sEEG is a Safe Procedure for a Comprehensive Anatomic Exploration of the Insula: A Retrospective Study of 108 Procedures Representing 254 Transopercular Insular Electrodes

2017 ◽  
Vol 14 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Anne Laure Salado ◽  
Laurent Koessler ◽  
Gabriel De Mijolla ◽  
Emmanuelle Schmitt ◽  
Jean-Pierre Vignal ◽  
...  
Keyword(s):  
Clustering Analysis ◽  
Insular Cortex ◽  
Preoperative Assessment ◽  
Homogeneous Distribution ◽  
Safe Procedure ◽  
Drug Resistant ◽  
Computed Tomography Images ◽  
Surgical Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND The exploration of the insula in pre-surgical evaluation of epilepsy is considered to be associated with a high vascular risk resulting in an incomplete exploration of the insular cortex. OBJECTIVE To report a retrospective observational study of insular exploration using stereoelectroencephalography (sEEG) with transopercular and parasagittal oblique intracerebral electrodes from January 2008 to January 2016. The first purpose of this study was to evaluate the surgical risks of insular cortex sEEG exploration. The second purpose was to define the ability of placing intracerebral contacts in the whole insular cortex. METHODS Ninety-nine patients underwent 108 magnetic resonance imaging (MRI)-guided stereotactic implantations of intracerebral electrodes in the context of preoperative assessment of drug-resistant epilepsy, including at least 1 electrode placed in the insular cortex. On postoperative computed tomography images co-registered with MRI, followed by MRI segmentation and application of a transformation matrix, intracerebral contact coordinates of the insular electrodes’ contacts were anatomically localized in the Talairach space. Finally, dispersion and clustering analysis was performed. RESULTS There was no morbidity, in particular hemorrhagic complications, or mortality related to insular electrodes. Statistical comparison of intracerebral contact positions demonstrated that whole insula exploration is possible on the left and right sides. In addition, the clustering analysis showed the homogeneous distribution of the electrodes within the insular cortex. CONCLUSION In the presurgical evaluation of drug-resistant epilepsy, the insular cortex can be explored safely and comprehensively using transopercular sEEG electrodes. Parasagittal oblique trajectories may also be associated to achieve an optimal exploration.

scholarly journals B.03 Safety and effectiveness of insular resections for drug-resistant epilepsy

2017 ◽  
Vol 44 (S2) ◽  
pp. S11-S11
Author(s):  
S Vuddagiri ◽  
L Bello-Espinosa ◽  
S Singh ◽  
S Wiebe ◽  
Y Agha-khani ◽  
...  
Keyword(s):  
Insular Cortex ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Total Resection ◽  
Temporal Epilepsy ◽  
Surgical Evaluation ◽  
Drug Resistant Epilepsy ◽  
Age Range

Background: Insular cortex involvement as a part of epileptogenic zone is often suspected in the context of operculo-insular semiology and can be confirmed by routine interrogation of the insula with stereo-electroencephalography (SEEG). However the safety and efficacy of insular resections remains unclear. Methods: We reviewed all the patients who underwent insular resection for drug-resistant epilepsy, from 2002 – 2016, in the Calgary Epilepsy Program. Details of the comprehensive pre-surgical evaluation, surgery performed, complications and seizure outcome at the latest follow-up were collected. Results: Fifteen patients (8 males, 7 females) with age range 3 – 41 years were identified. MRI was normal in 9 patients. The decision to resect the Insula was made based on clinical semiology and structural and functional imaging in 6 patients and on SEEG findings in 9 patients. Insular resection was total in 11 and partial in 4 patients. Four (26%) patients had transient hemiparesis and 1 patient had permanent mild upper extremity weakness following total resection. After a mean follow-up period of 45.6 months (range 2 – 150 months), 40% of the patients are seizure free. Conclusions: Insular cortex resections for drug resistant epilepsy can be performed safely and may contribute to additional effectiveness in seizure outcomes in patients with challenging extra-temporal epilepsy.

