Publications by authors named "William O Tatum"

132 Publications

Brain structural differences in temporal lobe and frontal lobe epilepsy patients: A voxel-based morphometry and vertex-based surface analysis.

Neuroradiol J 2021 Jul 27:19714009211034839. Epub 2021 Jul 27.

Department of Radiology, 6915Mayo Clinic, Mayo Clinic, USA.

Purpose: Exploration of the effect of chronic recurrent seizures in focal epilepsy on brain volumes has produced many conflicting reports. To determine differences in brain structure in temporal lobe epilepsy (TLE) and extratemporal epilepsy (using frontal lobe epilepsy (FLE) a surrogate) further, we performed a retrospective analysis of a large cohort of patients with seizure-onset zone proven by intracranial monitoring.

Methods: A total of 120 TLE patients, 86 FLE patients, and 54 healthy controls were enrolled in this study. An analysis of variance of voxel-based morphometry (VBM) was used to seek morphometric brain differences among TLE patients, FLE patients, and healthy controls. Additionally, a vertex-based surface analysis was utilized to analyze the hippocampus and thalamus. Significant side-specific differences in hippocampal gray matter volume were present between the left TLE (LTLE), right TLE RTLE (RTLE), and control groups (<0.05, family-wise error (FWE) corrected).

Results: Vertex analyses revealed significant volume reduction in inferior parts of the left hippocampus in the LTLE group and lateral parts of the right hippocampus in the RTLE group compared to controls (<0.05, FWE corrected). Significant differences were also detected between the LTLE and control group in the bilateral medial and inferior thalamus (<0.05, FWE corrected). FLE patients did not exhibit focal atrophy of gray matter across the brain.

Conclusion: Our results highlight the variation in morphometric lateralized changes in the brain between different epilepsy onset zones, providing critical insight into the natural history of people with drug-resistant focal epilepsies.
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http://dx.doi.org/10.1177/19714009211034839DOI Listing
July 2021

When should we obtain a routine EEG while managing people with epilepsy?

Epilepsy Behav Rep 2021 3;16:100454. Epub 2021 May 3.

Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.

More than eight decades after its discovery, routine electroencephalogram (EEG) remains a safe, noninvasive, inexpensive, bedside test of neurological function. Knowing when a routine EEG should be obtained while managing people with epilepsy is a critical aspect of optimal care. Despite advances in neuroimaging techniques that aid diagnosis of structural lesions in the central nervous system, EEG continues to provide critical diagnostic evidence with implications on treatment. A routine EEG performed after a first unprovoked seizure can support a clinical diagnosis of epilepsy and differentiate those without epilepsy, classify an epilepsy syndrome to impart prognosis, and characterize seizures for antiseizure management. Despite a current viral pandemic, EEG services continue, and the value of routine EEG is unchanged.
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http://dx.doi.org/10.1016/j.ebr.2021.100454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141667PMC
May 2021

Brain-responsive neurostimulation in adult-onset rasmussen's encephalitis.

Epilepsy Behav Rep 2021 29;15:100445. Epub 2021 Mar 29.

Mayo Clinic Florida, Jacksonville, FL, United States.

Epilepsy associated with Rasmussen's encephalitis (RE) is highly resistant to standard therapy and continues to present a therapeutic challenge. While epilepsy surgery remains the most effective management for patients with drug-resistant focal epilepsy and RE, hemispherotomy may debilitating consequences on adult patients. Here we present the outcome of a 32-year-old woman with adult-onset Rasmussen's, who was treated with brain-responsive neurostimulation (RNS) after failure of several immunotherapeutic and anti-seizure medications.
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http://dx.doi.org/10.1016/j.ebr.2021.100445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063734PMC
March 2021

Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array.

Oper Neurosurg (Hagerstown) 2021 Jul;21(2):E147-E152

Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.

Background And Importance: Data supporting the use of electrocorticography (ECoG) monitoring during electrical stimulation in awake craniotomies for resection of supratentorial neoplasms is robust, but its applicability during active resection is often limited by the inability to keep the array in place. Given the known survival benefit of gross total resection in glioma surgery, novel approaches to surgical monitoring are warranted to maximize safe resection and optimize surgical outcomes in patients with glioblastoma.

Clinical Presentation: A 68-yr-old right-handed woman presented to the emergency department with confusion. Imaging studies revealed a bifrontal intra-axial brain lesion. She underwent a left-sided awake craniotomy procedure with cortical and subcortical mapping. During surgical resection, multiple electrographic seizures were detected on continuous ECoG monitoring with a customized 22-channel high-density hollow circular array. She remained without clinical evidence of seizures at 3 mo after surgery.

Conclusion: We report a unique case of serial electrographic seizures detected during continuous intraoperative ECoG monitoring during active surgical resection of a glioblastoma using a novel circular hollow array during an awake craniotomy. The use of continuous ECoG monitoring during active resection may provide additional data, with potential influence in outcomes for patients undergoing resection of high-grade glial neoplasms.
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http://dx.doi.org/10.1093/ons/opab110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279837PMC
July 2021

Analysis of intraoperative human brain tissue transcriptome reveals putative risk genes and altered molecular pathways in glioma-related seizures.

Epilepsy Res 2021 Jul 18;173:106618. Epub 2021 Mar 18.

Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA. Electronic address:

Background: The pathogenesis of glioma-related seizures (GRS) is poorly understood. Here in, we aim to identify putative molecular pathways that lead to the development of GRS.

Methods: We determined brain transcriptome from intraoperative human brain tissue of patients with either GRS, glioma without seizures (non-GRS), or with idiopathic temporal lobe epilepsy (iTLE). We performed transcriptome-wide comparisons between disease groups tissue from non-epileptic controls (non-EC) to identify differentially-expressed genes (DEG). We compared DEGs to identify those that are specific or common to the groups. Through a gene ontology analysis, we identified molecular pathways enriched for genes with a Log-fold change ≥1.5 or ≤-1.5 and p-value <0.05 compared to non-EC.

Results: We identified 110 DEGs that are associated with GRS vs. non-GRS: 80 genes showed high and 30 low expression in GRS. There was significant overexpression of genes involved in cell-to-cell and glutamatergic signaling (CELF4, SLC17A7, and CAMK2A) and down-regulation of genes involved immune-trafficking (CXCL8, H19, and VEGFA). In the iTLE vs GRS analysis, there were 1098 DEGs: 786 genes were overexpressed and 312 genes were underexpressed in the GRS samples. There was significant enrichment for genes considered markers of oncogenesis (GSC, MYBL2, and TOP2A). Further, there was down-regulation of genes involved in the glutamatergic neurotransmission (vesicular glutamate transporter-2) in the GRS vs. iTLE samples.

Conclusions: We identified a number of altered processes such as cell-to-cell signaling and interaction, inflammation-related, and glutamatergic neurotransmission in the pathogenesis of GRS. Our findings offer a new landscape of targets to further study in the fields of brain tumors and seizures.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106618DOI Listing
July 2021

Automated seizure detection using wearable devices: A clinical practice guideline of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology.

Clin Neurophysiol 2021 May 5;132(5):1173-1184. Epub 2021 Mar 5.

Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.

The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy, on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found moderate level of evidence for seizure types without GTCs or FBTCs. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.
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http://dx.doi.org/10.1016/j.clinph.2020.12.009DOI Listing
May 2021

Automated seizure detection using wearable devices: A clinical practice guideline of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology.

Epilepsia 2021 Mar;62(3):632-646

Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.

The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend the use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found a moderate level of evidence for seizure types without GTCS or FBTCS. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.
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http://dx.doi.org/10.1111/epi.16818DOI Listing
March 2021

Ambulatory EEG Usefulness in Epilepsy Management.

J Clin Neurophysiol 2021 Mar;38(2):101-111

Department of Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A.

Summary: Long-term video-EEG monitoring has been the gold standard for diagnosis of epileptic and nonepileptic events. Medication changes, safety, and a lack of recording EEG in one's habitual environment may interfere with diagnostic representation and subsequently affect management. Some spells defy standard EEG because of ultradian and circadian times of occurrence, manifest nocturnal expression of epileptiform activity, and require classification for clarifying diagnostic input to identify optimal treatment. Some patients may be unaware of seizures, have frequent events, or subclinical seizures that require quantification before optimal management. The influence on antiseizure drug management and clinical drug research can be enlightened by long-term outpatient ambulatory EEG monitoring. With recent governmental shifts to focus on mobile health, ambulatory EEG monitoring has grown beyond diagnostic capabilities to target the dynamic effects of medical and nonmedical treatment for patients with epilepsy in their natural environment. Furthermore, newer applications in ambulatory monitoring include additional physiologic parameters (e.g., sleep, detection of myogenic signals, etc.) and extend treatment relevance to patients beyond seizure reduction alone addressing comorbid conditions. It is with this focus in mind that we direct our discussion on the present and future aspects of using ambulatory EEG monitoring in the treatment of patients with epilepsy.
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http://dx.doi.org/10.1097/WNP.0000000000000601DOI Listing
March 2021

Utility of Ambulatory Surface Electroencephalography.

J Clin Neurophysiol 2021 03;38(2):75-76

Mayo Clinic, Jacksonville, Florida, U.S.A.

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http://dx.doi.org/10.1097/WNP.0000000000000747DOI Listing
March 2021

Television-induced electronegative photoparoxysmal response: an extratemporal seizure mimic?

Epileptic Disord 2021 Feb;23(1):161-166

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

Video-EEG monitoring is an established gold-standard procedure for diagnosis and differentiation of epileptic and non-epileptic seizures. Epilepsy misdiagnosis, to which factors such as EEG artifact misinterpretation contribute to, is common, and can have long-lasting iatrogenic repercussions to the clinical management of affected patients. Among the many types of responses to photic stimulation, artifacts and physiologic and epileptic responses are possible. All of these can interfere with EEG interpretation when provoked by a source of illumination. Photic-induced responses are of increasing relevance given the ubiquity of screens and other light-emitting electronics in our modern world. One of these, the photoparoxysmal response, is a frequent finding in photosensitive patients with genetic generalized epilepsies. Various responses beyond abnormal occurrence of cortical spikes or spike-and-wave discharges are known to occur on EEG in response to intermittent photic stimulation (IPS), with different clinical implications. To our knowledge, we report a unique electronegative photoparoxysmal response during video-EEG monitoring induced by fluctuating illumination caused by a distant television screen. This response mimicked an extratemporal seizure in a young woman with frontal lobe epilepsy, admitted for presurgical evaluation. Novel electronegative responses to electronic devices during video-EEG monitoring merit consideration by EEG interpreters to help avoid misdiagnosis.
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http://dx.doi.org/10.1684/epd.2021.1239DOI Listing
February 2021

Crying with depressed affect induced by electrical stimulation of the anterior insula: A stereo EEG case study.

Epilepsy Behav Rep 2021 31;15:100421. Epub 2020 Dec 31.

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

Stereo-EEG (sEEG) is an invasive recording technique used to localize the seizure-onset zone for epilepsy surgery in people with drug-resistant focal seizures. Pathological crying reflects disordered emotional expression and the anterior insula is known to play a role in empathy and socio-emotional processing. We describe a patient where electrical stimulation mapping (ESM) of the anterior insula during sEEG generated pathological crying and profound sadness that was time-locked to the electrical stimulus. We evaluated a 35-year-old left-handed female for repeat epilepsy surgery. The patient had drug resistant focal impaired awareness seizures despite a previous left temporal neocortical resection informed by an invasive study using subdural grid and strip electrodes seven years earlier. She was studied invasively with 10 sEEG electrodes sampling temporal, occipital, and insular targets. In the process of functional mapping, stimulation of the anterior insular cortex provoked tearful crying with sad affect, reproducible upon repeat stimulation. Our case is unique in demonstrating transitory pathological crying with profound sadness provoked by ESM of the left anterior insula. Furthermore we demonstrate repeated time-synched crying from electrical stimulation, which supports the hypothesis that the anterior insula in the brain plays an important role in the biology of emotion, as implicated by previous studies.
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http://dx.doi.org/10.1016/j.ebr.2020.100421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817500PMC
December 2020

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study.

Eur J Neurol 2021 May 11;28(5):1453-1462. Epub 2021 Feb 11.

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Background And Purpose: The aim of this study was to evaluate the quality of smartphone videos (SVs) of neurologic events in adult epilepsy outpatients. The use of home video recording in patients with neurological disease states is increasing. Experts interpretation of outpatient smartphone videos of seizures and neurological events has demonstrated similar diagnostic accuracy to inpatient video-electroencephalography (EEG) monitoring.

Methods: A prospective, multicenter cohort study was conducted to evaluate SV quality in patients with paroxysmal neurologic events from August 15, 2015 through August 31, 2018. Epileptic seizures (ESs), psychogenic nonepileptic attacks (PNEAs), and physiologic nonepileptic events (PhysNEEs) were confirmed by video-EEG monitoring. Experts and senior neurology residents blindly viewed cloud-based SVs without clinical information. Quality ratings with regard to technical and operator-driven metrics were provided in responses to a survey.

Results: Forty-four patients (31 women, age 45.1 years [r = 20-82]) were included and 530 SVs were viewed by a mean of seven experts and six residents; one video per patient was reviewed for a mean of 133.8 s (r = 9-543). In all, 30 patients had PNEAs, 11 had ESs, and three had PhysNEEs. Quality was suitable in 70.8% of SVs (375/530 total views), with 36/44 (81.8%) patient SVs rated as adequate by the majority of reviewers. Accuracy improved with the presence of convulsive features from 72.4% to 98.2% in ESs and from 71.1% to 95.7% in PNEAs. An accurate diagnosis was given by all reviewers (100%) in 11/44 SVs (all PNEAs). Audio was rated as good by 86.2% of reviewers for these SVs compared with 75.4% for the remaining SVs (p = 0.01). Lighting was better in SVs associated with high accuracy (p = 0.06), but clarity was not (p = 0.59). Poor video quality yielded unknown diagnoses in 24.2% of the SVs reviewed. Features hindering diagnosis were limited interactivity, restricted field of view and short video duration.

Conclusions: Smartphone video quality is adequate for clinical interpretation in the majority of patients with paroxysmal neurologic events. Quality can be optimized by encouraging interactivity with the patient, adequate duration of the SV, and enlarged field of view during videography. Quality limitations were primarily operational though accuracy remained for SV review of ESs and PNEAs.
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http://dx.doi.org/10.1111/ene.14744DOI Listing
May 2021

Smartphones in Epilepsy: The New Age of Aquarius.

Mayo Clin Proc 2021 01;96(1):29-31

Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia.

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http://dx.doi.org/10.1016/j.mayocp.2020.09.035DOI Listing
January 2021

Injection of prophylactic lorazepam versus antiseizure drugs on the localization value of ictal SPECT studies and treatment-emergent adverse events: A single-center prospective study.

Epilepsy Behav 2021 02 13;115:107500. Epub 2020 Dec 13.

Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. Electronic address:

Objective: We aimed to examine the impact of resumption of home antiseizure drugs alone (ASD-) compared with adjunct administration of scheduled intravenous (IV) lorazepam 2 mg every 6 h (ASD+) following ictal single-photon emission computed tomography (SPECT) injection on the localization value of SPECT studies and treatment-emergent adverse events (TEAEs).

Methods: We conducted a prospective study at Mayo Clinic inpatient epilepsy monitoring unit (EMU) between January 2018 and May 2020 in Jacksonville, Florida. The ASD- and ASD+ groups were compared for concordance of SPECT studies with the epilepsy surgical conference (ESC) consensus or intracranial electroencephalography (icEEG) findings as reference. Treatment-emergent adverse events, obtained from surveys at 24 h and one week postictal SPECT injection, were also compared between both groups.

Results: Twenty-two consecutive patients with temporal (eight patients, 36%) and extratemporal (14 patients, 64%) epilepsy were included: 12 ASD+ and 10 ASD-. The two groups were well matched with regard to clinical and ictal SPECT injection characteristics including the occurrence of seizure between ictal and interictal SPECT injections. The localization value of SPECT studies was similar in the two groups. Patients in the ASD+ group reported higher rates of dizziness and excessive sedation at 24 h (p-value = 0.008). Fourteen patients (64%) underwent icEEG monitoring. For the entire cohort, the localization concordance of SPECT analysis by statistical parametric mapping (SPM) was superior to raw ictal SPECT (p-value = 0.003) and subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM; p-value = 0.021). Eventually, seven patients (31.8%) underwent resective brain surgery of whom four (57.1%) became seizure-free (median follow-up = 22 months).

Conclusions: Our findings suggest that resuming home ASDs without the addition of scheduled IV lorazepam following inpatient ictal SPECT injection is equally efficacious for seizure onset zone (SOZ) localization on SPECT studies, especially SPM. This approach is also associated with fewer transient TEAEs and lower financial cost with no difference in preventing seizure between ictal and interictal SPECT injections.
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http://dx.doi.org/10.1016/j.yebeh.2020.107500DOI Listing
February 2021

True abdominal epilepsy is clonic jerking of the abdominal musculature.

Epileptic Disord 2020 Oct;22(5):582-591

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

Abdominal epilepsy (AE) has long been reported as a rare phenomenon in children with various episodic gastrointestinal sensory and painful symptoms suspected to be due to epileptic seizures. Originally, AE was diagnosed when abdominal sensory or painful symptoms were associated with pain, temporal lobe origin, an epileptiform or paroxysmal EEG pattern, and a clinical response to antiseizure medication. AE has also been associated with non-epileptic etiologies such as migraine. Reports of abdominal epilepsy based on an abnormal EEG or clinical response to antiseizure medication without diagnosis confirmation by video-EEG are at best speculative, and at worst, misdiagnoses. We describe three adult patients with focal aware motor seizures manifesting as recurrent, isolated prolonged painless rhythmic clonic jerking of the abdominal musculature including epilepsia partialis continua. All patients had a contralateral structural lesion on high-resolution brain MRI in the abdominal region of the motor homunculus. Standard EEG was unrevealing and only after extra EEG electrodes and video-EEG monitoring was the ictal origin confirmed. Historically, AE has been described as a disorder involving subjective sensory symptoms including vague abdominal pain, instead of epileptic motor signs of abdominal clonic jerking. We recommend replacing the use of vague terms such as AE with International League Against Epilepsy terminology along with diagnostic confirmation validated by video-EEG monitoring. [Published with video sequence].
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http://dx.doi.org/10.1684/epd.2020.1196DOI Listing
October 2020

Teaching NeuroImages: Texting rhythm: A common EEG finding in the era of smartphone use.

Neurology 2020 12 4;95(24):e3454-e3455. Epub 2020 Sep 4.

From the Department of Neurology (B.H.), University of Rochester Medical Center, NY; and Department of Neurology (W.O.T.), Mayo Clinic, Jacksonville, FL.

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http://dx.doi.org/10.1212/WNL.0000000000010757DOI Listing
December 2020

Comment on: RTTBD-like activity in association with hippocampal ictal discharges in patients with temporal lobe epilepsy by Sun et al.

Epileptic Disord 2020 08;22(4):473-475

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

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http://dx.doi.org/10.1684/epd.2020.1178DOI Listing
August 2020

Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery.

J Neurooncol 2020 Jul 10;148(3):587-598. Epub 2020 Jun 10.

Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.

Introduction: 20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery?

Methods: Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants.

Results: 0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (- 4.3, - 8.7, respectively, P = 0.03).

Conclusion: We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.
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http://dx.doi.org/10.1007/s11060-020-03554-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968692PMC
July 2020

Brain-responsive neurostimulation treatment in patients with GAD65 antibody-associated autoimmune mesial temporal lobe epilepsy.

Epilepsia Open 2020 Jun 14;5(2):307-313. Epub 2020 Apr 14.

Department of Neurology University of North Carolina at Chapel Hill Chapel Hill North Carolina.

Glutamic acid decarboxylase 65-kilodalton isoform (GAD65) antibodies have been associated with multiple nonneurological and neurological syndromes including autoimmune epilepsy (AE). Although immunotherapy remains the cornerstone for the treatment of AE, those with GAD65 Ab-associated AE (GAD65-AE) remain refractory to immunotherapy and antiseizure medication (ASM). Outcomes of epilepsy surgery in this patient population have also been unsatisfactory. The role of neuromodulation therapy, particularly direct brain-responsive neurostimulation therapy, has not been previously examined in GAD65-AE. Here, we describe four consecutive patients with refractory GAD-65-associated temporal lobe epilepsy (GAD65-TLE) receiving bilateral hippocampal RNS System treatment. The RNS System treatment was well tolerated and effective in this study cohort. Three patients had a >50% clinical seizure reduction, and one patient became clinically seizure-free following resective surgery informed by the RNS System data with continued RNS System treatment. In all four of our patients, the long-term ambulatory data provided by the RNS System allowed us to gain objective insights on electrographic seizure lateralization, patterns, and burden as well as guided immunotherapy and ASM optimization. Our results suggest the potential utility of the RNS System in the management of ASM intractable GAD65-AE.
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http://dx.doi.org/10.1002/epi4.12395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278537PMC
June 2020

Epileptiform discharges: Are we still defining them?

Neurology 2020 05 22;94(20):862-863. Epub 2020 Apr 22.

From the Department of Neurology (W.O.T.), Mayo Clinic, Jacksonville, FL; and Department of Pediatrics (R.A.S.), University of Michigan, Ann Arbor, MI.

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http://dx.doi.org/10.1212/WNL.0000000000009432DOI Listing
May 2020

Variability Between Direct and Indirect Targeting of the Anterior Nucleus of the Thalamus.

World Neurosurg 2020 07 14;139:e70-e77. Epub 2020 Apr 14.

Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address:

Background: Preoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. We aimed to address variability noted between traditional indirect targeting and direct targeting methods for the anterior nucleus of the thalamus (ANT).

Methods: Fifteen consecutive patients undergoing ANT deep brain stimulator placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed using a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were calculated for each patient, and degree of thalamic volume loss was assessed compared with matched control subjects. Vertex analysis was performed to assess shape changes in the thalamus compared with age- and sex-matched subjects.

Results: There was significant variation between direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both P = 0.02). On the right, the direct target was located at y = 2.9 ± 1.8 mm and z = 9.2 ± 2 mm (both P ≤ 0.0003). There was no significant difference in the x-coordinate on either side (P > 0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in the y-axis and the z-axis.

Conclusions: We showed a significant difference in direct and indirect targeting in the y-axis and z-axis when targeting the ANT for deep brain stimulation for epilepsy. This difference is correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy.
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http://dx.doi.org/10.1016/j.wneu.2020.03.107DOI Listing
July 2020

Wada testing and fMRI in a polyglot evaluated for epilepsy surgery.

Epileptic Disord 2020 Apr;22(2):207-213

Department of Neurology.

Despite advancements in the neurophysiology of language and presurgical evaluation for epilepsy surgery, there is a paucity of information in the literature regarding presurgical evaluation of multilingual patients. We present a case of a 52-year-old right-handed woman with refractory epilepsy who was fluent in six languages and underwent subsequent trilingual presurgical evaluation which included neuropsychological testing, Wada testing, functional magnetic resonance imaging (fMRI), and electrocortical stimulation. These studies suggested a seizure focus in the left temporal lobe and language localization that was predominantly right-hemispheric; she subsequently underwent left temporal laser interstitial thermal therapy without clinical disturbance in language function while remaining seizure-free. A multidisciplinary effort was integral in providing an optimal outcome for this patient.
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http://dx.doi.org/10.1684/epd.2020.1145DOI Listing
April 2020

Class IV studies, meta-analyses, meta-syntheses-Scope and limitations.

Seizure 2020 Feb 29;76:179-180. Epub 2020 Feb 29.

Mayo Clinic College of Medicine & Health Sciences, Mayo Clinic, Jacksonville, FL, USA.

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http://dx.doi.org/10.1016/j.seizure.2020.02.016DOI Listing
February 2020

Detection of after-discharges during intraoperative functional brain mapping in awake brain tumor surgery using a novel high-density circular grid.

Clin Neurophysiol 2020 04 30;131(4):828-835. Epub 2020 Jan 30.

Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA. Electronic address:

Objective: To evaluate intraoperative use of a novel high-density circular grid in detecting after-discharges (AD) on electrocorticography (ECoG) during functional brain mapping (FBM).

Methods: FBM during glioma surgery (10/2016 to 5/2019) recorded ADs using a 22-channel circular grid compared to conventional strip electrodes. ADs were analyzed for detection, duration, amplitude, morphology, histology, direction, and clinical signs.

Results: Thirty-two patients (mean age 54.2 years; r = 30-75) with glioma (WHO grade II-IV; 20 grade IV) had surgery. ADs during FBM were more likely in patients with wild-type as opposed to IDH-1 mutants (p < 0.0001) using more contacts compared with linear strip electrodes (p = 0.0001). More sensors tended to be involved in ADs detected by the circular grid vs strips (6.61 vs 3.43; p = 0.16) at lower stimulus intensity (3.14 mA vs 4.13 mA; p = 0.09). No difference in the number of cortical stimulations before resection was present (38.9 mA vs 47.9 mA; p = 0.26). ADs longer than 10 seconds were 32.5 seconds (circular grid) vs 58.4 (strips) (p = 0.12).

Conclusions: High-density circular grids detect ADs in 360 degrees during FBM for glioma resection. Provocation of ADs was more likely in patients with wild-type than IDH-1 mutation.

Significance: Circular grids offer high-resolution ECoG during intraoperative FBM for detection of ADs.
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http://dx.doi.org/10.1016/j.clinph.2019.12.416DOI Listing
April 2020

Functional Activation Patterns of Deep Brain Stimulation of the Anterior Nucleus of the Thalamus.

World Neurosurg 2020 Apr 27;136:357-363.e2. Epub 2020 Jan 27.

Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.

Background: Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a recently approved therapy for patients with drug-resistant epilepsy. To date, there is a poor understanding of the mechanism of action and lack of in vivo biomarkers. We propose a method for investigating the in vivo stimulation effects using blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI) and present the brain activation pattern associated with ANT DBS.

Methods: Two patients undergoing ANT DBS for epilepsy underwent BOLD MRI using a block design after the DBS was programmed to alternate ON/OFF in 30-second blocks. The scanner was triggered using surface electrophysiologic recordings to detect the DBS cycle. Nine total runs were obtained and were analyzed using a general linear model.

Results: Active ANT stimulation produced activation within several areas of the brain, including the thalamus, bilateral anterior cingulate and posterior cingulate cortex, precuneus, medial prefrontal cortex, amygdala, ventral tegmental area, hippocampus, striatum, and right angular gyrus.

Conclusions: Using block-design BOLD MRI, we were able to show widespread activation resulting from ANT DBS. Overlap with multiple areas of both the default mode and limbic networks was shown, suggesting that these nodes may modulate the effect of seizure control with ANT DBS.
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http://dx.doi.org/10.1016/j.wneu.2020.01.108DOI Listing
April 2020

Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures.

JAMA Neurol 2020 05;77(5):593-600

Department of Neurology, Mayo Clinic, Rochester, Minnesota.

Importance: Misdiagnosis of epilepsy is common. Video electroencephalogram provides a definitive diagnosis but is impractical for many patients referred for evaluation of epilepsy.

Objective: To evaluate the accuracy of outpatient smartphone videos in epilepsy.

Design, Setting, And Participants: This prospective, masked, diagnostic accuracy study (the OSmartViE study) took place between August 31, 2015, and August 31, 2018, at 8 academic epilepsy centers in the United States and included a convenience sample of 44 nonconsecutive outpatients who volunteered a smartphone video during evaluation and subsequently underwent video electroencephalogram monitoring. Three epileptologists uploaded videos for physicians from the 8 epilepsy centers to review.

Main Outcomes And Measures: Measures of performance (accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) for smartphone video-based diagnosis by experts and trainees (the index test) were compared with those for history and physical examination and video electroencephalogram monitoring (the reference standard).

Results: Forty-four eligible epilepsy clinic outpatients (31 women [70.5%]; mean [range] age, 45.1 [20-82] years) submitted smartphone videos (530 total physician reviews). Final video electroencephalogram diagnoses included 11 epileptic seizures, 30 psychogenic nonepileptic attacks, and 3 physiologic nonepileptic events. Expert interpretation of a smartphone video was accurate in predicting a video electroencephalogram monitoring diagnosis of epileptic seizures 89.1% (95% CI, 84.2%-92.9%) of the time, with a specificity of 93.3% (95% CI, 88.3%-96.6%). Resident responses were less accurate for all metrics involving epileptic seizures and psychogenic nonepileptic attacks, despite greater confidence. Motor signs during events increased accuracy. One-fourth of the smartphone videos were correctly diagnosed by 100% of the reviewing physicians, composed solely of psychogenic attacks. When histories and physical examination results were combined with smartphone videos, correct diagnoses rose from 78.6% to 95.2%. The odds of receiving a correct diagnosis were 5.45 times greater using smartphone video alongside patient history and physical examination results than with history and physical examination alone (95% CI, 1.01-54.3; P = .02).

Conclusions And Relevance: Outpatient smartphone video review by experts has predictive and additive value for diagnosing epileptic seizures. Smartphone videos may reliably aid psychogenic nonepileptic attacks diagnosis for some people.
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http://dx.doi.org/10.1001/jamaneurol.2019.4785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990754PMC
May 2020

Knitting induced fronto-central theta rhythm.

Epilepsy Behav Rep 2019 31;12:100335. Epub 2019 Oct 31.

Department of Neurology, Mayo Clinic, Jacksonville, FL, United States of America.

Fronto-central theta rhythms on EEG have been associated with cognitive tasks requiring attention and concentration, such as mental arithmetic or geometric construction. With the advent of video monitoring, there have been reports of new, task-specific, fronto-central theta rhythms reported with active texting or playing videogames on mobile phones. Concentration or attention combined with manual dexterous acts is challenging to simulate in an artificial and non-spontaneous environment, such as an epilepsy monitoring unit. We report a case of a fronto-central theta rhythm during active knitting using a needle and yarn with only passive concentration to highlight involvement of a corticomotor component underlying the neural networks involved in the efferent expression of scalp EEG to differentiate it from similar rhythms.
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http://dx.doi.org/10.1016/j.ebr.2019.100335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854057PMC
October 2019

Video Game-Induced Theta Rhythm.

J Clin Neurophysiol 2019 Sep;36(5):389-391

Department of Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A.

Smartphones and other personal electronic devices present novel cortical processing tasks with potential for identification of novel EEG waveforms. A 17-year-old patient with epilepsy manifested as recurrent myoclonic seizures, absence seizures, and a single generalized tonic-clonic seizure was hospitalized to undergo video-EEG monitoring for seizure quantification and classification of the epilepsy syndrome. During the monitoring session, a frontocentral predominant 5 to 6 Hz theta rhythm was identified only when the patient was actively texting or playing a video game on his smartphone. Previously, patients with focal epilepsy have been found to have a frontocentral theta rhythm on EEG while texting on mobile devices. We report similar EEG findings in a patient with genetic generalized epilepsy during smartphone gaming to expand the population and triggers for this theta waveform. Given the young age and type of epilepsy, we suggest that the waveform represents the EEG manifestation of the attention-visuomotor pathway that is stimulus independent.
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http://dx.doi.org/10.1097/WNP.0000000000000575DOI Listing
September 2019

Laser thermal ablation in epilepsy.

Expert Rev Neurother 2019 12 6;19(12):1211-1218. Epub 2019 Aug 6.

Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.

:Many different types of surgical procedures are available for patients with drug-resistant epilepsy. MRI-guided laser interstitial thermal therapy is a stereotactic procedure with the potential to provide excellent seizure outcomes, while minimizing surgical approach related complications.:This review will cover the role of MRgLITT in the treatment of multiple facets of epilepsy including temporal lobe epilepsy, nodular heterotopias, hypothalamic hamartomas, as well as corpus Callosotomy.:The development of magnetic resonance thermography has advanced continuous monitoring of thermal tissue destruction of pathological tissue in near real-time to allow for individualized neurological care for a person with epilepsy. Overall the results of MRgLITT appear similar to larger open forms of epilepsy surgery though with the promise of a safer side-effect profile. To improve this technique we must develop intraoperative biomarkers of procedural success, and develop tools to improve our patient selection.
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http://dx.doi.org/10.1080/14737175.2019.1650642DOI Listing
December 2019

Epilepsy & Behavior Reports.

Authors:
William O Tatum

Epilepsy Behav Rep 2019 29;12:100322. Epub 2019 May 29.

Mayo Clinic College of Medicine and Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America.

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http://dx.doi.org/10.1016/j.ebr.2019.100322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657534PMC
May 2019
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