Invasive monitoring after resection of epileptogenic neocortical lesions in multistaged epilepsy surgery in children

Hidalgo, Eveline Teresa; Frankel, Hyman; Rodriguez, Crystalann; Orillac, Cordelia; Phillips, Sophie; Patel, Neelkumar; Devinsky, Orrin; Friedman, Daniel; Weiner, Howard L.

doi:10.1016/j.eplepsyres.2018.09.001

Cited by 10 publications

(12 citation statements)

References 22 publications

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“…Several previous studies that have attributed an epileptogenic potential to the perituberal region have been limited by (1) incomplete sampling, (2) interpretation of interictal data alone under anesthesia, and (3) nonvalidated measures of epileptogenicity . However, a recent pediatric study showed that tissue adjacent to the initial invasive EEG‐guided tuberectomy frequently had ongoing IEDs and seizure activity on immediate postresection invasive EEG …”

Section: Discussionmentioning

confidence: 99%

“…As such, 3‐T MRI is recommended over 1.5‐T for presurgical assessments. In addition, pathological studies of the perituberal cortex have revealed mammalian target of rapamycin (mTOR) pathway activation, increased axonal connectivity, and dysplastic cells . Finally, diffuse, extratuber abnormalities have been detected in humans with TSC and in epileptic TSC1 knockout mice that do not exhibit tubers .…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies utilizing intratuber depth recordings found that tubers were the predominant if not sole generator of seizures rather than surrounding cortex . Despite these findings, postresection intracranial epileptic activity is described adjacent to tuberectomy boundaries, approximately 40% of patients have ongoing seizures after tuberectomy, and resections extending beyond tuber margins appear to be associated with better outcomes at the group level . In a range of malformative pathologies, it is well established that the EZ can extend beyond visible lesions .…”

Section: Introductionmentioning

confidence: 99%

“…In the common setting of multiple tubers, several seizure types, and discordant noninvasive investigations, intracranial electroencephalography (EEG) is required to precisely identify the epileptogenic zone (EZ) and guide surgical resection. In patients requiring invasive EEG, postresection seizure freedom rates approach 50%‐70% . However, there is a paucity of literature examining invasive EEG in TSC and even less that has analyzed neurophysiological data .…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a paucity of literature examining invasive EEG in TSC and even less that has analyzed neurophysiological data . Subdural grid and strip studies, which occasionally incorporate depth electrodes, predominate in the literature, and there has been no dedicated analysis of stereo‐EEG (SEEG) data. As a result, the optimal invasive EEG approach is still not defined.…”

Section: Introductionmentioning

confidence: 99%

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Epileptogenicity in tuberous sclerosis complex: A stereoelectroencephalographic study

et al. 2019

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Objective:In tuberous sclerosis complex (TSC)-associated drug-resistant epilepsy, the optimal invasive electroencephalographic (EEG) and operative approach remains unclear. We examined the role of stereo-EEG in TSC and used stereo-EEG data to investigate tuber and surrounding cortex epileptogenicity. Methods: We analyzed 18 patients with TSC who underwent stereo-EEG (seven adults). One hundred ten seizures were analyzed with the epileptogenicity index (EI).In 13 patients with adequate tuber sampling, five anatomical regions of interest (ROIs) were defined: dominant tuber (tuber with highest median EI), perituber cortex, secondary tuber (tuber with second highest median EI), nearby cortex (normal-appearing cortex in the same lobe as dominant tuber), and distant cortex (in other lobes). At the seizure level, epileptogenicity of ROIs was examined by comparing the highest EI recorded within each anatomical region. At the patient level, epileptogenic zone (EZ) organization was separated into focal tuber (EZ confined to dominant tuber) and complex (all other patterns). Results: The most epileptogenic ROI was the dominant tuber, with higher EI than perituber cortex, secondary tuber, nearby cortex, and distant cortex (P < .001). A focal tuber EZ organization was identified in seven patients. This group had 80% Engel IA postsurgical outcome and distinct dominant tuber characteristics: continuous interictal discharges (IEDs; 100%), fluid-attenuated inversion recovery (FLAIR) hypointense center (86%), center-to-rim EI gradient, and stimulation-induced seizures (71%). In contrast, six patients had a complex EZ organization, characterized by nearby cortex as the most epileptogenic region and 40% Engel IA outcome.At the intratuber level, the combination of FLAIR hypointense center, continuous IEDs, and stimulation-induced seizures offered 98% specificity for a focal tuber EZ organization. Significance: Tubers with focal EZ organization have a striking similarity to type II focal cortical dysplasia. The presence of distinct EZ organizations has significant implications for EZ hypothesis generation, invasive EEG approach, and resection strategy. |

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epileptogenicity in tuberous sclerosis complex: A stereoelectroencephalographic study

et al. 2019

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The state of pediatric tuberous sclerosis complex epilepsy care: Results from a national survey

et al. 2022

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Objective: Epilepsy associated with tuberous sclerosis complex (TSC) can be challenging to treat and is associated with significant disease burden. Our objective was to better understand the state of epilepsy care of TSC amongst pediatric neurologists in Canada, identify gaps in care and determine whether access to a dedicated TSC clinic has an impact on epilepsy management. Methods: A survey was developed after a literature review and discussion amongst two pediatric epileptologists and one nurse practitioner with expertise in TSC about the state of epilepsy care of TSC patients in Canada. Canadian pediatric neurologists were asked to participate in sharing their experiences via an anonymous web-based survey through the Canadian League Against Epilepsy (CLAE) and the Canadian Neurological Sciences Federation (CNSF).Results: Fifty-seven responses were received. Access to a dedicated TSC clinic was reported by 25% (n = 14). Sixty percent (n = 34) reported performing serial EEG monitoring in infants with TSC and 57% (n = 33) started prophylactic antiseizure therapy when EEG abnormalities were detected, regardless of whether there was access to a TSC clinic (P = .06 and P = .29, respectively). While 52% (n = 29) did not feel comfortable prescribing mTORi for epilepsy, 65% (n = 36) indicated they would consider it with additional training. Epilepsy surgery was offered in 93% (n = 13) of centers with a dedicated TSC clinic but only 45% of centers without a TSC clinic (n = 19) (P = .002).Significance: Our findings demonstrate the variability in neurological care of pediatric patients with TSC as it pertains to epilepsy management. There is a need for the establishment of epilepsy practice guidelines and a national network to support clinical practice, research, and education.

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Epilepsy surgery in tuberous sclerosis complex (TSC): emerging techniques and redefinition of treatment goals

et al. 2020

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Invasive monitoring after resection of epileptogenic neocortical lesions in multistaged epilepsy surgery in children

Cited by 10 publications

References 22 publications

Epileptogenicity in tuberous sclerosis complex: A stereoelectroencephalographic study

Epileptogenicity in tuberous sclerosis complex: A stereoelectroencephalographic study

The state of pediatric tuberous sclerosis complex epilepsy care: Results from a national survey

Epilepsy surgery in tuberous sclerosis complex (TSC): emerging techniques and redefinition of treatment goals

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