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Annu Int Conf IEEE Eng Med Biol Soc 2021 11;2021:408-411

Children with medically refractory epilepsy (MRE) require resective neurosurgery to achieve seizure freedom, whose success depends on accurate delineation of the epileptogenic zone (EZ). Functional connectivity (FC) can assess the extent of epileptic brain networks since intracranial EEG (icEEG) studies have shown its link to the EZ and predictive value for surgical outcome in these patients. Here, we propose a new noninvasive method based on magnetoencephalography (MEG) and high-density (HD-EEG) data that estimates FC metrics at the source level through an "implantation" of virtual sensors (VSs). Read More

Clin Neurophysiol 2021 12 30;132(12):3197-3206. Epub 2021 Aug 30.

Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

Objective: To examine the individual-patient-level localization value of resting-state functional MRI (rsfMRI) metrics for the seizure onset zone (SOZ) defined by stereo-electroencephalography (SEEG) in patients with medically intractable focal epilepsies.

Methods: We retrospectively included 19 patients who underwent SEEG implantation for epilepsy presurgical evaluation. Voxel-wise whole-brain analysis was performed on 3. Read More

Front Neurol 2021 4;12:709400. Epub 2021 Aug 4.

Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States.

Multimodal image integration (MMII) is a promising tool to help delineate the epileptogenic zone (EZ) in patients with medically intractable focal epilepsies undergoing presurgical evaluation. We report here the detailed methodology of MMII and an overview of the utility of MMII at the Cleveland Clinic Epilepsy Center from 2014 to 2018, exemplified by illustrative cases. The image integration was performed using the Curry platform (Compumedics Neuroscan, Charlotte, NC, USA), including all available diagnostic modalities such as Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), single-photon emission computed tomography (SPECT) and Magnetoencephalography (MEG), with additional capability of trajectory planning for intracranial EEG (ICEEG), particularly stereo-EEG (SEEG), as well as surgical resection planning. Read More

Orv Hetil 2021 02 7;162(6):219-226. Epub 2021 Feb 7.

1 Országos Klinikai Idegtudományi Intézet, Neurológia Osztály, Epilepszia Centrum, Budapest, Amerikai út 57., 1145.

Összefoglaló. Bevezetés és célkitűzés: A terápiarezisztens fokális epilepsziák sebészeti kezelése elterjedten használt kezelési lehetőség. Célunk az epilepsziasebészet-hatékonyság változásának vizsgálata egy évtizednyi távlatból a budapesti centrumban. Read More

Epileptic Disord 2020 Oct;22(5):592-609

Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ, USA.

Hemispheric disconnection surgery (HDS) is one of the most effective surgical options for appropriate candidates with medically-refractory epilepsy (MRE) in whom most or all seizures arise from diffuse areas within a single hemisphere. While there are several well-accepted indications for HDS, there are additional patients who may benefit from HDS. However, there are no standardized recommendations for how preoperative studies should be used to identify appropriate candidates for HDS. Read More

Epilepsy Behav 2020 11 3;112:107398. Epub 2020 Sep 3.

Department of Neurosurgery, Epilepsy Center, Aviation General Hospital, China Medical University, Beijing, China; Beijing Institute of Translational Medicine of Chinese Academy of Sciences, Beijing, China. Electronic address:

Pediatric patients frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the epileptogenic zones (EZ). We intend to discuss the efficacy and safety of stereoelectroencephalophraphy (SEEG) monitoring in pediatric patients with difficulty to localize the EZ. We retrospectively analyzed presurgical findings, SEEG data, resections, and outcomes of a series of 72 consecutive pediatric patients (<18 yrs) who had medically refractory epilepsy and received SEEG recording between January 2015 and September 2019. Read More

Epilepsy Behav 2020 10 1;111:107259. Epub 2020 Jul 1.

Cellular and network Physiology Group, Neuroscience Research Center, Charité - Universitätsmedizin Berlin, Germany; Neuroscience Lab, Caucasus Medical Centre, Tbilisi, Georgia. Electronic address:

Surgery is the most effective therapeutic approach for medically refractory epilepsies and a safe and cost-efficient treatment in terms of long-term expenses of direct, indirect, and intangible costs. Georgia is a Caucasian low- to middle-income country with a remarkable effort to deal with epileptic diseases, but without an appropriate epilepsy surgery program. To address the needs for such a service in this country, two joint German-Georgian projects were initiated in 2017 and 2019. Read More

Epilepsy Behav 2020 09 22;110:107171. Epub 2020 Jun 22.

The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, Los Angeles, California, USA; Keck School of Medicine, University of Southern California, Department of Anesthesiology, USA; Keck School of Medicine, University of Southern California, Department of Psychiatry & Behavioral Sciences, USA. Electronic address:

Pediatric epilepsy is a prevalent childhood neurological disorder. Youth with a diagnosis of medically uncontrollable or intractable epilepsy are at increased risk for poor neurocognitive and psychosocial functioning. To date, there is a paucity of clinical research examining and/or characterizing the relations of neuropsychological, clinical, and epilepsy-specific medical factors in clinical outcomes among youth with diagnosed intractable epilepsy. Read More

Childs Nerv Syst 2020 12 9;36(12):3085-3093. Epub 2020 May 9.

Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.

Purpose: For selected children with medically intractable epilepsy, hemispherectomy can be an excellent treatment option and its efficacy in achieving seizure freedom or reduction in seizure frequency has been shown in several studies, but patients' selection could not be straightforward and often it is taken on subjective basis. We described a multimodal approach to assess patient eligible for hemispherectomy and possibly predicting post-surgical outcomes.

Methods: We describe pre- and post-surgical clinical features along with neuroradiological results by magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), MR-tractography (MRT), and neurophysiological study by single and paired pulses transcranial magnetic stimulation (TMS) in a child with cerebral palsy with epileptic encephalopathy, eligible for epilepsy surgery. Read More

World Neurosurg 2019 Dec 3;132:93-98. Epub 2019 Sep 3.

Comprehensive Epilepsy Program, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Background: Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex.

Case Description: We report a case of a 25-year-old woman with medically refractory epilepsy secondary to a focal cortical dysplasia in the motor cortex and extending deeply into the subcortical white matter. Read More

Epilepsy Behav 2019 08 22;97:130-134. Epub 2019 Jun 22.

Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.

Objectives: The aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy.

Methods: We conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Read More

J Clin Neurophysiol 2019 Sep;36(5):371-374

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.

Purpose: Magnetoencephalography (MEG) is a noninvasive tool used clinically for presurgical evaluation of patients with medically intractable epilepsy. These recordings require patients to lie still for prolonged periods of time in a magnetically shielded room. Children or uncooperative adults with epilepsy may require sedation to reduce movement artefact and obtain high-quality recordings. Read More

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 05 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