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Rev Neurol (Paris) 2019 Mar 25;175(3):163-182. Epub 2019 Jan 25.

Lyon's Neuroscience Research Center, Inserm U1028/CNRS UMR 5292, 69003 Lyon, France; Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, 69003 Lyon, France.

Medically treated patients suffering from tuberous sclerosis complex (TSC) have less than 30% chance of achieving a sustained remission. Both the international TSC consensus conference in 2012, and the panel of European experts in 2012 and 2018 have concluded that surgery should be considered for medically refractory TSC patients. However, surgery remains currently underutilized in TSC. Read More

J Magn Reson Imaging 2019 May 23;49(5):1333-1346. Epub 2018 Dec 23.

Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA.

Background: Conventional MRI can be limited in detecting subtle epileptic lesions or identifying active/epileptic lesions among widespread, multifocal lesions.

Purpose: We developed a high-resolution 3D MR fingerprinting (MRF) protocol to simultaneously provide quantitative T , T , proton density, and tissue fraction maps for detection and characterization of epileptic lesions.

Study Type: Prospective. Read More

Seizure 2018 Apr 6;57:56-62. Epub 2018 Mar 6.

Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.

Purpose: The incidence of epilepsy in older adults is growing, as does the incidence of comorbidities. Therefore, when it comes to epilepsy surgery in medically intractable epilepsy, age is often seen as a limiting factor. To investigate the outcome after epilepsy surgery in a population of older adults, we compared the benefit for patients aged 50-59 years with those aged 60 years and older in respect of efficacy and safety. Read More

Brain Sci 2018 Mar 21;8(4). Epub 2018 Mar 21.

Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.

Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. Read More

J Neurosurg Pediatr 2018 04 2;21(4):421-427. Epub 2018 Feb 2.

Departments of1Neurosurgery and.

The responsive neurostimulation (RNS) system, an adjunctive treatment for pharmacoresistant partial-onset seizures with 1 or 2 foci, has been available to patients aged 18 years or older since the device's FDA approval in 2013. Herein, the authors describe their off-label application of this technology in 2 pediatric patients and the consequent therapeutic benefit without surgical complications or treatment side effects. A 14-year-old nonambulatory, nonverbal male with severe developmental delay was considered for RNS therapy for medically and surgically refractory epilepsy with bilateral seizure onsets in the setting of a normal radiological examination and a known neuropathological diagnosis of type I cortical dysplasia. Read More

Front Neurol 2017 30;8:14. Epub 2017 Jan 30.

Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA.

Up to one-third of patients with epilepsy are medically intractable and need resective surgery. To be successful, epilepsy surgery requires a comprehensive preoperative evaluation to define the epileptogenic zone (EZ), the brain area that should be resected to achieve seizure freedom. Due to lack of tools and methods that measure the EZ directly, this area is defined indirectly based on concordant data from a multitude of presurgical non-invasive tests and intracranial recordings. Read More

Brain 2017 02 23;140(2):319-332. Epub 2016 Dec 23.

Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK

SEE EISSA AND SCHEVON DOI101093/AWW332 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Surgery can be a last resort for patients with intractable, medically refractory epilepsy. For many of these patients, however, there is substantial risk that the surgery will be ineffective. The prediction of who is likely to benefit from a surgical approach is crucial for being able to inform patients better, conduct principled prospective clinical trials, and ultimately tailor therapeutic approaches to these patients more effectively. Read More

Oper Neurosurg (Hagerstown) 2016 03 25;12(1):39-48. Epub 2015 Sep 25.

Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.

Background: Surgery is indicated for cerebral cavernous malformations (CCM) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. Read More

J Clin Neurophysiol 2016 Dec;33(6):503-510

*Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; †Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, Marseille, France; ‡INSERM UMR 1106, INS, Marseille, France; and §Faculté de Médecine, Aix Marseille Université, Marseille, France.

Intracranial EEG has been in use for more than 50 years in the presurgical evaluation of patients with medically intractable focal epilepsy. The stereoelectroencephalography (SEEG) method has expanded very significantly over the last 5 years, in parallel with the increase in the number of complex cases (i.e. Read More

Epilepsy Res 2016 12 4;128:149-157. Epub 2016 Nov 4.

