scholarly journals Intracranial Electroencephalographic Monitoring: From Subdural to Depth Electrodes

2018 ◽  
Vol 45 (3) ◽  
pp. 336-338 ◽  
Author(s):  
Holger Joswig ◽  
David A. Steven ◽  
Andrew G. Parrent ◽  
Keith W. MacDougall ◽  
Seyed M. Mirsattari ◽  
...  
Keyword(s):  
Paradigm Shift ◽  
Operative Time ◽  
Surgical Techniques ◽  
Risk Profile ◽  
Drug Resistant ◽  
The Past ◽  
Subdural Electrodes ◽  
Depth Electrodes ◽  
London Health ◽  
Drug Resistant Epilepsy

AbstractAt the London Health Sciences Centre Epilepsy Program, stereotactically implanted depth electrodes have largely replaced subdural electrodes in the presurgical investigation of patients with drug-resistant epilepsy over the past 4 years. The rationale for this paradigm shift was more experience with, and improved surgical techniques for, stereoelectroencephalography, a possible lower-risk profile for depth electrodes, better patient tolerability, shorter operative time, as well as increased recognition of potential surgical targets that are not accessible to subdural electrodes.

scholarly journals Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode

2016 ◽  
Vol 18 (5) ◽  
pp. 511-522 ◽  
Author(s):  
Alexander G. Weil ◽  
Aria Fallah ◽  
Evan C. Lewis ◽  
Sanjiv Bhatia
Keyword(s):  
Epilepsy Surgery ◽  
Electrode Placement ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Age At Surgery ◽  
Feasible Alternative ◽  
The Mean ◽  
Drug Resistant Epilepsy

OBJECTIVE Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy. METHODS The authors performed a retrospective analysis of all children (< 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015. RESULTS Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5–16 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4–8), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40–92). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula. CONCLUSIONS Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.

Stereoencephalography Electrode Placement Accuracy and Utility Using a Frameless Insertion Platform Without a Rigid Cannula

2019 ◽  
Author(s):  
Erin D’Agostino ◽  
John Kanter ◽  
Yinchen Song ◽  
Joshua P Aronson
Keyword(s):  
Electrode Placement ◽  
Target Point ◽  
Localization Error ◽  
Drug Resistant ◽  
Guide Cannula ◽  
Lateral Entry ◽  
Accurate Localization ◽  
Depth Electrodes ◽  
Rigid Frame ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND Implantation of depth electrodes to localize epileptogenic foci in patients with drug-resistant epilepsy can be accomplished using traditional rigid frame-based, custom frameless, and robotic stereotactic systems. OBJECTIVE To evaluate the accuracy of electrode implantation using the FHC microTargeting platform, a custom frameless platform, without a rigid insertion cannula. METHODS A total of 182 depth electrodes were implanted in 13 consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant epilepsy using the microTargeting platform and depth electrodes without a rigid guide cannula. MATLAB was utilized to evaluate targeting accuracy. Three manual coordinate measurements with high inter-rater reliability were averaged. RESULTS Patients were predominantly male (77%) with average age 35.62 (SD 11.0, range 21-57) and average age of epilepsy onset at 13.4 (SD 7.2, range 3-26). A mean of 14 electrodes were implanted (range 10-18). Mean operative time was 144 min (range 104-176). Implantation of 3 out of 182 electrodes resulted in nonoperative hemorrhage (2 small subdural hematomas and one small subarachnoid hemorrhage). Putative location of onset was identified in all patients. We demonstrated a median lateral target point localization error (LTPLE) of 3.95 mm (IQR 2.18-6.23), a lateral entry point localization error (LEPLE) of 1.98 mm (IQR 1.2-2.85), a target depth error of 1.71 mm (IQR 1.03-2.33), and total target point localization error (TPLE) of 4.95 mm (IQR 2.98-6.85). CONCLUSION Utilization of the FHC microTargeting platform without the use of insertion cannulae is safe, effective, and accurate. Localization of seizure foci was accomplished in all patients and accuracy of depth electrode placement was satisfactory.

scholarly journals DRUG-RESISTANT EPILEPSY IN CASE OF CRANIOCEREBRAL DISPROPORTION. A PILOT STUDY

2021 ◽  
Vol 83 (3) ◽  
pp. 19-23
Author(s):  
Oleg Biketov
Keyword(s):  
Drug Resistance ◽  
Drug Therapy ◽  
Pilot Study ◽  
Antiepileptic Drugs ◽  
Pathological Process ◽  
Research Trends ◽  
Drug Resistant ◽  
The Past ◽  
Craniocerebral Disproportion ◽  
Drug Resistant Epilepsy

The problem of ineff ective drug therapy of epilepsy continues to be relevant during many decades and determines many key research trends in clinical and fundamental epileptology. Despite the emergence of a large number of various antiepileptic drugs the eff ectiveness of drug therapy for epilepsy has remained almost unchanged over the past decades. In this article drug-resistance in epilepsy is considered as a consequence of a concomitant pathological process in the form of craniocerebral disproportion.