scholarly journals Dyke-Davidoff-Masson Syndrome: A case Report in a patient presenting with drug-resistant epilepsy and pseudoseizures

2021 ◽  
Author(s):  
Pedro Schmidt dos Reis Matos Figueiredo ◽  
Thiago Oliveira Chaves
Keyword(s):  
Case Report ◽  
Cognitive Dysfunction ◽  
Brain Magnetic Resonance Imaging ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Drug Resistant ◽  
Cerebral Hemiatrophy ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy

Context: Dyke-Davidoff-Masson (DDM) syndrome is a rare neurological condition, first described in 1933. Characteristics include cerebral hemiatrophy, contralateral hemiparesis, seizures, and cognitive dysfunction, combined into different degrees and patterns. Brain magnetic resonance imaging (MRI) is used to perform diagnosis throughout its specific findings. Case Report: A eighteen-year-old female presented to our service with a history of cognitive dysfunction and seizures since early childhood, which persistence even with adequate use of antiepileptic drugs. During Investigation were found signs and symptoms compatible with DDM syndrome, and evidence of pseudoseizures captured in a video electroencephalography monitoring. Conclusion: DDM syndrome is a rare condition that must be part of differential diagnosis in patients with seizures and cerebral hemiatrophy. Management is based on adequate control of seizures and other comorbidities.

scholarly journals Case Report: Hemispherotomy in the First Days of Life to Treat Drug-Resistant Lesional Epilepsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Konstantin L. Makridis ◽  
Christine Prager ◽  
Anna Tietze ◽  
Deniz A. Atalay ◽  
Sebastian Triller ◽  
...  
Keyword(s):  
Perioperative Management ◽  
Seizure Control ◽  
Neurological Deficits ◽  
Safe Procedure ◽  
Drug Resistant ◽  
Young Infants ◽  
Specialized Center ◽  
Surgical Conditions ◽  
Drug Resistant Epilepsy ◽  
Early Surgical Intervention

Background: Neonatal drug-resistant epilepsy is often caused by perinatal epileptogenic insults such as stroke, ischemia, hemorrhage, and/or genetic defects. Rapid seizure control is particularly important for cognitive development. Since early surgical intervention and thus a short duration of epilepsy should lead to an optimal developmental outcome, we present our experience with hemispherotomy in an infant at the corrected age of 1 week.Methods: We report successful hemispherotomy for drug-resistant epilepsy in an infant with hemimegalencephaly at a corrected age of 1 week.Results: The infant was diagnosed with drug-resistant lesional epilepsy due to hemimegalencephaly affecting the left hemisphere. Given congruent electroclinical findings, we performed a left vertical parasagittal transventricular hemispherotomy after critical interdisciplinary discussion. No complications occurred during the surgery. Intraoperatively; 118 ml of red blood cells (30 ml/kg) and 80 ml of plasma were transfused. The patient has been seizure-free since discharge without further neurological deficits.Conclusion: We demonstrate that early epilepsy surgery is a safe procedure in very young infants if performed in a specialized center experienced with age-specific surgical conditions and perioperative management. The specific surgical difficulties should be weighed against the risk of life-long developmental drawbacks of ongoing detrimental epilepsy.

Accuracy and Feasibility Analysis of SEEG Electrode Implantation using the VarioGuide Frameless Navigation System in Patients with Drug-Resistant Epilepsy

2021 ◽  
Author(s):  
Shiwei Song ◽  
Yihai Dai ◽  
Zhen Chen ◽  
Songsheng Shi
Keyword(s):  
Navigation System ◽  
Demographic Data ◽  
Operating Time ◽  
Small Region ◽  
Target Point ◽  
Localization Error ◽  
Drug Resistant ◽  
Electrode Implantation ◽  
Computed Tomography Images ◽  
Drug Resistant Epilepsy