School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China. Electronic address:

Localization of the epileptogenic zone (EZ) is essential for the successful surgical treatment of medically intractable epilepsy. In the present study, stereo-EEG (SEEG) recordings were obtained from seven patients underwent presurgical evaluation for treatment of intractable epilepsy. Partial directed coherence (PDC) analysis was applied to construct peri-ictal effective connectivity networks. Read More

Epilepsy Res 2016 12 24;128:73-82. Epub 2016 Oct 24.

Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon 1 University, Lyon 69500, France; Lyon Neuroscience Research Centre (CRNL), INSERM U1028/CNRS UMR5292, Lyon, France. Electronic address:

Objective: In this study we investigated the electrical characteristics of seizures recorded by stereo-EEG (SEEG) in a cohort of patients with bitemporal lobe epilepsy (BTLE), in the attempt to verify the presence/absence of different seizure patterns and to identify good surgical candidates.

Methods: We retrospectively reviewed 14 consecutive patients with medically refractory BTLE confirmed by scalp video-EEG (VEEG) recording of bitemporal independent or non-lateralizing seizure onset. All patients had a comprehensive evaluation including history and neurologic examination, MRI, scalp VEEG and SEEG monitoring. Read More

J Neurosurg Pediatr 2016 Nov 29;18(5):523-535. Epub 2016 Jul 29.

Pediatric Neurosurgery, Miami (Nicklaus) Children's Hospital, Miami, Florida.

OBJECTIVE Seizure onset in the insular cortex as a cause of refractory epilepsy is underrepresented in the pediatric population, possibly due to difficulties localizing seizure onset in deep anatomical structures and limited surgical access to the insula, a complex anatomical structure with a rich overlying vascular network. Insular seizure semiology may mimic frontal, temporal, or parietal lobe semiology, resulting in false localization, incomplete resection, and poor outcome. METHODS The authors retrospectively reviewed the records of all pediatric patients who underwent insular cortical resections for intractable epilepsy at Miami Children's Hospital from 2009 to 2015. Read More

Epilepsy Res 2016 11 16;127:291-301. Epub 2016 Aug 16.

Department of Neurology, Samsung Medical Center, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Samsung Biomedical Research Institute, Seoul, Republic of Korea. Electronic address:

Background: We conducted the study to examine accuracy of the magnetoencephalography (MEG) spike source localization in presurgical evaluation of patients with medically refractory focal epilepsy.

Methods: Ten consecutive patients with refractory focal epilepsy who were candidates for two-stage surgery with long-term intracranial electroencephalography (ICEEG) monitoring were enrolled. Interictal MEG recordings with simultaneous scalp EEG were obtained within 7days before the ICEEG electrode implantation. Read More

Pediatr Neurol 2016 11 5;64:21-31. Epub 2016 Jul 5.

Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.

First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Read More

Radiology 2016 10 28;281(1):264-9. Epub 2016 Jul 28.

From the Athinoula A. Martinos Center for Biomedical Imaging, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., D.N.G., S.M.S.); and Departments of Neurology (C.L.L.) and Radiology (B.R.B., S.M.S.), Massachusetts General Hospital, Boston, Mass.

Purpose To measure the accuracy of resting-state functional magnetic resonance (MR) imaging in determining hemispheric language dominance in patients with medically intractable focal epilepsies against the results of an intracarotid amobarbital procedure (IAP). Materials and Methods This study was approved by the institutional review board, and all subjects gave signed informed consent. Data in 23 patients with medically intractable focal epilepsy were retrospectively analyzed. Read More

Epilepsia 2016 08 11;57(8):1236-44. Epub 2016 Jun 11.

Nuclear Medicine Department, Hospital Clinic, Barcelona, Spain.

Objective: Neuroimaging is crucial in the presurgical evaluation of patients with medically refractory epilepsy. To improve the moderate sensitivity of [(18) F]fluorodeoxyglucose-positron emission tomography ((18) F-FDG-PET), our aim was to evaluate the usefulness of statistical parametric mapping (SPM) to localize the seizure-onset zone (SOZ) in PET studies deemed normal by visual assessment.

Methods: Fifty-five patients with medically refractory epilepsy whose (18) F-FDG-PET was visually evaluated as normal were retrospectively included. Read More

Can J Neurol Sci 2015 Nov 6;42(6):360-71. Epub 2015 Oct 6.

