision making and to enable large scale data analysis across centers and prospective clinical trials.
View Article and Find Full Text PDFEpilepsia Open
September 2023
Department of Neurology, The Ohio State University, Columbus, Ohio, USA.
Objective: For people with drug-resistant epilepsy, the use of epilepsy surgery is low despite favorable odds of seizure freedom. To better understand surgery utilization, we explored factors associated with inpatient long-term EEG monitoring (LTM), the first step of the presurgical pathway.
Methods: Using 2001-2018 Medicare files, we identified patients with incident drug-resistant epilepsy using validated criteria of ≥2 distinct antiseizure medication (ASM) prescriptions and ≥1 drug-resistant epilepsy encounter among patients with ≥2 years pre- and ≥1 year post-diagnosis Medicare enrollment.
Eur J Neurol
October 2023
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Background And Purpose: We analyzed the association of neuropsychological outcomes after epilepsy surgery with the intracranial electrode type (stereo electroencephalography [SEEG] and subdural electrodes [SDE]), and electrical stimulation mapping (ESM) of speech/language.
Methods: Drug-resistant epilepsy patients who underwent comprehensive neuropsychological evaluation before and 1 year after epilepsy surgery were included. SEEG and SDE subgroups were matched by age, handedness, operated hemisphere, and seizure freedom.
Cureus
May 2023
Epilepsy, King Saud Medical City, Riyadh, SAU.
Epilepsy has a prevalence rate of 6.54 per 1,000 people in Saudi Arabia, making it a prevalent chronic condition. Drug-resistant epilepsy (DRE) is thought to affect one-third of patients; in these circumstances, a complete presurgical examination in the epilepsy monitoring unit (EMU) is necessary.
View Article and Find Full Text PDFSeizure
August 2023
Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany; Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Germany. Electronic address:
Purpose: To analyze the safety profile of subdural and depth electrode implantation in a large monocentric cohort of patients of all ages undergoing intracranial EEG exploration because of drug resistant focal epilepsy diagnosed and implanted by a constant team of epileptologists and neurosurgeons.
Methods: We retrospectively analyzed data from 452 implantations in 420 patients undergoing invasive presurgical evaluation at the Freiburg Epilepsy Center from 1999 to 2019 (n = 160 subdural electrodes, n = 156 depth electrodes and n = 136 combination of both approaches). Complications were classified as hemorrhage with or without clinical manifestations, infection-associated and other complications.
Brain Commun
May 2023
Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, 28040, Spain.
Epilepsy surgery continues to be a recommended treatment for intractable (medication-resistant) epilepsy; however, 30-70% of epilepsy surgery patients can continue to have seizures. Surgical failures are often associated with incomplete resection or inaccurate localization of the epileptogenic zone. This retrospective study aims to improve surgical outcome through in silico testing of surgical hypotheses through a personalized computational neurosurgery model created from individualized patient's magnetoencephalography recording and MRI.
View Article and Find Full Text PDFEpilepsy Behav
June 2023
Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA. Electronic address:
Background And Objectives: Neuropsychological research on mesial temporal lobe epilepsy (MTLE) often highlights material-specific memory deficits, but a lesion-focused model may not accurately reflect the underlying networks that support episodic memory in these patients. Our study evaluated the pathophysiology behind verbal learning/memory deficits as revealed by hypometabolism quantified through 18-fluorodeoxyglucose positron emission tomography (FDG-PET).
Methods: This retrospective study included thirty presurgical patients with intractable unilateral MTLE who underwent interictal FDG-PET and verbal memory assessment (12 females, mean age: 38.
Epilepsy Res
July 2023
Office of the Clinical Director, NINDS, National Institutes of Health, Bethesda, MD, USA. Electronic address:
Purpose: Non-invasive imaging studies play a critical role in the presurgical evaluation of patients with drug-resistant temporal lobe epilepsy (TLE), particularly in helping to lateralize the seizure focus. Arterial Spin Labeling (ASL) MRI has been widely used to non-invasively study cerebral blood flow (CBF), with somewhat variable interictal alterations reported in TLE. Here, we compare temporal lobe subregional interictal perfusion and symmetry in lesional (MRI+) and non-lesional (MRI-) TLE compared to healthy volunteers (HVs).
View Article and Find Full Text PDFEpilepsy Res
July 2023
Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55906, United States.
Purpose: The objective of this study was to describe the sEEG-defined seizure onset zone (SOZ), seizure semiology, presurgical evaluations, surgical intervention and outcome in patients with midline onset noninvasive phase I monitoring.
Methods: A single center sEEG database was reviewed to identify patients with seizures onset predominantly involving midline electrodes (FZ, CZ, PZ, OZ) on scalp EEG. Data abstracted included clinical factors, seizure semiology graded into lobar segmentation, imaging and electrographic findings, sEEG plan, interventions, and outcome.
