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Epileptic Foci (epileptic + focus)
Selected AbstractsElectrical Stimulation of the Hippocampal Epileptic Foci for Seizure Control: A Double-Blind, Long-Term Follow-Up StudyEPILEPSIA, Issue 10 2007Ana Luisa Velasco Summary:,Purpose: Our aim was to evaluate the safety and efficacy of electrical stimulation of the hippocampus in a long-term follow-up study, as well as its impact on memory performance in the treatment of patients with refractory mesial temporal lobe epilepsy. Methods: Nine patients were included. All had refractory partial complex seizures, some with secondary generalizations. All patients had a 3-month-baseline-seizure count, after which they underwent bilateral hippocampal diagnostic electrode implantation to establish focus laterality and location. Three patients had bilateral, and six, unilateral foci. Diagnostic electrodes were explanted and definitive Medtronic electrodes were implanted directed into the hippocampal foci. Position was confirmed with MRI and afterwards, the deep brain stimulation system internalized. Patients signed the informed consent approved by the Hospital's Ethics Committee and began a double-blind stimulation protocol. Patients attended a medical appointment every 3 months for seizure diary collection, deep brain stimulation system checkup, and neuropsychological testing. Results: Follow-up ranged from 18 months to 7 years. Patients were divided in two groups: five had normal MRIs and seizure reduction of >95%, while four had hippocampal sclerosis and seizure reduction of 50,70%. No patient had neuropsychological deterioration, nor did any patient show side effects. Three patients were explanted after 2 years due to skin erosion in the trajectory of the system. Conclusions: Electrical stimulation of the hippocampus provides a nonlesional method that improves seizure outcome without memory deterioration in patients with hippocampal epileptic foci. [source] SEEG-guided RF Thermocoagulation of Epileptic Foci: Feasibility, Safety, and Preliminary ResultsEPILEPSIA, Issue 11 2004Marc Guénot Summary:,Purpose:,Depth electrodes recordings may be required in some cases of epilepsy surgery to delineate the best region for cortical resection. We usually implant depth electrodes according to Talairach's stereoelectroencephalography (SEEG) method. By using these permanently implanted depth electrodes, we are able to perform radiofrequency (RF)-thermolesions of the epileptic foci. We report the technical data required to perform such multiple cortical thermolesions, as well as preliminary results in terms of seizure outcome in a group of 20 patients. Methods:,Lesions were performed by using 100- to 110-mA bipolar current (50 V), applied for 10 to 50 s. Each thermocoagulation produced a 5- to 7-mm diameter cortical lesion. In total, two to 16 lesions were performed in each of the 20 patients. Lesions were placed without anesthesia. No general or neurologic complication occurred during the procedures. Two transient postprocedure side effects, consisting of paresthetic sensations in the mouth and mild apraxia of the hand, were observed. Results:,At a follow-up time of 8 to 31 months (mean, 19 months), 15% of the patients became seizure free, 40% experienced a ,80% reduction of their seizure frequency, and 45% were not significantly improved. Conclusions:,SEEG-guided RF thermolesions is a safe technique. Our preliminary results indicate that such lesions can lead to a significant reduction of seizure frequency and could be proposed as a palliative procedure if no resective surgery is possible. A randomized controlled trial is needed to determine which patients are likely to respond to SEEG-guided RF thermolesions. [source] Molecular and diffusion tensor imaging of epileptic networksEPILEPSIA, Issue 2008Aimee F. Luat Summary Several studies have shown that seizure-induced cellular and molecular changes associated with chronic epilepsy can lead to functional and structural alterations in the brain. Chronic epilepsy, when medically refractory, may be associated with an expansion of the epileptic circuitry to involve complex interactions between cortical and subcortical neuroanatomical substrates. Progress in neuroimaging has led not only to successful identification of epileptic foci for surgical resection, but also to an improved understanding of the functional and microstructural changes in long-standing epilepsy. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) are all promising tools that can assist in elucidating the underlying pathophysiology in chronic epilepsy. Studies using PET scanning have demonstrated dynamic changes associated with the evolution from acute to chronic intractable epilepsy. Among these changes are data to support the existence of secondary epileptogenesis in humans. MRI with DTI is a powerful tool which has the ability to characterize microstructural abnormalities in epileptic foci, and to demonstrate the white matter fibers and tracts participating in the epileptic network. In this review, we illustrate how PET and DTI can be applied to depict the functional and microstructural alterations associated with chronic epilepsy. [source] Electrical Stimulation of the Hippocampal Epileptic Foci for Seizure Control: A Double-Blind, Long-Term Follow-Up StudyEPILEPSIA, Issue 10 2007Ana Luisa Velasco Summary:,Purpose: Our aim was to evaluate the safety and efficacy of electrical stimulation of the hippocampus in a long-term follow-up study, as well as its impact on memory performance in the treatment of patients with refractory mesial temporal lobe epilepsy. Methods: Nine patients were included. All had refractory partial complex seizures, some with secondary generalizations. All patients had a 3-month-baseline-seizure count, after which they underwent bilateral hippocampal diagnostic electrode implantation to establish focus laterality and location. Three patients had bilateral, and six, unilateral foci. Diagnostic electrodes were explanted and definitive Medtronic electrodes were implanted directed into the hippocampal foci. Position was confirmed with MRI and afterwards, the deep brain stimulation system internalized. Patients signed the informed consent approved by the Hospital's Ethics Committee and began a double-blind stimulation protocol. Patients attended a medical appointment every 3 months for seizure diary collection, deep brain stimulation system checkup, and neuropsychological testing. Results: Follow-up ranged from 18 