3Division of Neurology,Department of Pediatrics,Hospital for Sick Children and University of Toronto,Toronto,Ontario.

The role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. Read More

Pediatr Neurol 2015 Sep 9;53(3):207-10. Epub 2015 Jun 9.

Divisions of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, Rochester, Minnesota. Electronic address:

Rationale: One challenge for families whose children are undergoing presurgical evaluation for epilepsy surgery is the unpredictable length of hospitalization for video-electroencephalograph monitoring. The goal of this study was to retrospectively evaluate length of stay in children admitted for presurgical evaluation at a tertiary referral center.

Methods: Duration of stay for children with medically intractable epilepsy admitted for presurgical evaluation to the Pediatric Epilepsy Monitoring Unit at Mayo Clinic Rochester between 2010 and 2013 was evaluated retrospectively. Read More

Pediatr Neurol 2015 Jul 30;53(1):58-64. Epub 2015 Mar 30.

Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address:

Objective: The aim of this study was to identify preadmission variables that are prognostic of epilepsy surgical candidacy for children admitted into an epilepsy-monitoring unit.

Methods: This study is a retrospective review of patients 0-18 years who were admitted into the pediatric epilepsy-monitoring unit at Mayo Clinic between November 2010 and December 2013 to assess for surgery candidacy for medically intractable epilepsy. Demographic data, epilepsy details, treatments, electroencephalograph and imaging results, and the consensus notes of the epilepsy surgery conferences were collected. Read More

Epilepsy Behav 2015 Jun 16;47:115-9. Epub 2015 May 16.

Department of Neurology, Gazi University Faculty of Medicine, 06830 Ankara, Turkey.

Resective epilepsy surgery has been accepted as an effective treatment for patients with medically intractable temporal lobe epilepsy (TLE) to control the seizures and to limit cognitive dysfunction. Complete resection of the epileptic zone, and therefore the success of the surgery, depends on the identification of the seizure focus. Reliable lateralizing semiologic signs, together with other presurgical assessments, are of great importance for an accurate identification of the seizure focus. Read More

J Neurosurg Pediatr 2015 Jul 24;16(1):94-100. Epub 2015 Apr 24.

Departments of 1 Neurosurgery.

OBJECT Resection can sometimes offer the best chance of meaningful seizure reduction in children with medically intractable epilepsy. However, when surgery fails to achieve the desired outcome, reoperation may be an option. The authors sought to investigate outcomes following resective reoperation in pediatric patients with refractory epilepsy, excluding tumoral epilepsies. Read More

Brain Dev 2015 Oct 7;37(9):916-8. Epub 2015 Apr 7.

Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Rationale: Medication resistant temporal lobe epilepsy occurs in a small population of patients with fragile X syndrome. We present the case of a 24-year-old man with medically refractory temporal lobe epilepsy and fragile X syndrome who underwent left anterior temporal lobectomy resulting in cessation of seizures.

Methods: Our patient was diagnosed with fragile X syndrome with a fully mutated, fully methylated FMR1 gene resulting in 572 CGG repeats. Read More

J Neurosurg Sci 2017 Jun 10;61(3):277-282. Epub 2015 Feb 10.

Medical Imaging Research Center, Department of Radiology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran.

Methods: Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Read More

Turk Neurosurg 2015 ;25(1):53-7

Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey.

Aim: Surgery is a treatment option for medically intractable epilepsy patients. Abnormalities in regional cerebral glucose metabolism, as identified by 18-fluorodeoxyglucose positron emission tomography (FDG-PET) have predictive prognostic value in evaluating the outcome of epilepsy surgery. This study investigated the efficacy of FDG-PET for delineation of the epileptogenic zone (EZ) by comparing its consistency with other diagnostic tools and surgical outcome. Read More

Front Biosci (Elite Ed) 2015 Jan 1;7:42-57. Epub 2015 Jan 1.

Epilepsy Surgery Program, International Center for Neurological Restoration (CIREN), Ave 25 # 15805 % 158 and 160, Playa 11300, Havana Cuba.

Identification and localization of epileptogenic zone (EZ) is vital in patients with medically-intractable focal epilepsy, who may be candidates for potentially curative resective epilepsy surgery. Presence of a lesion on magnetic resonance imaging (MRI) influences both diagnostic classification and selection for surgery. However, the implications for MRI-negative cases are not well-defined for such patients. Read More

Acta Neuropathol 2014 Jul 12;128(1):5-19. Epub 2014 Jun 12.

Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA,

Focal cortical dysplasias (FCDs) are increasingly recognized as one of the most common causes of pharmaco-resistant epilepsies. FCDs were recently divided into various clinico-pathological subtypes due to distinct imaging, electrophysiological, and outcome characteristics. In this review, we will overview the international consensus classification of FCDs in light of more recently reported clinical, electrical, imaging and functional observations, and will also address areas of ongoing debate. Read More

Ann Indian Acad Neurol 2014 Mar;17(Suppl 1):S65-8

Department of Neurosurgery, Dayanand Medical College, Ludhaina, Punjab, India.

The association between neurocysticercosis (NCC) and epilepsy is well known and NCC is an important risk factor for epileptic seizures in many Taenia solium-endemic regions of the world. However, while the relationship between NCC and epilepsy is well known, the association between NCC and medically refractory (or surgically remediable epilepsy) has received little attention in the past. Our experience and review of the sparse literature available suggests that NCC is causally related to surgically remediable epilepsy albeit uncommonly so and that association derives its underpinnings from several different scenarios: (1) Medically refractory lesional epilepsy, in which seizures arise from the vicinity of the calcified neurocysticercus lesion (CNL), (2) Medically refractory epilepsy with dual pathology type of relationship between the hippocampal sclerosis (HS) and CNL in which both have been unequivocally demonstrated to give rise to independent seizures and (3) Mesial temporal lobe epilepsy due to HS with a distantly-located CNL, which is in itself not epileptogenic. Read More

J Clin Neurosci 2014 Aug 24;21(8):1441-5. Epub 2014 Jan 24.

Epilepsy Center, Desk S60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address:

Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. Read More

Zh Vopr Neirokhir Im N N Burdenko 2013 ;77(6):14-21

Magnetoencephalography (MEG) in combination with structural MRI (magnetic source imaging, MSI) plays an increasingly important role as one of the tools for presurgical evaluation of medically intractable focal epilepsy. The aim of the study was to compare the MSI and commonly used video EEG monitoring method (vEEG) in their sensitivity to interictal epileptic discharges (IED) in 22 patients with drug resistant epilepsy. Furthermore, the detection and localization results obtained by both methods were verified using the data of electrocorticography (ECoG) and postsurgical outcome in 13 patients who underwent invasive EEG monitoring and surgery. Read More

Epilepsy Behav 2013 Nov 5;29(2):285-8. Epub 2013 Sep 5.

Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA. Electronic address:

Purpose: We present our experience with corpus callosotomy (CC) in a developing country with limited resources in patients with Lennox-Gastaut syndrome (LGS) and medically refractory seizures.

Methods: All patients with LGS who underwent CC for medically refractory epilepsy at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through March 2012 were reviewed in a retrospective study. Presurgical evaluation included clinical history, neurological examination, a 2-hour video-EEG recording, and 1. Read More

J Nucl Med 2013 Aug 15;54(8):1270-7. Epub 2013 Jul 15.

Departments of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Royal Parade, Parkville, Victoria, Australia.

Unlabelled: Studies report that (11)C-flumazenil (FMZ) PET more specifically localizes the epileptogenic zone in patients with medically refractory focal epilepsy than (18)F-FDG PET. However, practical aspects of (11)C use limit clinical application. We report a phase I/IIa study assessing the clinical use of (18)F-FMZ PET for the localization of the epileptogenic zone in patients with drug-resistant temporal lobe epilepsy (TLE). Read More

Neurosurg Focus 2013 Jun;34(6):E9

Department of Neurosurgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.

Object: During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete "clusterectomy" (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes. Read More

J Med Assoc Thai 2013 Jan;96(1):121-31

Division of Neurosurgery, Department of Surgery, Faculty ofMedicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: A significant number of epileptic patients suffer from medically refractory epilepsy. Epilepsy surgery is considered an appropriate option for management in such cases.

Objective: The surgery endeavors to eradicate disabling seizures with preservation of important neurologic function and improve long-term quality of life. Read More

Epilepsia 2013 Feb 2;54(2):341-50. Epub 2012 Oct 2.

Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.

Purpose: Interictal positron emission tomography (PET) and ictal subtraction single photon emission computed tomography (SPECT) of the brain have been shown to be valuable tests in the presurgical evaluation of epilepsy. To determine the relative utility of these methods in the localization of seizure foci, we compared interictal PET and ictal subtraction SPECT to subdural and depth electrode recordings in patients with medically intractable epilepsy.

Methods: Between 2003 and 2009, clinical information on all patients at our institution undergoing intracranial electroencephalography (EEG) monitoring was charted in a prospectively recorded database. Read More

Am J Clin Pathol 2012 Oct;138(4):506-10

Departments of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.

Invasive electroencephalography (EEG) monitoring is often needed for presurgical evaluation in patients with medically intractable epilepsy (MIE). This study retrospectively reviews the pathologic changes associated with EEG monitoring. Two hundred twenty-six patients who underwent invasive monitoring (53. Read More

J Epilepsy Res 2012 Mar 30;2(1):16-20. Epub 2012 Mar 30.

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder. Epileptic seizure is the most common neurological symptom. Medically intractable epilepsy in these patients is candidates of epilepsy surgery. Read More

Epilepsy Res 2012 May 16;99(3):214-24. Epub 2011 Dec 16.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Purpose: Magnetoencephalography (MEG) has been shown a useful diagnostic tool for presurgical evaluation of pediatric medically intractable partial epilepsy as MEG source localization has been shown to improve the likelihood of seizure onset zone (SOZ) sampling during subsequent evaluation with intracranial EEG (ICEEG). We investigated whether ictal MEG onset source localization further improves results of interictal MEG in defining the SOZ.

Methods: We identified 20 pediatric patients with one habitual seizure during MEG recordings between October 2007 and April 2011. Read More

Panminerva Med 2011 Dec;53(4):227-40

Department of Neurosurgery, Reference Center for Refractory Epilepsy, Ghent University Hospital, Belgium.

Invasive monitoring with intracranial electrodes continues to play a critical role in the presurgical evaluation of patients with medically intractable epilepsy. Intracranial monitoring helps in localizing the epileptogenic zone and can be used to delineate eloquent cortical areas adjacent to this zone. In this review we analyzed surgical successes and failures of invasive video-electroencephalography (EEG) monitoring. Read More

Rev Neurol 2010 Mar;50 Suppl 3:S49-57

Hospital Infantil Universitario Niño Jesús, Madrid, España.

Introduction: Neuropsychological assessment is included in the protocols for evaluation of epilepsy surgery candidates, providing information about the patient's cognitive dysfunctions, allowing for prediction of possible cognitive deficits derived from surgery and yielding objective measures of any post-surgical changes. Neuropsychological disturbances constitute an important co-morbidity of medically intractable epilepsy. An early epilepsy onset in infancy may lead to cognitive dysfunctions that are atypical in terms of brain localization, due to the inherent plasticity and reorganization processes of the immature brain. Read More

Hong Kong Med J 2010 Feb;16(1):44-7

Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.

Magnetoencephalography is a newly developed technology used for diagnostic and brain mapping imaging during the presurgical evaluation of patients with medically intractable epilepsy. It provides comprehensive localisation of an epileptogenic focus using simultaneous recordings from the entire brain surface. Magnetoencephalography and electroencephalography are considered complementary and confirmatory to one another. Read More

Epilepsia 2010 Apr 8;51(4):564-72. Epub 2009 Oct 8.

Department of Biomedical Engineering, University of Minnesota, 312 Church Street, Minneapolis, MN 55455, USA.

Purpose: Determination of the origin of extratemporal neocortical onset seizures is often challenging due to the rapid speed at which they propagate throughout the cortex. Typically, these patients are poor surgical candidates and many times experience recurrences of seizure activity following resection of the assumed seizure focus.

Methods: We applied a causal measurement technique--the directed transfer function (DTF)--in an effort to determine the cortical location responsible for the propagation of the seizure activity. Read More

J Korean Neurosurg Soc 2009 Jun 30;45(6):329-35. Epub 2009 Jun 30.

Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.

Objective: Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. Read More

J Clin Neurophysiol 2009 Aug;26(4):290-3

Center for Advanced Brain Magnetic Source Imaging (CABMSI), Departments of Neurology & Neurosurgery, The University of Pittsburgh, Pittsburgh, PA, USA.

Epilepsy Res 2009 Aug 24;85(2-3):279-86. Epub 2009 Apr 24.

Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA.

The purpose of this study is to assess the clinical value of spatiotemporal source analysis for analyzing ictal magnetoencephalography (MEG). Ictal MEG and simultaneous scalp EEG was recorded in five patients with medically intractable frontal lobe epilepsy. Dynamic statistical parametric maps (dSPMs) were calculated at the peak of early ictal spikes for the purpose of estimating the spatiotemporal cortical source distribution. Read More

Epileptic Disord 2009 Mar;11(1):75-9

Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.

[Case records of Epileptic Disorders. Anatomo-electro clinical correlations. Case 01-2009]. Read More

Childs Nerv Syst 2009 Jul 28;25(7):875-80. Epub 2009 Feb 28.

Department of Neurology, Psychiatry and Psychology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Purpose: In the present study, we evaluated the preoperative demographic, clinical, and neuropsychological variables that could predict postoperative seizure outcome in a group of pediatric epileptic patients.

Materials And Methods: We studied 40 consecutive pediatric patients, ages ranging from 6 to 16 years, that underwent resective surgery for the treatment of medically intractable epilepsy at the Clinical Hospital of Ribeirão Preto School of Medicine. We performed ictal electroencephalography (EEG), interictal EEG, magnetic resonance imaging (MRI), and a preoperative neuropsychological assessment in the presurgical workup. Read More

Neuroimage 2009 Jan 24;44(2):399-410. Epub 2008 Sep 24.

Max Planck Institute for Human Cognitive and Brain Science, Leipzig, Germany.

The major goal of the evaluation in presurgical epilepsy diagnosis for medically intractable patients is the precise reconstruction of the epileptogenic foci, preferably with non-invasive methods. This paper evaluates whether surface electroencephalography (EEG) source analysis based on a 1 mm anisotropic finite element (FE) head model can provide additional guidance for presurgical epilepsy diagnosis and whether it is practically feasible in daily routine. A 1 mm hexahedra FE volume conductor model of the patient's head with special focus on accurately modeling the compartments skull, cerebrospinal fluid (CSF) and the anisotropic conducting brain tissues was constructed using non-linearly co-registered T1-, T2- and diffusion-tensor-magnetic resonance imaging data. Read More

Semin Neurol 2008 Jul 24;28(3):355-63. Epub 2008 Jul 24.

Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA.

Epilepsy surgery treatment should be considered as standard of care for all patients with medically intractable partial-onset epilepsy who are found to be good surgical candidates based on their presurgical evaluation. Delaying surgical treatment continues to be a problem among neurologists. The early recognition of pharmacoresistance and patients' referral for presurgical evaluation can shorten the time to identify potential surgical candidates. Read More

Neurosurg Focus 2008 Sep;25(3):E2

Division of Neurology, Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.

It is important to correctly diagnose medically intractable epilepsy in children and to identify those children whose medically refractory, localization-related seizures may be surgically remediable as soon as possible to optimize the surgical outcome. In this paper the authors review the definition of medically intractable seizures and discuss the various causes and risk factors for this disorder in children. They also outline the presurgical diagnostic evaluation process for pharmacologically intractable epilepsy in children who may be candidates for surgical treatment of localization-related seizures. Read More

Epilepsia 2008 Aug 6;49(8):1340-7. Epub 2008 Mar 6.

The National Centre for Young People with Epilepsy, Lingfield, United Kingdom.

Background: The presurgical evaluation of children with intractable epilepsy includes evaluation by an experienced clinician, MRI, video EEG, and functional imaging techniques to localize seizure onset. However, the contributions of each investigation to surgical decision making has not been systematically assessed.

Method: Data used for decision on eligibility for surgery on 353 children was discussed at a presurgical multidisciplinary meeting and systematically recorded. Read More