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Kapil Gururangan, Babak Razavi, Josef Parvizi
OBJECTIVE: To investigate the utility of electroencephalography (EEG) for evaluation of patients with altered mental status (AMS). METHODS: We retrospectively reviewed 200 continuous EEGs (cEEGs) obtained in ICU and non-ICU wards and 100 spot EEGs (sEEGs) obtained from the emergency department (ED) of a large tertiary medical center. Main outcomes were access time (from study request to hookup), and diagnostic yield (percentage of studies revealing significant abnormality)...
October 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
H X Wang, B Q Zhang, J L Lin, X C Song, J Ruan, Y O Liu, J He, Z H Sun, W J Zhou
OBJECTIVE: Insular and opercular cortex is involved in complicated physiological function.Insular seizures involve extensive epileptic network, which results in the complex and diverse semiology.Electrical cortical stimulation(ECS) can explore the functional mapping and symptomatogenic zone. METHODS: The clinical presurgical evaluation and ECS data of 20 patients whose electrode contacts were located in the insular and opercular were analyzed retrospectively.CT scan/3D MRI data fusion was performed in order to accurately identify and locate each contact and check the electrode trajectory by the MRI images performed after the electrodes were removed...
August 2, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Fabrice Bartolomei, Francesca Bonini, Elsa Vidal, Agnes Trébuchon, Stanislas Lagarde, Isabelle Lambert, Aileen McGonigal, Didier Scavarda, Romain Carron, Christian G Benar
An effect of vagal nerve stimulation (VNS) on cortical synchronization has been postulated but remains to be verified. In this study we investigated the impact of VNS on functional connectivity (Fc) using direct intracerebral recordings (stereotactic EEG, SEEG). Five patients with epilepsy who underwent SEEG recordings during ongoing VNS therapy were investigated. Interdependencies between twenty-six selected bipolar SEEG channels were estimated by nonlinear regression analysis during ON and OF periods of stimulation...
October 2016: Epilepsy Research
Catherine M Sweeney-Reed, Harim Lee, Stefan Rampp, Tino Zaehle, Lars Buentjen, Juergen Voges, Martin Holtkamp, Hermann Hinrichs, Hans-Jochen Heinze, Friedhelm C Schmitt
The relationships between interictal epileptiform discharges (IEDs) in the anterior (ANT) and dorsomedial nuclei (DMNT) of the thalamus and electro-clinical parameters in pharmacoresistant focal epilepsy patients receiving intrathalamic electrodes for deep brain stimulation (DBS) were investigated. Thalamus-localized IEDs (LIEDs) and surface EEG (sEEG)-IEDs were evaluated in eight patients who underwent ANT-DBS. Occurrence and frequency of ANT- and DMNT-LIEDs and pre-operative sEEG-IEDs were examined with respect to seizure onset location and seizure outcome following ANT-DBS...
October 2016: Journal of Neurology
V K Jirsa, T Proix, D Perdikis, M M Woodman, H Wang, J Gonzalez-Martinez, C Bernard, C Bénar, M Guye, P Chauvel, F Bartolomei
Individual variability has clear effects upon the outcome of therapies and treatment approaches. The customization of healthcare options to the individual patient should accordingly improve treatment results. We propose a novel approach to brain interventions based on personalized brain network models derived from non-invasive structural data of individual patients. Along the example of a patient with bitemporal epilepsy, we show step by step how to develop a Virtual Epileptic Patient (VEP) brain model and integrate patient-specific information such as brain connectivity, epileptogenic zone and MRI lesions...
July 28, 2016: NeuroImage
Sandrine Aubert, Francesca Bonini, Jonathan Curot, Luc Valton, William Szurhaj, Philippe Derambure, Sylvain Rheims, Philippe Ryvlin, Fabrice Wendling, Aileen McGonigal, Agnes Trébuchon, Fabrice Bartolomei
OBJECTIVE: We aimed at better delineating the functional anatomical organization of bitemporal lobe epilepsy. METHODS: We studied the epileptogenic zone (EZ) by quantifying the epileptogenicity of brain structures explored by depth electrodes in patients investigated by stereoelectroencephalography (SEEG). We compared 15 patients with bilateral mesial temporal lobe epilepsy (BTLE) and 15 patients with unilateral mesial temporal lobe epilepsy (UTLE). This quantification was performed using the 'Epileptogenicity Index' (EI)...