Epilepsia Open
September 2023
Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Objective: Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE.
View Article and Find Full Text PDFEpilepsy Behav
June 2023
Institute of Neurosciences (IoNS/NEUR), Université Catholique de Louvain (UCL), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Reference Center for Refractory Epilepsy (CRE), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Neurology Unit, Brussels, Belgium; WELBIO Department, WEL Research Institute, Avenue Pasteur 6, 1300 Wavre, Belgium.
Objective: During the presurgical evaluation, manual electrical source imaging (ESI) provides clinically useful information in one-third of the patients but it is time-consuming and requires specific expertise. This prospective study aims to assess the clinical added value of a fully automated ESI analysis in a cohort of patients with MRI-negative epilepsy and describe its diagnostic performance, by evaluating sublobar concordance with stereo-electroencephalography (SEEG) results and surgical resection and outcome.
Methods: All consecutive patients referred to the Center for Refractory Epilepsy (CRE) of St-Luc University Hospital (Brussels, Belgium) for presurgical evaluation between 15/01/2019 and 31/12/2020 meeting the inclusion criteria, were recruited to the study.
Clin Neurol Neurosurg
June 2023
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:
Objective: We investigated the accuracy of interictal electrical source imaging (II-ESI) in localizing the epileptogenic zone in MRI-negative epilepsy patients who underwent epilepsy surgery. We also aimed to compare II-ESI's utility with other presurgical investigations and its role in guiding intracranial electroencephalography (iEEG) planning.
Methods: We retrospectively reviewed the medical records of patients with operated MRI-negative intractable epilepsy at our center between 2010 and 2016.
Seizure
May 2023
Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address:
Objective: To perform a systematic review and meta-analysis to identify whether tuberectomy and tuberectomy plus are associated with different postoperative seizure outcomes in patients with tuberous sclerosis complex (TSC) -related epilepsy.
Methods: Electronic databases (PubMed, Embase, Cochrane, Proquest, Web of Science, Scopus, Biosis Previews) were searched without date restriction. Retrospective cohort studies of participants with TSC-associated epilepsy undergoing resective surgery that reported demographics, presurgical evaluation, extent of resection and postoperative seizure outcomes were included.
Seizure
May 2023
Department of Diagnostic Imaging, The Hospital for Sick Children, Canada; Division of Neurology, The Hospital for Sick Children, Canada; Department of Medical Imaging, Lurie Children's Hospital of Chicago, United States. Electronic address:
Seizure
April 2023
Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.
Background: Stereo-electroencephalography (SEEG) and magnetoencephalography (MEG) have generally been used independently as part of the pre-surgical evaluation of drug-resistant epilepsy (DRE) patients. However, the possibility of simultaneously employing these recording techniques to determine whether MEG has the potential of offering the same information as SEEG less invasively, or whether it could offer a greater spatial indication of the epileptogenic zone (EZ) to aid surgical planning, has not been previously evaluated.
Methods: Data from 24 paediatric and adult DRE patients, undergoing simultaneous SEEG and MEG as part of their pre-surgical evaluation, was analysed employing manual and automated high-frequency oscillations (HFOs) detection, and spectral and source localisation analyses.
Clin Neurophysiol
June 2023
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA. Electronic address:
Objective: To determine how sevoflurane anesthesia modulates intraoperative epilepsy biomarkers on electrocorticography, including high-frequency oscillation (HFO) effective connectivity (EC), and to investigate their relation to epileptogenicity and anatomical white matter.
Methods: We studied eight pediatric drug-resistant focal epilepsy patients who achieved seizure control after invasive monitoring and resective surgery. We visualized spatial distributions of the electrocorticography biomarkers at an oxygen baseline, three time-points while sevoflurane was increasing, and at a plateau of 2 minimum alveolar concentration (MAC) sevoflurane.
Lancet Neurol
May 2023
Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France.
Epilepsy Res
May 2023
Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address:
Presurgical evaluation of refractory epilepsy involves functional investigations to minimize postoperative deficit. Assessing language and memory is conventionally undertaken using Wada and fMRI, and occasionally supplemented by data from invasive intracranial electroencephalography, such as electrical stimulation, corticortical evoked potentials, mapping of high frequency activity and phase amplitude coupling. We describe the comparative and complementary role of these methods to inform surgical decision-making and functional prognostication.
View Article and Find Full Text PDFEpileptic Disord
February 2023
Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.
Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults.
View Article and Find Full Text PDFNeurology
May 2023
From the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Background And Objectives: Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug-resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared with medical management alone, to assist with decisions about resource allocation.
Methods: A systematic literature search was conducted on June 1, 2022, using MEDLINE, EMBASE, the NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database.
Transl Pediatr
February 2023
Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA.