Robot-Assisted Stereoelectroencephalography: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Efstathios Kondylis ◽  
Alexander C Whiting ◽  
Stephen P Harasimchuk ◽  
Juan Bulacio ◽  
William Bingaman
Keyword(s):  
Video Recording ◽  
The United States ◽  
Electrode Placement ◽  
Robotic Assistance ◽  
Seizure Onset ◽  
Planning Software ◽  
Seizure Onset Zone ◽  
Barriers To Implementation ◽  
New Applications ◽  
Patients With Epilepsy

Abstract Invasive neuromonitoring is an important component of presurgical workup and seizure onset zone localization in patients with epilepsy being considered for surgical resection. In the United States, intraparenchymal stereoelectroencephalography (SEEG) electrodes have been replacing subdural grid electrodes for most cases, following a trend that has already matured in Europe. The use of robotic assistance has been shown to improve operative times and accuracy in SEEG electrode placement, as users benefit from the embedded planning software as well as the efficiency and accuracy of the robotic arm. The greatest barriers to implementation of this technology are the upfront cost and learning curve. This case-based surgeon's perspective operative video could benefit those considering incorporating robotic assistance for SEEG electrode placement. Those considering robotic assistance for pedicle screw placement and other budding applications may also benefit, as well as innovators looking for new applications. The patient consented for the procedure, video recording, and inclusion in subsequent publications.

Comparing Noninvasive Dense Array and Intracranial Electroencephalography for Localization of Seizures

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. 354-362 ◽  
Author(s):  
Mark D. Holmes ◽  
Don M. Tucker ◽  
Jason M. Quiring ◽  
Shahin Hakimian ◽  
John W. Miller ◽  
...  
Keyword(s):  
Closed Head Injury ◽  
Epileptic Seizures ◽  
Electrode Placement ◽  
Source Analysis ◽  
Noninvasive Evaluation ◽  
Dense Array ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Intracranial Electrode ◽  
Intracranial Electroencephalography

Abstract OBJECTIVE To compare the localization of the seizure onset zone estimated from ictal recordings with high spatial resolution, 256-channel scalp dense array electroencephalographic video long-term monitoring (LTM) with the aid of source analysis with that obtained from subsequent intracranial ictal recordings. METHODS Ten patients with medically refractory epilepsy, all surgical candidates, underwent intracranial LTM after standard noninvasive evaluation failed to provide adequate localizing information regarding ictal origins. Before invasive studies, all patients underwent dense array electroencephalographic LTM in which habitual clinical seizures were recorded for each patient. Source analysis was applied to ictal onsets. Intracranial electrode placement followed conventional guidelines, although the neurosurgeon was aware of the dense array electroencephalographic results. Patients ranged in age from 10 to 49 years (mean age, 24 y); 7 were male. Identified risk factors included closed head injury in 1 patient and childhood meningitis in another. No focal neurological signs were found in any patient. Magnetic resonance imaging findings were normal in 6 patients; 1 patient had cerebellar hypoplasia, 1 had right frontoparietal dysplasia, 1 had bilateral nonspecific white matter abnormalities, and 1 had bilateral cavernous angiomas. RESULTS Ictal onsets, based on invasive recordings, were in the mesiotemporal lobe (3 patients), lateroparietal (2 patients), mesioparietal (1 patient), laterofrontal (1 patient), superolateral frontocentral (1 patient), frontopolar (1 patient), and posteroinferior temporo-occipital neocortex (1 patient). Dense array electroencephalography localized ictal onsets to the same region as intracranial monitoring in 8 of 10 cases; invasive studies disclosed an additional ictal focus in 2 of these patients. Surgical resections were based only on intracranial electroencephalographic findings. CONCLUSION Dense array electroencephalography has the potential to assist in the noninvasive localization of epileptic seizures and to guide the placement of invasive electrodes for localizing seizure onset.

Freehand placement of depth electrodes using electromagnetic frameless stereotactic guidance

2011 ◽  
Vol 8 (5) ◽  
pp. 464-467 ◽  
Author(s):  
Carter D. Wray ◽  
Diana L. Kraemer ◽  
Tong Yang ◽  
Sandra L. Poliachik ◽  
Andrew L. Ko ◽  
...  
Keyword(s):  
Electrode Placement ◽  
Frameless Stereotaxy ◽  
Seizure Onset ◽  
Presurgical Evaluation ◽  
Electromagnetic System ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Stereotactic Frame ◽  
Stereotactic Guidance ◽  
Patients With Epilepsy

