scholarly journals Epilepsy surgery near or in eloquent cortex in children-Practice patterns and recommendations for minimizing and reporting deficits

Epilepsia ◽  
2018 ◽  
Vol 59 (8) ◽  
pp. 1484-1491 ◽  
Author(s):  
Prasanna Jayakar ◽  
Anuj Jayakar ◽  
Mark Libenson ◽  
Alexis Arzimanoglou ◽  
Bertil Rydenhag ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Practice Patterns ◽  
Eloquent Cortex

Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 174-182
Author(s):  
Evangelos Kogias ◽  
Thomas Bast ◽  
Susanne Schubert-Bast ◽  
Gert Wiegand ◽  
Armin Brandt ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Benign Tumors ◽  
Seizure Freedom ◽  
Childhood And Adolescence ◽  
Epileptogenic Zone ◽  
Seizure Recurrence ◽  
Eloquent Cortex

Abstract BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones–and lesions–localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

Epilepsy surgery at or near eloquent cortex: Challenges, approaches and outcomes

2019 ◽  
Vol 405 ◽  
pp. 22-23
Author(s):  
S. Kumar ◽  
D. Nayak ◽  
R.M. Rao ◽  
L. k ◽  
S. Kumar ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Eloquent Cortex

Epilepsy Surgery in Eloquent Cortex

2016 ◽  
pp. 171-179
Author(s):  
Carter S. Gerard ◽  
Lee A. Tan ◽  
Guy M. McKhann ◽  
Richard W. Byrne
Keyword(s):  
Epilepsy Surgery ◽  
Eloquent Cortex

The role of magnetoencephalography in epilepsy surgery

2008 ◽  
Vol 25 (3) ◽  
pp. E16 ◽  
Author(s):  
Zulma S. Tovar-Spinoza ◽  
Ayako Ochi ◽  
James T. Rutka ◽  
Cristina Go ◽  
Hiroshi Otsubo
Keyword(s):  
Mr Imaging ◽  
Epilepsy Surgery ◽  
Neuropsychological Testing ◽  
Source Image ◽  
Epileptogenic Zone ◽  
Anatomical Localization ◽  
Functional Mr Imaging ◽  
Eloquent Cortex ◽  
Magnetic Source Image ◽  
Functional Areas

Epilepsy surgery requires the precise localization of the epileptogenic zone and the anatomical localization of eloquent cortex so that these areas can be preserved during cortical resection. Magnetoencephalography (MEG) is a technique that maps interictal magnetic dipole sources onto MR imaging to produce a magnetic source image. Magneto-encephalographic spike sources can be used to localize the epileptogenic zone and be part of the workup of the patient for epilepsy surgery in conjunction with data derived from an analysis of seizure semiology, scalp video electroencephalography, PET, functional MR imaging, and neuropsychological testing. In addition, magnetoencephalographic spike sources can be linked to neuronavigation platforms for use in the neurosurgical field. Finally, paradigms have been developed so that MEG can be used to identify functional areas of the cerebral cortex including the somatosensory, motor, language, and visual evoked fields. The authors review the basic principles of MEG and the utility of MEG for presurgical planning as well as intra-operative mapping and discuss future applications of MEG technology.

scholarly journals Pre-surgical mapping of eloquent cortex for paediatric epilepsy surgery candidates: Evidence from a review of advanced functional neuroimaging

Seizure ◽  
2017 ◽  
Vol 52 ◽  
pp. 136-146 ◽  
Author(s):  
Sarah Collinge ◽  
Garreth Prendergast ◽  
Steven T. Mayers ◽  
David Marshall ◽  
Poppy Siddell ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Functional Neuroimaging ◽  
Eloquent Cortex ◽  
Paediatric Epilepsy

scholarly journals The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

2016 ◽  
Vol 40 (3) ◽  
pp. E16 ◽  
Author(s):  
Matthew F. Sacino ◽  
Cheng-Ying Ho ◽  
Jonathan Murnick ◽  
Robert F. Keating ◽  
William D. Gaillard ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Neurological Deficit ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Resection Group ◽  
Eloquent Cortex ◽  
Postoperative Seizure

OBJECTIVE Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale. RESULTS At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02). CONCLUSIONS These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.

scholarly journals Deep Learning provides exceptional accuracy to ECoG-based Functional Language Mapping for epilepsy surgery

