Recent developments in the surgical management of paediatric epilepsy

Ravindra, Vijay M.; Sweney, Matthew; Bollo, Robert J.

doi:10.1136/archdischild-2016-311183

Cited by 23 publications

(25 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately 1% of the population is affected with epilepsy, and surgical management is recommended in medication-resistant cases to minimize the risks of neurocognitive dysfunction and premature death (Kwan, Schachter, & Brodie, 2011). This 1% includes children, who may be at increased risk of long-term cognitive and behavioral deficits due to the early age of onset compared to adults—and, so, for whom surgical management is believed to be under-utilized (Ravindra, Sweney, & Bollo, 2017). Though collecting the data is not without logistical challenges (Chiong, et al, 2017), it is important to note that ECoG/sEEG data may be obtained during performance of experimental tasks and free of seizure activity between episodes; and the traces recorded from non-pathologic sites likely represent healthy tissue (Rossini, et al, 2017).…”

Section: Innovative Methods: What Should We Aim For?mentioning

confidence: 99%

Memory and the developing brain: From description to explanation with innovation in methods

Ofen

Tang

et al. 2019

Developmental Cognitive Neuroscience

View full text Add to dashboard Cite

Recent advances in human cognitive neuroscience show great promise in extending our understanding of the neural basis of memory development. We briefly review the current state of knowledge, highlighting that most work has focused on describing the neural correlates of memory in cross-sectional studies. We then delineate three examples of the application of innovative methods in addressing questions that go beyond description, towards a mechanistic understanding of memory development. First, structural brain imaging and the harmonization of measurements across laboratories may uncover ways in which the maturation of the brain constrains the development of specific aspects of memory. Second, longitudinal designs and sophisticated modeling of the data may identify age-driven changes and the factors that determine individual developmental trajectories. Third, recording memory-related activity directly from the developing brain presents an unprecedented opportunity to examine how distinct brain structures support memory in real time. Finally, the growing prevalence of data sharing offers additional means to tackle questions that demand large-scale datasets, ambitious designs, and access to rare samples. We propose that the use of such innovative methods will move our understanding of memory development from a focus on describing trends to explaining the causal factors that shape behavior.

show abstract

Section: Innovative Methods: What Should We Aim For?mentioning

confidence: 99%

Memory and the developing brain: From description to explanation with innovation in methods

Ofen

Tang

et al. 2019

Developmental Cognitive Neuroscience

View full text Add to dashboard Cite

show abstract

“…Early evidence supports the safety and efficacy of these procedures. 2,6,7,9,16,18,30,31 However, there are currently no data describing outcomes of cases in which the two techniques have been used in concert. We hoped to demonstrate clinical scenarios that call for this method and explore its potential benefits and pitfalls.…”

mentioning

confidence: 99%

Early outcomes of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy: a paradigm for minimally invasive epilepsy surgery

Cobourn¹,

Fayed²,

Keating³

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEStereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures individually, reports are almost nonexistent on their use in conjunction. The authors’ aim was to report early outcomes regarding efficacy and safety of sEEG followed by MRgLITT for localization and ablation of seizure foci in the pediatric population with medically refractory lesional epilepsy.METHODSA single-center retrospective review of pediatric patients who underwent sEEG followed by MRgLITT procedures was performed. Demographic, intraoperative, and outcome data were compiled and analyzed.RESULTSFour pediatric patients with 9 total lesions underwent sEEG followed by MRgLITT procedures between January and September 2017. The mean age at surgery was 10.75 (range 2–21) years. Two patients had tuberous sclerosis and 2 had focal cortical dysplasia. Methods of stereotaxy consisted of BrainLab VarioGuide and ROSA robotic guidance, with successful localization of seizure foci in all cases. The sEEG procedure length averaged 153 (range 67–235) minutes, with a mean of 6 (range 4–8) electrodes and 56 (range 18–84) contacts per patient. The MRgLITT procedure length averaged 223 (range 179–252) minutes. The mean duration of monitoring was 6 (range 4–8) days, and the mean total hospital stay was 8 (range 5–11) days. Over a mean follow-up duration of 9.3 (range 5.1–16) months, 3 patients were seizure free (Engel class I, 75%), and 1 patient saw significant improvement in seizure frequency (Engel class II, 25%). There were no complications.CONCLUSIONSThese early data demonstrate that sEEG followed by MRgLITT can be used safely and effectively to localize and ablate epileptogenic foci in a minimally invasive paradigm for treatment of medically refractory lesional epilepsy in pediatric populations. Continued collection of data with extended follow-up is needed.

show abstract

“…Surgical resection of medically refractory epilepsy has been shown to have long-term seizure control rates in the 50%–70% range, but of the 100,000–500,000 patients who are candidates for surgical resection, less than 1% receive an operation. 25 , 26 While the reasons for this treatment gap are complex, part of the issue stems from the invasiveness and risk of complications associated with the current gold standard of craniotomy followed by resection. Laser ablation for certain epileptogenic lesions, particularly those near deep or eloquent brain structures, offers a compelling alternative.…”

Section: Pediatricsmentioning

confidence: 99%

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Shukla¹,

Ho²,

Pendharkar³

et al. 2017

NDT

View full text Add to dashboard Cite

Medically intractable epilepsy is associated with increased morbidity and mortality. For those with focal epilepsy and correlated electrophysiological or radiographic features, open surgical resection can achieve high rates of seizure control, but can be associated with neurologic deficits and cognitive effects. Recent innovations have allowed for more minimally invasive methods of surgical seizure control such as magnetic resonance-guided laser interstitial therapy (MRgLITT). MRgLITT achieves the goal of ablating seizure foci while preserving neuropsycho-logical function and offering real-time feedback and monitoring of tissue ablation. This review summarizes the utilization of MRgLITT for mesial temporal lobe epilepsy and other seizure disorders. Overall, the efficacy of MRgLITT is comparable to that of open surgery and offers a less invasive approach in patients with significantly less morbidity.

show abstract

Recent developments in the surgical management of paediatric epilepsy

Cited by 23 publications

References 60 publications

Memory and the developing brain: From description to explanation with innovation in methods

Memory and the developing brain: From description to explanation with innovation in methods

Early outcomes of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy: a paradigm for minimally invasive epilepsy surgery

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Contact Info

Product

Resources

About