Abstract Objective The objective of the study was to evaluate the feasibility and accuracy of frameless stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy using the VarioGuide system. Methods The VarioGuide frameless navigation system was used to implant SEEG electrodes in patients with medically drug-resistant epilepsy. Demographic data, surgery duration, number of electrodes, and complications were retrospectively analyzed. Accuracy was compared by measuring the distance between the planned and actual electrode positions as determined by postoperative computed tomography images. Results A total of 141 SEEG electrodes were implanted in 19 patients from May 2015 to December 2018 with an average of 7.42 (range: 4–10) leads per patient. The average entry point localization error (EPLE) was 1.96 ± 0.47 mm (range: 0.32–3.29) and average target point localization error (TPLE) was 2.47 ± 0.79 mm (range: 0.72–4.83). The average operating time per lead (OTPL) was 14.16 ± 2.68 minutes (range: 8.64–21.58). No complications occurred. Conclusion The VarioGuide frameless navigation system can be an effective method for SEEG electrode implantation in patients with drug-resistant epilepsy, particularly when the electrodes are concentrated in a relatively small region and the number of implanted electrodes is small.

Electroclinical Phenotype-Genotype Homogeneity in Drug-Resistant “Generalized” Tonic-Clonic Seizures of Early Childhood

2020 ◽  
pp. 155005942095373
Author(s):  
Anis Jukkarwala ◽  
Ramshekhar N. Menon ◽  
E. R. Sunesh ◽  
Ashalatha Radhakrishnan
Keyword(s):  
Genetic Testing ◽  
Dravet Syndrome ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Epileptiform Discharges ◽  
Mri Scans ◽  
Clonic Seizures ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

Purpose Children with refractory focal to bilateral tonic-clonic seizures, despite normal high-resolution imaging, are often not subjected to genetic tests due to the costs involved and instead undergo multimodality presurgical evaluation targeted at delineating a focal onset. The objective of this study was to ascertain genotype-phenotype correlations in this group of patients. Method An online hospital database search was conducted for children who presented in 2019 with drug-resistant epilepsy dominated by nonlateralizing focal-onset/rapid generalized (bilateral) tonic-clonic seizures (GTCS), subjected to presurgical evaluation and subsequent genetic testing due to absence of a clear focus hypothesis. Results Phenotypic homogeneity was apparent in 3 children who had onset in infancy with drug-resistant GTCS (predominantly unprovoked and occasionally fever provoked) and subsequent delayed development. 3-Tesla magnetic resonance imaging (MRI) scans were negative and video EEG documented a homogeneous pattern of multifocal and/or generalized epileptiform discharges with phenomenology favoring probable focal-onset/generalized-onset bilateral tonic-clonic seizures. All 3 tested positive for SCN1A gene variants (heterozygous missense substitution variants in 2 children, one of which was novel and a novel duplication in one that led to frameshift and premature truncation of the protein), suggestive of SCN1A-mediated epilepsy. This electroclinical profile constituted 3 out of 25 patients with SCN1A-epilepsy phenotypes at our center. Conclusions These cases suggest that children with early-onset drug-resistant “generalized” epilepsy are likely to have a genetic basis although the presentation may not be typical of Dravet syndrome. Hence, genetic testing for SCN1A variants is recommended in children with drug-resistant MRI negative focal-onset/generalized-onset bilateral tonic-clonic seizures before subjecting them to exhaustive presurgical workup and to guide appropriate treatment and prognostication.

scholarly journals Syncope in patients with drug-resistant epilepsy without apparent cardiovascular disease

2013 ◽  
Vol 71 (12) ◽  
pp. 925-930 ◽  
Author(s):  
Soniza Vieira Alves-Leon ◽  
Moises Pereira Pinto ◽  
Maria Emilia Cosenza Andraus ◽  
Valeria Coelho Santa Rita Pereira ◽  
Isabella D'Andrea Meira ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Heart Disease ◽  
Vasovagal Syncope ◽  
Brain Magnetic Resonance Imaging ◽  
Drug Resistant ◽  
Autonomic Symptoms ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy ◽  
Clinical Conditions ◽  
Open Prospective Study