2018 ◽  
Author(s):  
Harish RaviPrakash ◽  
Milena Korostenskaja ◽  
Eduardo M. Castillo ◽  
Ki H. Lee ◽  
Christine M. Salinas ◽  
...  
Keyword(s):  
Deep Learning ◽  
Epilepsy Surgery ◽  
Brain Regions ◽  
Language Mapping ◽  
Surgical Morbidity ◽  
Brain Surface ◽  
Alternative Approach ◽  
Increased Risk ◽  
Eloquent Cortex ◽  
Cortical Stimulation Mapping

AbstractThe success of surgical resection in epilepsy patients depends on preserving functionally critical brain regions, while removing pathological tissues. Being the gold standard, electro-cortical stimulation mapping (ESM) helps surgeons in localizing the function of eloquent cortex through electrical stimulation of electrodes placed directly on the cortical brain surface. Due to the potential hazards of ESM, including increased risk of provoked seizures, electrocorticography based functional mapping (ECOG-FM) was introduced as a safer alternative approach. However, ECoG-FM has a low success rate when compared to the ESM. In this study, we address this critical limitation by developing a new algorithm based on deep learning for ECoG-FM and thereby we achieve an accuracy comparable to ESM in identifying eloquent language cortex. In our experiments, with 11 epilepsy patients who underwent presurgical evaluation (through deep learning-based signal analysis on 637 electrodes), our proposed algorithm made an exceptional 23% improvement with respect to the conventional ECoG-FM analysis (∼60%). We obtained the state-of-the-art accuracy of 83.05% in identifying language regions, which has never been achieved before. Our findings have demonstrated, for the first time, that deep learning powered ECoG-FM can serve as a stand-alone modality and avoid likely hazards of the ESM in epilepsy surgery. Hence, reducing the potential for developing post-surgical morbidity in the language function.

Surgically treatable adult epilepsy: a changing patient population. Experience from a level 4 epilepsy center

2021 ◽  
pp. 1-6
Author(s):  
Jacob R. Lepard ◽  
Esther Dupépé ◽  
Matthew Davis ◽  
Jennifer DeWolfe ◽  
Bonita Agee ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Patient Population ◽  
Group Versus ◽  
Patient Characteristics ◽  
Seizure Freedom ◽  
Invasive Monitoring ◽  
Patient Demographics ◽  
Significant Difference ◽  
Before And After ◽  
Eloquent Cortex

OBJECTIVE Invasive monitoring has long been utilized in the evaluation of patients for epilepsy surgery, providing localizing information to guide resection. Stereoelectroencephalography (SEEG) was introduced at the authors’ level 4 epilepsy surgery program in 2013, with responsive neurostimulation (RNS) becoming available the following year. The authors sought to characterize patient demographics and epilepsy-related variables before and after SEEG introduction to understand whether differences emerged in their patient population. This information will be useful in understanding how SEEG, possibly in conjunction with RNS availability, may have changed practice patterns over time. METHODS This is a retrospective cohort study of consecutive patients who underwent surgery for epilepsy from 2006 to 2018, comprising 7 years before and 5 years after the introduction of SEEG. The authors performed univariate analyses of patient characteristics and outcomes and used generalized estimating equations logistic regression for predictive analysis. RESULTS A total of 178 patients were analyzed, with 109 patients in the pre-SEEG cohort and 69 patients in the post-SEEG cohort. In the post-SEEG cohort, more patients underwent invasive monitoring for suspected bilateral seizure onsets (40.6% vs 22.0%, p = 0.01) and extratemporal seizure onsets (68.1% vs 8.3%, p < 0.0001). The post-SEEG cohort had a higher proportion of patients with seizures arising from eloquent cortex (14.5% vs 0.9%, p < 0.001). Twelve patients underwent RNS insertion in the post-SEEG group versus none in the pre-SEEG group. Fewer patients underwent resection in the post-SEEG group (55.1% vs 96.3%, p < 0.0001), but there was no significant difference in rates of seizure freedom between cohorts for those patients having undergone a follow-up resection (53.1% vs 59.8%, p = 0.44). CONCLUSIONS These findings demonstrate that more patients with suspected bilateral, eloquent, or extratemporal epilepsy underwent invasive monitoring after adoption of SEEG. This shift occurred coincident with the adoption of RNS, both of which likely contributed to increased patient complexity. The authors conclude that their practice now considers invasive monitoring for patients who likely would not previously have been candidates for surgical investigation and subsequent intervention.

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