The presurgical evaluation of patients with epilepsy often requires an intracranial study in which both subdural grid electrodes and depth electrodes are needed. Performing a craniotomy for grid placement with a stereotactic frame in place can be problematic, especially in young children, leading some surgeons to consider frameless stereotaxy for such surgery. The authors report on the use of a system that uses electromagnetic impulses to track the tip of the depth electrode. Ten pediatric patients with medically refractory focal lobar epilepsy required placement of both subdural grid and intraparenchymal depth electrodes to map seizure onset. Presurgical frameless stereotaxic targeting was performed using a commercially available electromagnetic image-guided system. Freehand depth electrode placement was then performed with intraoperative guidance using an electromagnetic system that provided imaging of the tip of the electrode, something that has not been possible using visually or sonically based systems. Accuracy of placement of depth electrodes within the deep structures of interest was confirmed postoperatively using CT and CT/MR imaging fusion. Depth electrodes were appropriately placed in all patients. Electromagnetic-tracking–based stereotactic targeting improves the accuracy of freehand placement of depth electrodes in patients with medically refractory epilepsy. The ability to track the electrode tip, rather than the electrode tail, is a major feature that enhances accuracy. Additional advantages of electromagnetic frameless guidance are discussed.

scholarly journals Synchrony in Normal and Focal Epileptic Brain: The Seizure Onset Zone is Functionally Disconnected

2010 ◽  
Vol 104 (6) ◽  
pp. 3530-3539 ◽  
Author(s):  
Christopher P. Warren ◽  
Sanqing Hu ◽  
Matt Stead ◽  
Benjamin H. Brinkmann ◽  
Mark R. Bower ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Brain Regions ◽  
Seizure Onset ◽  
Neuronal Synchrony ◽  
Seizure Onset Zone ◽  
Paradoxical Finding ◽  
Eeg Recordings ◽  
Learning And Cognition ◽  
Patients With Epilepsy ◽  
And Control

Synchronization of local and distributed neuronal assemblies is thought to underlie fundamental brain processes such as perception, learning, and cognition. In neurological disease, neuronal synchrony can be altered and in epilepsy may play an important role in the generation of seizures. Linear cross-correlation and mean phase coherence of local field potentials (LFPs) are commonly used measures of neuronal synchrony and have been studied extensively in epileptic brain. Multiple studies have reported that epileptic brain is characterized by increased neuronal synchrony except possibly prior to seizure onset when synchrony may decrease. Previous studies using intracranial electroencephalography (EEG), however, have been limited to patients with epilepsy. Here we investigate neuronal synchrony in epileptic and control brain using intracranial EEG recordings from patients with medically resistant partial epilepsy and control subjects with intractable facial pain. For both epilepsy and control patients, average LFP synchrony decreases with increasing interelectrode distance. Results in epilepsy patients show lower LFP synchrony between seizure-generating brain and other brain regions. This relative isolation of seizure-generating brain underlies the paradoxical finding that control patients without epilepsy have greater average LFP synchrony than patients with epilepsy. In conclusion, we show that in patients with focal epilepsy, the region of epileptic brain generating seizures is functionally isolated from surrounding brain regions. We further speculate that this functional isolation may contribute to spontaneous seizure generation and may represent a clinically useful electrophysiological signature for mapping epileptic brain.

scholarly journals Phase-Amplitude Coupling between Infraslow and High-Frequency Activities is a Potential Biomarker for Seizure Prediction

2020 ◽  
Author(s):  
Hiroaki Hashimoto ◽  
Hui Ming Khoo ◽  
Takufumi Yanagisawa ◽  
Naoki Tani ◽  
Satoru Oshino ◽  
...  
Keyword(s):  
High Frequency ◽  
Characteristic Curve ◽  
Case Series ◽  
Discrimination Performance ◽  
Electrode Placement ◽  
Seizure Prediction ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Potential Biomarker ◽  
Phase Amplitude

