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Epilepsy Surgery

Martine Fohlen, Delphine Taussig, Sarah Ferrand-Sorbets, Mathilde Chipaux, Nathalie Dorison, Olivier Delalande, Georg Dorfmüller
PURPOSE: Epilepsy surgery has been shown to be effective in treating focal epilepsy related to tuberous sclerosis complex (TSC). We analyzed the advantage of early surgical management in terms of seizure frequency and development. METHOD: We retrospectively studied the 15 patients younger than 6 years who underwent resective surgery between 2006 and 2016. Fourteen of them had invasive monitoring while the 15th was operated on under corticography. RESULTS: Epilepsy began before 5 months of age in all patients...
June 18, 2018: Seizure: the Journal of the British Epilepsy Association
L D Ladino, V Benjumea-Cuartas, D M Diaz-Marin, R Lopez-Gonzalez, J P Orozco-Hernandez, P Bedoya-Rodriguez, J F Tellez-Zenteno
INTRODUCTION: Selected patients with drug-resistant focal epilepsy benefit from epilepsy surgery, however significant delays remain. The aim of this study was to assess knowledge and attitudes toward epilepsy surgery among patients with epilepsy and identify barriers that might delay the treatment. PATIENTS AND METHODS: A 10-minute questionnaire was administered to patients with epilepsy in Colombia. Survey assessed the following: knowledge of surgical options, perceptions about the risks of surgery vs...
July 1, 2018: Revista de Neurologia
Cristina Rosazza, Francesco Deleo, Ludovico D'Incerti, Luigi Antelmi, Giovanni Tringali, Giuseppe Didato, Maria G Bruzzone, Flavio Villani, Francesco Ghielmetti
Objective: Mechanisms of motor plasticity are critical to maintain motor functions after cerebral damage. This study explores the mechanisms of motor reorganization occurring before and after surgery in four patients with drug-refractory epilepsy candidate to disconnective surgery. Methods: We studied four patients with early damage, who underwent tailored hemispheric surgery in adulthood, removing the cortical motor areas and disconnecting the corticospinal tract (CST) from the affected hemisphere. Motor functions were assessed clinically, with functional MRI (fMRI) tasks of arm and leg movement and Diffusion Tensor Imaging (DTI) before and after surgery with assessments of up to 3 years...
2018: Frontiers in Neurology
Mei Liang, Jialin Jiang, Hongmei Dai, Xiafei Hong, Xianlin Han, Lin Cong, Anli Tong, Fang Li, Yaping Luo, Weinan Liu, Liangrui Zhou, Wenyu Di, Wenming Wu, Yupei Zhao
BACKGROUND: A patient with a rare pediatric insulinoma and MEN1 syndrome was treated by robotic enucleation surgery. CASE PRESENTATION: We present a case of a 9-year-old girl presenting with repeated loss of consciousness, concomitant with a pale face, palpitations, and convulsions, which had persisted for 2 years and had been aggravated during the previous 2 months. She was previously misdiagnosed with epilepsy in another hospital. We further examined her while she was hospitalized...
June 19, 2018: BMC Surgery
David W Roberts, Jaime J Bravo, Jonathan D Olson, William F Hickey, Brent T Harris, Lananh N Nguyen, Jennifer Hong, Linton T Evans, Xiaoyao Fan, Dennis Wirth, Brian C Wilson, Keith D Paulsen
BACKGROUND: Three patients enrolled in a clinical trial of 5-aminolevulinic-acid (5-ALA)-induced fluorescence-guidance, which has been demonstrated to facilitate intracranial tumor resection, were found on neuropathological examination to have focal cortical dysplasia (FCD). OBJECTIVE: To evaluate in this case series visible fluorescence and quantitative levels of protoporphyrin IX (PpIX) during surgery and correlate these findings with preoperative magnetic resonance imaging (MRI) and histopathology...
June 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Riёm El Tahry, Z Irene Wang, Aung Thandar, Irina Podkorytova, Balu Krishnan, Simon Tousseyn, Wu Guiyun, Richard C Burgess, Andreas V Alexopoulos
OBJECTIVE: Selected patients with intractable focal epilepsy who have failed a previous epilepsy surgery can become seizure-free with reoperation. Preoperative evaluation is exceedingly challenging in this cohort. We aim to investigate the diagnostic value of two noninvasive approaches, magnetoencephalography (MEG) and ictal single-photon emission computed tomography (SPECT), in patients with failed epilepsy surgery. METHODS: We retrospectively included a consecutive cohort of patients who failed prior resective epilepsy surgery, underwent re-evaluation including MEG and ictal SPECT, and had another surgery after the re-evaluation...