Epilepsy and syncope are clinical conditions with high prevalence rates in the general population, and the differential diagnosis between them is difficult. Objective To assess the frequency of syncope in patients diagnosed with drug-resistant epilepsy (DRE) without apparent heart disease, to investigate the relationship between clinical and electroencephalographic (EEG) changes, and to verify the role of the inclination test (IT). Method An open, prospective study from 2004 to 2006, including 35 consecutive patients from the Epilepsy Program of Hospital Universitário Clementino Fraga Filho who were diagnosed with DRE without apparent heart disease. Results The frequency of syncope was 25.7% (n=9), with a significant prevalence in women. Vasovagal syncope (VVS) was the most frequent diagnosis. Conclusion We found a significant association between syncope and the presence of autonomic symptoms (p=0.005). The IT plays an important role in the differential diagnosis of patients with DRE presenting with autonomic symptoms, regardless of EEG results and brain magnetic resonance imaging (MRI) abnormalities.

scholarly journals Imaging the Extent and Location of Spatiotemporally Distributed Epileptiform Sources from MEG Measurements

2021 ◽  
Author(s):  
Xiyuan Jiang ◽  
Shuai Ye ◽  
Abbas Sohrabpour ◽  
Anto Bagic ◽  
Bin He
Keyword(s):  
Focal Epilepsy ◽  
Real Data ◽  
Drug Resistant ◽  
Interictal Spikes ◽  
Source Imaging ◽  
Non Invasive ◽  
Eeg Source Imaging ◽  
Surgical Evaluation ◽  
Extended Sources ◽  
Drug Resistant Epilepsy

Non-invasive MEG/EEG source imaging provides valuable information about the epileptogenic brain areas which can be used to aid presurgical planning in focal epilepsy patients suffering from drug-resistant seizures. However, the source extent estimation for electrophysiological source imaging remains to be a challenge and is usually largely dependent on subjective choice. Our recently developed algorithm, fast spatiotemporal iteratively reweighted edge sparsity minimization (FAST-IRES) strategy, has been shown to objectively estimate extended sources from EEG recording, while it has not been applied to MEG recordings. In this work, through extensive numerical experiments and real data analysis in a group of focal drug-resistant epilepsy patients interictal spikes, we demonstrated the ability of FAST-IRES algorithm to image the location and extent of underlying epilepsy sources from MEG measurements. Our results indicate the merits of FAST-IRES in imaging the location and extent of epilepsy sources for pre-surgical evaluation from MEG measurements.

scholarly journals Diagnostic evaluation of drug-resistant insular epilepsy

2019 ◽  
Vol 10 (4) ◽  
pp. 83-93 ◽  
Author(s):  
R. G. Khachatryan ◽  
G. S. Ibatova ◽  
T. M. Alekseeva ◽  
W. A. Khachatryan
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Insular Cortex ◽  
Drug Resistant ◽  
Epileptogenic Focus ◽  
Anatomical Features ◽  
Temporal Epilepsy ◽  
Drug Resistant Epilepsy ◽  
Possible Cause ◽  
Selection Of

About 30% of patients with temporal epilepsy are resistant to antiepileptic drugs; in such cases, surgical treatment is considered to be the best option. Existence of an extra-temporal epileptogenic focus in the insula is a possible cause of seizures after temporal lobe surgery in about 20% of patients. Because of its localization, the anatomical features of the insular lobe, as well as the entire concept of insular epilepsy have not been well documented. Yet, it has been established that the seizures developing from the insular cortex can mimic the paroxysms arising from the temporal lobe. When the insula is involved in the epileptic process, resection of the insular cortex improves the outcome of surgical treatment. Rational and well-based selection of candidates for surgical treatment is of paramount importance for patients with drug-resistant epilepsy. The article presents a review of the up-to-date literature on this matter.

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