September 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Angela Marchi, Francesca Bonini, Stanislas Lagarde, Aileen McGonigal, Martine Gavaret, Didier Scavarda, Romain Carron, Sandrine Aubert, Nathalie Villeneuve, Samuel Médina Villalon, Christian Bénar, Agnes Trebuchon, Fabrice Bartolomei
Compared with temporal or frontal lobe epilepsies, the occipital lobe epilepsies (OLE) remain poorly characterized. In this study, we aimed at classifying the ictal networks involving OLE and investigated clinical features of the OLE network subtypes. We studied 194 seizures from 29 consecutive patients presenting with OLE and investigated by stereoelectroencephalography (SEEG). Epileptogenicity of occipital and extraoccipital regions was quantified according to the 'epileptogenicity index' (EI) method. We found that 79% of patients showed widespread epileptogenic zone organization, involving parietal or temporal regions in addition to the occipital lobe...
September 2016: Epilepsy & Behavior: E&B
Stanislas Lagarde, Francesca Bonini, Aileen McGonigal, Patrick Chauvel, Martine Gavaret, Didier Scavarda, Romain Carron, Jean Régis, Sandrine Aubert, Nathalie Villeneuve, Bernard Giusiano, Dominique Figarella-Branger, Agnès Trebuchon, Fabrice Bartolomei
OBJECTIVES: The study of intracerebral electroencephalography (EEG) seizure-onset patterns is crucial to accurately define the epileptogenic zone and guide successful surgical resection. It also raises important pathophysiologic issues concerning mechanisms of seizure generation. Until now, several seizure-onset patterns have been described using distinct recording methods (subdural, depth electrode), mostly in temporal lobe epilepsies or with heterogeneous neocortical lesions. METHODS: We analyzed data from a cohort of 53 consecutive patients explored by stereoelectroencephalography (SEEG) and with pathologically confirmed malformation of cortical development (MCD; including focal cortical dysplasia [FCD] and neurodevelopmental tumors [NDTs])...
September 2016: Epilepsia
F Caruana, F Gozzo, V Pelliccia, M Cossu, P Avanzini
Laughter and smile are typical expressions of mirth and fundamental means of social communication. Despite their general interest, the current knowledge about the brain regions involved in the production of these expressions is still very limited, and the principal insights come from electrical stimulation (ES) studies in patients, in which, nevertheless, laughter or smile have been elicited very rarely. Previous studies showed that laughter is evoked by the stimulation of nodes of an emotional network encompassing the anterior cingulate, the superior frontal and basal temporal cortex...
August 2016: Neuropsychologia
Jeffrey Paul Mullin, Michael Shriver, Soha Abdu Alomar, Imad Najm, Jorge Alvaro Gonzalez-Martinez
INTRODUCTION: Stereotacticelectroencephalography (SEEG) is a procedure performed to define the epileptogenic zone in medically refractory epilepsy patients. Despite not requiring a craniotomy, intracerebral electrodes have gained a reputation of a "relatively high morbidity" associated with their placement. The goal of this study is to be the first to quantitatively review the incidence of various surgical complications associated with SEEG electrode implantation in the literature and to provide a summary estimate...
August 2016: Neurosurgery
Karl Roessler, Björn Sommer, Andreas Merkel, Stefan Rampp, Stephanie Gollwitzer, Hajo M Hamer, Michael Buchfelder
PURPOSE: Various complex techniques for depth electrode insertion in refractory epilepsy using preoperative imaging have been investigated. We evaluated a simple, accurate, cost- and time-effective method supported by intraoperative MR-imaging. METHOD: A neuronavigation-guided bone attached insertion tube facilitated the placement of stereotactic percutaneous drill holes, bolt implantation and frameless stereotactic insertion of depth electrodes. Image registration was carried out by head coil fiducials with trajectory planning and intraoperative electrode correction...
July 4, 2016: World Neurosurgery
P Bourdillon, J Isnard, H Catenoix, A Montavont, S Rheims, P Ryvlin, K Ostrowsky-Coste, F Mauguiere, M Guénot
BACKGROUND: Deep brain electrodes have been used for the last ten years to produce bipolar SEEG-guided radiofrequency thermo-coagulation (SEEG RF-TC). However, this technique is based on empirical knowledge. The aim of this study is threefold: 1) provide in vivo animal data concerning the effect of bipolar RF-TC on brain and its safety 2) assess the parameters of this procedure (current delivery and dipole selection) which produce the most efficient lesion and 3) provide technical guidelines...