June 6, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Bjoern Sommer, Stefan Rampp, Arnd Doerfler, Hermann Stefan, Hajo M Hamer, Michael Buchfelder, Karl Roessler
OBJECTIVES: One of the main obstacles of electrode implantation in epilepsy surgery is the electrode shift between implantation and the day of explantation. We evaluated this possible electrode displacement using intraoperative MRI (iopMRI) data and CT/MRI reconstruction. METHODS: Thirteen patients (nine female, four male, median age 26 ± 9.4 years) suffering from drug-resistant epilepsy were examined. After implantation, the position of subdural electrodes was evaluated by 3...
June 19, 2018: Neurological Research
Zhe Zhao, Haitao Wu
Electrical high-frequency stimulation (HFS), using implanted electrodes targeting various brain regions, has been proven as an effective treatment for various neurological and psychiatric disorders. HFS in the deep region of the brain, also named deep-brain stimulation (DBS), is becoming increasingly important in clinical trials. Recent progress in the field of high-frequency DBS (HF-DBS) surgery has begun to spread the possibility of utilizing this invasive technique to other situations, such as treatment for major depression disorder (MDD), obsessive-compulsive disorder (OCD), and so on...
June 2, 2018: Journal of Visualized Experiments: JoVE
Jianguo Shi, Zaifen Gao, Jun Gao, Gang Li, Yehong Chen
OBJECTIVE: The aim of this study is to identify the prognostic role of MRI and EEG in posterior cortex epilepsies (PCES) and to characterize their clinical features. PATIENT AND METHODS: We retrospectively studied 54 consecutive patients (18 females, 36 males) from April 2011 to November 2015, who had undergone PCES surgery. Electro-clinical, pathological and surgical data were evaluated. Of the patients, 18 (33.3%) patients underwent a cortical resection (corticectomy), 10 (18...
June 9, 2018: Clinical Neurology and Neurosurgery
Laurent M Willems, Philipp S Reif, Andrea Spyrantis, Adriano Cattani, Thomas M Freiman, Volker Seifert, Marlies Wagner, Se-Jong You, Susanne Schubert-Bast, Sebastian Bauer, Karl Martin Klein, Felix Rosenow, Adam Strzelczyk
INTRODUCTION: Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported...
June 13, 2018: Epilepsy & Behavior: E&B
Jacquelyn MacDonell, Niravkumar Patel, Gregory Fischer, E Clif Burdette, Jiang Qian, Vaibhav Chumbalkar, Goutam Ghoshal, Tamas Heffter, Emery Williams, Matthew Gounis, Robert King, Juliette Thibodeau, Gene Bogdanov, Olivia W Brooks, Erin Langan, Roy Hwang, Julie G Pilitsis
BACKGROUND: Ablative lesions are current treatments for epilepsy and brain tumors. Interstitial magnetic resonance (MR) guided focused ultrasound (iMRgFUS) may be an alternate ablation technique which limits thermal tissue charring as compared to laser therapy (LITT) and can produce larger ablation patterns nearer the surface than transcranial MR guided focused ultrasound (tcMRgFUS). OBJECTIVE: To describe our experience with interstitial focused ultrasound (iFUS) ablations in swine, using MR-guided robotically assisted (MRgRA) delivery...
June 14, 2018: Neurosurgery
Anne T Berg, John T Langfitt, Gregory D Cascino
No abstract text is available yet for this article.
June 13, 2018: Neurology
Maxime O Baud, Thomas Perneger, Attila Rácz, Max C Pensel, Christian Elger, Bertil Rydenhag, Kristina Malmgren, J Helen Cross, Grainne McKenna, Martin Tisdall, Herm J Lamberink, Sylvain Rheims, Philippe Ryvlin, Jean Isnard, François Mauguière, Alexis Arzimanoglou, Serdar Akkol, Kaancan Deniz, Cigdem Ozkara, Morten Lossius, Ivan Rektor, Reetta Kälviäinen, Lotta-Maria Vanhatalo, Petia Dimova, Krassimir Minkin, Anke Maren Staack, Bernhard J Steinhoff, Adam Kalina, Pavel Krsek, Petr Marusic, Zsofia Jordan, Daniel Fabo, Evelien Carrette, Paul Boon, Saulius Rocka, Rūta Mameniškienė, Serge Vulliemoz, Francesca Pittau, Kees P J Braun, Margitta Seeck
OBJECTIVE: Resective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart. METHODS: Sixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case...