IMPORTANCEThis research describes a method to accurately predict the onset of epileptic seizures; this will help treat patients timely, prevent future seizures, and improve outcomes.OBJECTIVEWe aimed to assess whether the phase-amplitude coupling (PAC) between infraslow activities (ISA) and high-frequency activities (HFA) increases before seizure onset.DESIGN AND SETTINGThis retrospective, single-center case series included patients admitted to the neurosurgery department at Osaka University Hospital in Suita, Osaka, from July 2018 to July 2019.PARTICIPANTSWe enrolled seven patients with drug-resistant focal epilepsy who underwent intracranial electrode placement as part of a presurgical invasive electroencephalography study.MAIN OUTCOMES AND MEASURESWe comparatively analyzed the ISA, HFA, and ISA-HFA PAC in the seizure onset zone (SOZ) or non-SOZ (nSOZ) in the interictal, preictal, and ictal states.RESULTSWe recorded 15 seizures in seven patients [1 female (14%); mean (SD) age = 26 (12) years; age range, 15-47 years]. HFA and ISA were larger in the ictal states than in the interictal and preictal states. During seizures, the HFA and ISA of the SOZ were larger and earlier than those of nSOZ. In the preictal states, the ISA-HFA PAC was larger than that of the interictal states, and it began increasing at 93 seconds before the seizure onset (95% confidence interval: −116 – −71 s). There were no differences in the values and time of ISA-HFA PAC between both zones. Our phase-based analysis revealed differences between the SOZ- and nSOZ-PAC. In SOZ, the HFA amplitudes were tuned at the trough of the ISA oscillations, and in nSOZ, the HFA amplitudes were tuned at the peak of these oscillations. The receiver-operating characteristic curve showed that the ISA-HFA PAC of the SOZ showed the highest discrimination performance in the preictal and interictal states, with an area under the curve (AUC) of 0.926. However, ISA-HFA PAC was not suitable to differentiate between SOZ and nSOZ (interictal AUC = 0.555, preictal AUC = 0.691, and ictal AUC = 0.646).CONCLUSION AND RELEVANCEThis study demonstrated the novel insight that ISA-HFA PAC increases before the onset of seizures, regardless of the seizure onset zone. Our findings indicate that ISA-HFA PAC is a potential biomarker for predicting the onset of seizures and may be valuable to physicians who routinely treat epileptic patients.Key PointsQuestionIs phase-amplitude coupling (PAC) between infraslow activities (ISA) and high-frequency activities (HFA) a useful biomarker for seizure prediction?FindingsIn this case series study on 15 focal-onset seizures in seven epileptic patients who underwent intracranial electrode placement, we found that a PAC of the ISA phase and HFA amplitude achieved significantly higher values in preictal states than in the interictal states, and ISA-HFA PAC of the seizure onset zone (SOZ) began increasing at 93 seconds before seizure onset (SO), while both HFA and ISA increased after SO. The receiver-operating characteristic curve showed that the ISA-HFA PAC of the SOZ showed the highest discrimination performance in the preictal and interictal states, with an area under the curve of 0.926.MeaningThis study demonstrates that ISA-HFA PAC can differentiate between the preictal and interictal states of a seizure, indicating that it is a potential marker for seizure prediction.

Neural fragility as an EEG marker of the seizure onset zone

2021 ◽  
Author(s):  
Adam Li ◽  
Chester Huynh ◽  
Zachary Fitzgerald ◽  
Iahn Cajigas ◽  
Damian Brusko ◽  
...  
Keyword(s):  
Seizure Onset ◽  
Seizure Onset Zone

scholarly journals Analysis of treatment adherence and cost among patients with epilepsy: a four‐year retrospective cohort study in Pakistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muhammad Arif Asghar ◽  
Ahad Abdul Rehman ◽  
Muhammad Liaquat Raza ◽  
Yousra Shafiq ◽  
Muhammad Asif Asghar
Keyword(s):  
Associated Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
The United States ◽  
Initial Therapy ◽  
Study Cohort ◽  
Entire Study ◽  
Cox Regression Analysis ◽  
Recommended Treatment ◽  
Patients With Epilepsy

Abstract Background The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan. Methods Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs. Results A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy. Conclusions Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.

Fake Pharmaceuticals: How They and Relevant Legislation or Lack Thereof Contribute to Consistently High and Increasing Drug Prices

2003 ◽  
Vol 29 (4) ◽  
pp. 525-542
Author(s):  
Merri C. Moken
Keyword(s):  
United States ◽  
Prescription Drugs ◽  
The United States ◽  
Pharmaceutical Products ◽  
New Drugs ◽  
Pharmaceutical Companies ◽  
Brand Name ◽  
Potential Factors ◽  
Counterfeit Pharmaceuticals ◽  
New Applications

The use of pharmaceutical products in the United States has increased more than the use of any other health resource from 1960 to 1990. In excess of 9,600 drugs were on the market in 1984, and the Food and Drug Administration (“FDA”) approves approximately 30 new drugs and countless new applications for alterations of already existing drugs each year. In 2001, the $300 billion pharmaceutical industry sold $154 billion worth of prescription drugs in the United States alone, nearly doubling its $78.9 billion in sales in 1997. With such a rapid increase in market domination and expenditures, the U.S. government and many hospitals have focused their attention on the sales and pricing practices of pharmaceutical companies, as well as other potential factors contributing to these escalating prices. One such cause of the steadily increasing prices of brand name pharmaceuticals is the sale of fake or counterfeit pharmaceuticals (also called “look-alike” drugs).

scholarly journals Characterizing the seizure onset zone and epileptic network using EEG-fMRI in a rat seizure model

NeuroImage ◽  
2021 ◽  
pp. 118133
Author(s):  
Junling Wang ◽  
Bin Jing ◽  
Ru Liu ◽  
Donghong Li ◽  
Wei Wang ◽  
...  
Keyword(s):  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Seizure Model
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