scholarly journals Presurgical Evaluation of Epilepsy Surgery

2020 ◽  
Author(s):  
Tak Lap Poon
Keyword(s):  
Epilepsy Surgery ◽  
Essential Elements ◽  
Epilepsy Syndrome ◽  
Drug Resistant ◽  
Eeg Monitoring ◽  
Presurgical Evaluation ◽  
Advanced Technique ◽  
Depth Electrodes ◽  
Drug Resistant Epilepsy ◽  
Modern Era

Drug-resistant epilepsy (DRE) is defined as failure of two adequate trials of appropriately chosen and administered antiepileptic drugs. Approximately about 30% of epilepsy patients are drug resistant. Accountable reasons to treatment failure including failure to recognize epilepsy syndrome, poor drug compliance, lifestyle factors, etc. In modern era of medicine, DRE patient should be encouraged to have early referral to tertiary epilepsy centre for presurgical evaluation. Comprehensive neurophysiology, structural neuroimaging, and neuropsychological and psychiatric assessment are regarded as essential elements. Invasive electroencephalography (EEG) monitoring in terms of subdural electrodes, depth electrodes, foramen ovale electrodes, and more advanced technique using stereoelectroencephalography (SEEG) are strong armamentarium for epilepsy surgeon. Epilepsy surgery in terms of resection, disconnection, or neuro-modulation should be recommended after a multi-disciplinary agreement.

Simultaneous Recording of Single-Neuron Activities and Broad-Area Intracranial Electroencephalography: Electrode Design and Implantation Procedure

2013 ◽  
Vol 73 (2) ◽  
pp. ons146-ons154 ◽  
Author(s):  
Takeshi Matsuo ◽  
Kensuke Kawai ◽  
Takeshi Uno ◽  
Naoto Kunii ◽  
Naohisa Miyakawa ◽  
...  
Keyword(s):  
Hippocampal Neurons ◽  
Single Neuron ◽  
Surgical Techniques ◽  
Simultaneous Recording ◽  
Broad Area ◽  
Subdural Electrodes ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Stereotactic Frame ◽  
Intracranial Electroencephalography

Abstract BACKGROUND: There has been growing interest in clinical single-neuron recording to better understand epileptogenicity and brain function. It is crucial to compare this new information, single-neuronal activity, with that obtained from conventional intracranial electroencephalography during simultaneous recording. However, it is difficult to implant microwires and subdural electrodes during a single surgical operation because the stereotactic frame hampers flexible craniotomy. OBJECTIVE: To describe newly designed electrodes and surgical techniques for implanting them with subdural electrodes that enable simultaneous recording from hippocampal neurons and broad areas of the cortical surface. METHODS: We designed a depth electrode that does not protrude into the dura and pulsates naturally with the brain. The length and tract of the depth electrode were determined preoperatively between the lateral subiculum and the lateral surface of the temporal lobe. A frameless navigation system was used to insert the depth electrode. Surface grids and ventral strips were placed before and after the insertion of the depth electrodes, respectively. Finally, a microwire bundle was inserted into the lumen of the depth electrode. We evaluated the precision of implantation, the recording stability, and the recording rate with microwire electrodes. RESULTS: Depth-microwire electrodes were placed with a precision of 3.6 mm. The mean successful recording rate of single- or multiple-unit activity was 14.8%, which was maintained throughout the entire recording period. CONCLUSION: We achieved simultaneous implantation of microwires, depth electrodes, and broad-area subdural electrodes. Our method enabled simultaneous and stable recording of hippocampal single-neuron activities and multichannel intracranial electroencephalography.

E-Projects Challenges in India – Role of Human Resource Management and Technology

2018 ◽  
Vol 6 (8) ◽  
pp. 263
Author(s):  
Ramnik Kaur
Keyword(s):  
Developing Countries ◽  
Public Administration ◽  
Paradigm Shift ◽  
Successful Implementation ◽  
The Public ◽  
Government Services ◽  
The Past ◽  
The Government ◽  
Traditional Approaches

E-governance is a paradigm shift over the traditional approaches in Public Administration which means rendering of government services and information to the public by using electronic means. In the past decades, service quality and responsiveness of the government towards the citizens were least important but with the approach of E-Government the government activities are now well dealt. This paper withdraws experiences from various studies from different countries and projects facing similar challenges which need to be consigned for the successful implementation of e-governance projects. Developing countries like India face poverty and illiteracy as a major obstacle in any form of development which makes it difficult for its government to provide e-services to its people conveniently and fast. It also suggests few suggestions to cope up with the challenges faced while implementing e-projects in India.

A RARE CASE OF DRUG-RESISTANT EPILEPSY ASSOCIATED WITH CORTICAL MICRODYSGENESIS

2018 ◽  
Vol 26 (2) ◽  
pp. 13-18
Author(s):  
Yu.M. Zabrodskaya ◽  
◽  
D.A. Sitovskaya ◽  
S.M. Malyshev ◽  
T.V. Sokolova ◽  
...  
Keyword(s):  
Rare Case ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy
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