June 13, 2018: Neurology
Cristian Donos, Joshua Breier, Elliott Friedman, Patrick Rollo, Jessica Johnson, Lauren Moss, Stephen Thompson, Melissa Thomas, Omotola Hope, Jeremy Slater, Nitin Tandon
OBJECTIVES: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique for focal epilepsy. A major appeal of LITT is that it may result in fewer cognitive deficits, especially when targeting dominant hemisphere mesial temporal lobe (MTL) epilepsy. To evaluate this, as well as to determine seizure outcomes following LITT, we evaluated the relationships between ablation volumes and surgical or cognitive outcomes in 43 consecutive patients undergoing LITT for MTL epilepsy...
June 12, 2018: Epilepsia
Rafeed Alkawadri, Richard C Burgess, Yosuke Kakisaka, John C Mosher, Andreas V Alexopoulos
Importance: Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. Objective: To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. Design, Setting, and Participants: A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012...
June 11, 2018: JAMA Neurology
Lara Jehi, Lamis Yehia, Charissa Peterson, Farshad Niazi, Robyn Busch, Richard Prayson, Zhong Ying, William Bingaman, Imad Najm, Charis Eng
We recently proposed that the maturation of a new epileptic focus (epileptogenesis) may explain late seizure recurrences, starting months to years after resective epilepsy surgery. We explore here the hypothesis that inherent transcriptomic changes may distinguish such "late relapsers." An in-depth clinical review of 2 patients with recurrent seizures starting years after surgery is contrasted to 4 controls who remained seizure-free postoperatively. This clinical analysis is combined with RNA sequencing from the resected brain tissue, followed by unsupervised hierarchical clustering, independent pathway analysis, and multidimensional scaling analysis...
June 2018: Epilepsia Open
Henri Lehtinen, Jyrki P Mäkelä, Teemu Mäkelä, Pantelis Lioumis, Liisa Metsähonkala, Laura Hokkanen, Juha Wilenius, Eija Gaily
Objective: Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients...
June 2018: Epilepsia Open
Shin-Ting Wu, Raphael Voltoline, Wallace Loos, Jose Angel Ivan Rubianes Silva, Lionis Watanabe, Barbara Amorim, Ana Coan, Fernando Cendes, Clarissa L Yasuda
Focal cortical dysplasia (FCD) is a malformation of cortical development and a common cause of pharmacoresistant epilepsy. Resective surgery of clear-cut lesions may be curative. However, the localization of the seizure focus and the evaluation of its spatial extent can be challenging in many situations. For concordance assessment, medical studies show the relevance of accurate correlation of multisource imaging sequences. to improve the sensitivity and specificity of the evaluation. In this paper, we share the process we went through to reach our simple, but effective, solution for integrating multi-volume rendering into an exploratory visualization environment for the diagnosis of FCD...
May 2018: IEEE Computer Graphics and Applications
Peter N Taylor, Nishant Sinha, Yujiang Wang, Sjoerd B Vos, Jane de Tisi, Anna Miserocchi, Andrew W McEvoy, Gavin P Winston, John S Duncan
Background: Temporal lobe surgical resection brings seizure remission in up to 80% of patients, with long-term complete seizure freedom in 41%. However, it is unclear how surgery impacts on the structural white matter network, and how the network changes relate to seizure outcome. Methods: We used white matter fibre tractography on preoperative diffusion MRI to generate a structural white matter network, and postoperative T1-weighted MRI to retrospectively infer the impact of surgical resection on this network...
2018: NeuroImage: Clinical
Kavelin Rumalla, Kyle A Smith, Paul M Arnold, Theodore H Schwartz
BACKGROUND: Hospital readmissions can be detrimental to patients and may interfere with the potential benefits of the therapeutic procedure. Government agencies have begun to focus on reducing readmissions; however, the etiology of readmissions is lacking. OBJECTIVE: To report the national rates, risk factors, and outcomes associated with 30- and 90-d readmissions following surgery for intractable epilepsy. METHODS: We queried the Nationwide Readmissions Database from January to September 2013 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify all patients with intractable epilepsy, who underwent hemispherectomy (01...
June 4, 2018: Operative Neurosurgery (Hagerstown, Md.)
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