June 29, 2016: World Neurosurgery
Rachel Sparks, Gergely Zombori, Roman Rodionov, Mark Nowell, Sjoerd B Vos, Maria A Zuluaga, Beate Diehl, Tim Wehner, Anna Miserocchi, Andrew W McEvoy, John S Duncan, Sebastien Ourselin
PURPOSE: About one-third of individuals with focal epilepsy continue to have seizures despite optimal medical management. These patients are potentially curable with neurosurgery if the epileptogenic zone (EZ) can be identified and resected. Stereo-electroencephalography (SEEG) to record epileptic activity with intracranial depth electrodes may be required to identify the EZ. Each SEEG electrode trajectory, the path between the entry on the skull and the cerebral target, must be planned carefully to avoid trauma to blood vessels and conflicts between electrodes...
July 1, 2016: International Journal of Computer Assisted Radiology and Surgery
Yislenz Narváez-Martínez, Sergio García, Pedro Roldán, Jorge Torales, Jordi Rumià
OBJECTIVE: To report a novel, accurate, and safe technique for deep brain electrode implantation to register brain electrical activity or SEEG, using frameless stereotaxy, neuronavigation assisted, and intraoperative CT-guided O-Arm(®) and the Vertek(®) articulated passive arm. MATERIAL AND METHODS: All patients implanted by this technique in Barcelona Hospital Clinic were included. A prospective evaluation was made of the accuracy of the technique, as well as complications, surgical time, length of stay, and short-term outcomes...
June 23, 2016: Neurocirugía
Jeffrey P Mullin, Saksith Smithason, Jorge Gonzalez-Martinez
SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients who are deemed appropriate candidates for invasive recordings, the decision to monitor is made between the subdural grids versus SEEG. Invasive neuromonitoring for epilepsy is pursued in patients with complex, medically refractory epilepsy. The goal of invasive monitoring is to offer resective surgery with the hope of allowing seizure freedom. SEEG's advantages include access to deep cortical structures, an ability to localize the epileptogenic zone (EZ) when subdural grids have failed to do so, and in patients with non-lesional extra-temporal epilepsies...
2016: Journal of Visualized Experiments: JoVE
Mark Nowell, Roman Rodionov, Gergely Zombori, Rachel Sparks, Michele Rizzi, Sebastien Ourselin, Anna Miserocchi, Andrew McEvoy, John Duncan
Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality image integration can be technically demanding, and is underutilised in clinical practice. We have developed a single software platform for image integration, 3D visualization and surgical planning. Here, our pipeline is described in step-by-step fashion, starting with image acquisition, proceeding through image co-registration, manual segmentation, brain and vessel extraction, 3D visualization and manual planning of stereoEEG (SEEG) implantations...
2016: Journal of Visualized Experiments: JoVE
F Pothof, L Bonini, M Lanzilotto, A Livi, L Fogassi, G A Orban, O Paul, P Ruther
OBJECTIVE: Drug resistant focal epilepsy can be treated by resecting the epileptic focus requiring a precise focus localisation using stereoelectroencephalography (SEEG) probes. As commercial SEEG probes offer only a limited spatial resolution, probes of higher channel count and design freedom enabling the incorporation of macro and microelectrodes would help increasing spatial resolution and thus open new perspectives for investigating mechanisms underlying focal epilepsy and its treatment...
August 2016: Journal of Neural Engineering
Guillaume Gras-Combe, Lorella Minotti, Dominique Hoffmann, Alexandre Krainik, Philippe Kahane, Stephan Chabardes
BACKGROUND: Hidden by the perisylvian operculi, insular cortex has long been underexplored in the context of epilepsy surgery. Recent studies advocated stereoelectroencephalography (SEEG) as a reliable tool to explore insular cortex and its involvement in intractable epilepsy and suggested that insular seizures could be an underestimated entity. However, the results of insular resection to treat pharmacoresistant epilepsy are rarely reported. OBJECTIVE: We report 6 consecutive cases of right insular resection performed based on anatomoelectroclinical correlations provided by SEEG...
October 2016: Neurosurgery
Michael Karsy, Jian Guan, Katrina Ducis, Robert J Bollo
In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy...
April 2016: Translational pediatrics
María Corsi-Cabrera, Francisco Velasco, Yolanda Del Río-Portilla, Jorge L Armony, David Trejo-Martínez, Miguel A Guevara, Ana L Velasco
The amygdaloid complex plays a crucial role in processing emotional signals and in the formation of emotional memories. Neuroimaging studies have shown human amygdala activation during rapid eye movement sleep (REM). Stereotactically implanted electrodes for presurgical evaluation in epileptic patients provide a unique opportunity to directly record amygdala activity. The present study analysed amygdala activity associated with REM sleep eye movements on the millisecond scale. We propose that phasic activation associated with rapid eye movements may provide the amygdala with endogenous excitation during REM sleep...
May 5, 2016: Journal of Sleep Research
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