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.

scholarly journals Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume

2018 ◽  
Vol 44 (5) ◽  
pp. E9 ◽  
Author(s):  
Sumeet Vadera ◽  
Alvin Y. Chan ◽  
Lilit Mnatsankanyan ◽  
Mona Sazgar ◽  
Indranil Sen-Gupta ◽  
...  
Keyword(s):  
Access To Care ◽  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Surgical Care ◽  
Invasive Monitoring ◽  
Strategic Partnerships ◽  
Significant Difference ◽  
Before And After ◽  
The University ◽  
Improve Patient

OBJECTIVESurgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.METHODSThe authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.RESULTSOver the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.CONCLUSIONSPartnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.

scholarly journals Freedom From Seizures Might Be Key to Continuing Occupation After Epilepsy Surgery

2021 ◽  
Vol 12 ◽  
Author(s):  
Toshiki Nozaki ◽  
Ayataka Fujimoto ◽  
Tomohiro Yamazoe ◽  
Keiko Niimi ◽  
Shimpei Baba ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Employment Status ◽  
Secondary Outcome ◽  
Rank Test ◽  
Seizure Freedom ◽  
Adult Intelligence Scale ◽  
Neuropsychological Status ◽  
Significant Difference ◽  
Before And After ◽  
Level 2

Introduction: We hypothesized that epilepsy surgery for adult patients with temporal lobe epilepsy (TLE) who obtained freedom from seizures could provide opportunities for these patients to continue their occupation, and investigated continuity of occupation to test this postulation.Methods: Data were obtained from patients who had undergone resective surgery for medically intractable TLE between October 2009 and April 2019 in our hospital. Inclusion criteria were as follows: (1) ≥16 years old at surgery; (2) post-operative follow-up ≥12 months; (3) seizure-free period ≥12 months. As a primary outcome, we evaluated employment status before and after surgery, classified into three categories as follows: Level 0, no job; Level 1, students or homemakers (financially supported by a family member); and Level 2, working. Neuropsychological status was also evaluated as a secondary outcome.Results: Fifty-one (87.9%) of the 58 enrolled TLE patients who obtained freedom from seizures after surgery continued working as before or obtained a new job (employment status: Level 2). A significant difference in employment status was identified between before and after surgery (p = 0.007; Wilcoxon signed-rank test). Twenty-eight patients (48.3%) were evaluated for neuropsychological status both before and after surgery. Significant differences in Wechsler Adult Intelligence Scale-III scores were identified between before and after surgery (p &lt; 0.05 each; paired t-test).Conclusion: Seizure freedom could be a factor that facilitates job continuity, although additional data are needed to confirm that possibility. Further investigation of job continuity after epilepsy surgery warrants an international, multicenter study.

Magnetoencephalography-guided resection of epileptogenic foci in children

2014 ◽  
Vol 14 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Gregory W. Albert ◽  
George M. Ibrahim ◽  
Hiroshi Otsubo ◽  
Ayako Ochi ◽  
Cristina Y. Go ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Csf Leak ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Invasive Monitoring ◽  
Mri Findings ◽  
Resective Surgery ◽  
Depth Electrodes ◽  
Additional Surgery ◽  
Sick Children

Object Resective surgery is increasingly used in the management of pediatric epilepsy. Frequently, invasive monitoring with subdural electrodes is required to adequately map the epileptogenic focus. The risks of invasive monitoring include the need for 2 operations, infection, and CSF leak. The aim of this study was to evaluate the feasibility and outcomes of resective epilepsy surgery guided by magnetoencephalography (MEG) in children who would have otherwise been candidates for electrode implantation. Methods The authors reviewed the records of patients undergoing resective epilepsy surgery at the Hospital for Sick Children between 2001 and 2010. They identified cases in which resections were based on MEG data and no intracranial recordings were performed. Each patient's chart was reviewed for presentation, MRI findings, MEG findings, surgical procedure, pathology, and surgical outcome. Results Sixteen patients qualified for the study. All patients had localized spike clusters on MEG and most had abnormal findings on MRI. Resection was carried out in each case based on the MEG data linked to neuronavigation and supplemented with intraoperative neuromonitoring. Overall, 62.5% of patients were seizure free following surgery, and 20% of patients experienced an improvement in seizures without attaining seizure freedom. In 2 cases, additional surgery was performed subsequently with intracranial monitoring in attempts to obtain seizure control. Conclusions MEG is a viable alternative to invasive monitoring with intracranial electrodes for planning of resective surgery in carefully selected pediatric patients with localization-related epilepsy. Good candidates for this approach include patients who have a well-delineated, localized spike cluster on MEG that is concordant with findings of other preoperative evaluations and patients with prior brain pathologies that make the implantation of subdural and depth electrodes somewhat problematic.

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.

Multi-Modal Intervention for Inpatient Management of Sickle Cell Pain Significantly decreases the rate of Acute Chest Syndrome.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1428-1428
Author(s):  
Megan Reagan ◽  
Michael R. DeBaun ◽  
Melissa Frei-Jones
Keyword(s):  
Sickle Cell ◽  
Physician Behavior ◽  
Acute Chest Syndrome ◽  
Bolus Administration ◽  
Caregiver Education ◽  
Patient Demographics ◽  
Pain Medications ◽  
Significant Difference ◽  
Before And After ◽  
Inpatient Management

Abstract Painful vaso-occlusive episodes (VOE) account for the majority of hospitalizations and nearly all morbidity in children with sickle cell disease (SCD). Frequently, VOE progresses into acute chest syndrome (ACS), a leading cause of mortality in SCD. Few strategies exist to prevent this potentially fatal complication. We present the results of a multi-modal intervention to improve the inpatient management of SCD. We performed a before-and-after prospective multi-modal intervention. All children with SCD admitted for uncomplicated VOE during the two-year study period were eligible. The multi-modal intervention included standardized VOE admission orders, monthly house staff education, and one-on-one patient and caregiver education. ACS was defined as a new radiologic density on chest radiograph. A total of 332 admissions for uncomplicated VOE occurred during the study period; 159 before the intervention and 173 during the intervention. The ACS rate declined by 50% during the intervention period (25%, 39/159 to 12%, 21/173; p=0.003). No significant difference was found in patient demographics, amount of intravenous fluid administered, frequency of normal saline bolus administration, or cumulative opioid amount delivered in first 24-hours. Patient controlled analgesia (PCA) use was more common after the intervention (52%, 82/159 vs 73%, 126/173; p=0.0001) and fewer patients required changes in analgesic dosing within the first 24-hours after admission (26%, 42/159 vs 16%, 28/173; p=0.015). PCA-use protected against progression to ACS (OR 0.5; 95% CI 0.3–0.0.94) while patients needing escalation of pain medications in the first 24-hours were more likely to develop ACS (OR 2.5; 95% CI 1.3–4.6). A multi-modal intervention to change physician behavior successfully improved patient outcomes by reducing the ACS rate.

scholarly journals Long-term evaluation of physical activity habits after epilepsy surgery

2009 ◽  
Vol 15 (4) ◽  
pp. 147-151 ◽  
Author(s):  
Adriana Leite ◽  
Fulvio Alexandre Scorza ◽  
Marly de Albuquerque ◽  
Arthur Cukiert ◽  
Cristine Baldauf ◽  
...  
Keyword(s):  
Physical Activity ◽  
Epilepsy Surgery ◽  
Physical Activities ◽  
Seizure Freedom ◽  
Physically Active ◽  
Co Morbidity ◽  
Before And After ◽  
Study Population ◽  
Term Evaluation ◽  
Degree Of Participation

OBJETIVES: Studies have shown that people with epilepsy have a low degree of participation in physical activities. The purpose of this study was to assess the physical exercise habits in patients after epilepsy surgery using a standardized questionnaire. MMETHODOLOGY: The study population consisted of 102 patients submitted to cortico-amigdalo-hippocampectomy. A questionnaire was designed to assess physical activities participation before and after surgery. Patients were classified as physically active, inadequately active or sedentary. The questionnaire was applied pre-operatively and after a mean of 47 months post-operatively. RESULTS: Forty eight per cent of the patients participated in physical activities before surgery and 56% of them did so post-operatively. No considerable changes in physical activity participation were observed after surgery. Additionally, the frequency they needed supervision during exercise, were advised by a physician not to practice exercise or cautioned by a relative or friend against participation in sports did not change significantly after successful epilepsy surgery. Less exercise-related seizures occurred postoperatively. CONCLUSION: Difficulties adapting to seizure freedom and psychosocial and psychiatric co-morbidity might be important factors interfering in these physical activity habits. A multidisciplinary approach might be the only way to try to alter some aspects of these patients' postoperative life style.

scholarly journals Cognitive performance in distinct groups of children undergoing epilepsy surgery—a single-centre experience

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7790
Author(s):  
Barbora Benova ◽  
Anezka Belohlavkova ◽  
Petr Jezdik ◽  
Alena Jahodová ◽  
Martin Kudr ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Epilepsy Surgery ◽  
Cognitive Outcomes ◽  
Tertiary Centre ◽  
Large Patient ◽  
Significant Difference ◽  
Before And After ◽  
Individual Variables ◽  
One Year ◽  
Paediatric Epilepsy

Background We aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical). Methods We analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change. Results Epilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model. Discussion Post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.

Epilepsy surgery for Rasmussen encephalitis: the UCLA experience

2020 ◽  
Vol 26 (4) ◽  
pp. 389-397
Author(s):  
Nikhil Bellamkonda ◽  
H. Westley Phillips ◽  
Jia-Shu Chen ◽  
Alexander M. Tucker ◽  
Cassia Maniquis ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Outcome Data ◽  
Seizure Freedom ◽  
Rasmussen Encephalitis ◽  
Seizure Recurrence ◽  
Functional Hemispherectomy ◽  
Significant Difference ◽  
Seizure Relapse ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure

OBJECTIVERasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution.METHODSThe records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children’s Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed.RESULTSThe cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11–355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention.CONCLUSIONSA large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.

Comparing the Cost and Outcomes of Laparoscopic versus Open Appendectomy for Perforated Appendicitis in Children

2013 ◽  
Vol 79 (9) ◽  
pp. 861-864 ◽  
Author(s):  
Leslie B Groves ◽  
Mitchell R. Ladd ◽  
Jared R. Gallaher ◽  
John Swanson ◽  
Robert D. Becher ◽  
...  
Keyword(s):  
Medical Center ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Inclusion Criteria ◽  
Patient Demographics ◽  
Significant Difference ◽  
The Cost ◽  
Laparoscopic Versus Open Appendectomy

Although laparoscopic appendectomy (LA) is accepted treatment for perforated appendicitis (PA) in children, concerns remain whether it has equivalent outcomes with open appendectomy (OA) and increased cost. A retrospective review was conducted of patients younger than age 17 years treated for PA over a 12.5-year period at a tertiary medical center. Patient characteristics, pre-operative indices, and postoperative outcomes were analyzed for patients undergoing LA and OA. Of 289 patients meeting inclusion criteria, 86 had LA (29.8%) and 203 OA (70.2%), the two groups having equivalent patient demographics and preoperative indices. Inpatient costs were not significantly different between LA and OA. LA had a lower rate of wound infection (1.2 vs 8.9%, P = 0.017), total parenteral nutrition use (23.3 vs 50.7%, P < 0.0001), and length of stay (5.56 ± 2.38 days vs 7.25 ± 3.77 days, P = 0.0001). There was no significant difference in the rate of postoperative organ space abscess, surgical re-exploration, or rehospitalization. In children with PA, LA had fewer surgical site infections and shorter lengths of hospital stay compared with OA without an increase in inpatient costs.

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.

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