months to 7 years. Patients were divided in two groups: five had normal MRIs and seizure reduction of >95%, while four had hippocampal sclerosis and seizure reduction of 50,70%. No patient had neuropsychological deterioration, nor did any patient show side effects. Three patients were explanted after 2 years due to skin erosion in the trajectory of the system. Conclusions: Electrical stimulation of the hippocampus provides a nonlesional method that improves seizure outcome without memory deterioration in patients with hippocampal epileptic foci. [source] Postictal But Not Interictal Hemispatial Neglect in Patients with Seizures of Lateralized OnsetEPILEPSIA, Issue 12 2006Olga Prilipko Summary:,Purpose: Unilateral spatial neglect, defined as a failure to report, respond, or orient to stimuli that are presented contralaterally, has been widely documented after brain damage to right, and to a lesser degree, left frontotemporoparietal networks. Group studies involving patients with seizures with a lateralized focus have demonstrated transient dysfunctions in memory and language; however, so far, only two case reports have described transient neglect after an epileptic seizure. Methods: To assess the existence and consistency of this phenomenon, we evaluated 33 epilepsy patients on a line-bisection task in interictal and postictal states as compared with an age- and sex-matched control group. Results: Spatial neglect, as determined by this test, was found in the postictal but not interictal examination in patients with right parietal epileptic foci and was maximal for the left-positioned lines, whereas no neglect was found in other groups. Conclusions: Our findings indicate that patients with right parietal foci can present a transient neglect phenomenon on the line-bisection task in the postictal period, even in the absence of overt clinical neglect signs. These findings might be useful in establishing the laterality and even localization of epileptic foci based on the postictal neuropsychological evaluation. [source] Neocortical Microenvironment in Patients with Intractable Epilepsy: Potassium and Chloride ConcentrationsEPILEPSIA, Issue 2 2006Ali Gorji Summary:,Purpose: The regulation of extracellular ion concentrations plays an important role in neuronal function and epileptogenesis. Despite the many studies into the mechanisms of epileptogenesis in human experimental models, no data are available regarding the fluctuations of extracellular potassium ([K+]o) and chloride ([Cl,]o) concentrations, which could underlie seizure susceptibility in human chronically epileptic tissues in vivo. Methods: By using cerebral microdialysis during surgical resection of epileptic foci, the basic [K+]o and [Cl,]o as well as their changes after epicortical electric stimulation were studied in samples of dialysates obtained from 11 patients by ion-selective microelectrodes. Results: The mean basal values of [K+]o and [Cl,]o in all patients were 3.83 ± 0.08 mM and 122.9 ± 2.6 mM, respectively. However, significant differences were observed in the basal levels of both [K+]o and [Cl,]o between different patients. Statistically, no correlation was found between basal [K+]o or [Cl,]o and electrocorticogram (ECoG) spike activity, but in one patient, dramatically lowered baseline [Cl,]o was accompanied by enhanced ECoG spike activity. Application of epicortical electrical stimulation increased [K+]o but not [Cl,]o in all cases. According to the velocity as well as spatial distribution of [K+]o reduction to the prestimulation levels, three different types of responses were observed: slow decline, fast decline, and slow and fast declines at adjacent sites. Conclusions: These data may represent abnormalities in ion homeostasis of the epileptic brain. [source] Kindling Limits the Interictal Neuronal Temporal Response Properties in Cat Primary Auditory CortexEPILEPSIA, Issue 2 2005Pamela A. Valentine Summary:,Purpose: The present study examined the effect of electrical kindling on the interictal temporal response properties of single units recorded from primary auditory cortex (AI) of the adult cat. Methods: Cats were permanently implanted with electrodes in AI, kindled twice daily for 40 sessions, and the contralateral AI was subsequently mapped. Kindling stimulation consisted of 1-s trains of biphasic square-wave pulses applied at a frequency of 60 Hz, 100 ,A above the afterdischarge (AD) threshold. The EEG activity was recorded during each kindling session, and the behavioral manifestation was scored. Subsequent to kindling, multiple single-unit responses were recorded under ketamine anesthesia in response to 1-s-long periodic click trains, with click rates between 2 and 64 Hz. Neuronal responses were characterized according to their ability to respond in time-locked fashion to the clicks. Results: Kindling stimulation resulted in progression of the AD characteristics and seizure behavior, with six of 10 kindled cats reaching a fully generalized state. In the fully kindled cats, the best modulation frequencies and limiting following rates for the single-unit responses were significantly lower compared with those of naive and sham controls. Conclusions: Repeated epileptiform activity interferes with temporal processing in cat auditory cortex in the interictal state. This may have implications for people with epileptic foci in auditory-related areas. [source] SEEG-guided RF Thermocoagulation of Epileptic Foci: Feasibility, Safety, and Preliminary ResultsEPILEPSIA, Issue 11 2004Marc Guénot Summary:,Purpose:,Depth electrodes recordings may be required in some cases of epilepsy surgery to delineate the best region for cortical resection. We usually implant depth electrodes according to Talairach's stereoelectroencephalography (SEEG) method. By using these permanently implanted depth electrodes, we are able to perform radiofrequency (RF)-thermolesions of the epileptic foci. We report the technical data required to perform such multiple cortical thermolesions, as well as preliminary results in terms of seizure outcome in a group of 20 patients. Methods:,Lesions were performed by using 100- to 110-mA bipolar current (50 V), applied for 10 to 50 s. Each thermocoagulation produced a 5- to 7-mm diameter cortical lesion. In total, two to 16 lesions were performed in each of the 20 patients. Lesions were placed without anesthesia. No general or neurologic complication occurred during the procedures. Two transient postprocedure side effects, consisting of paresthetic sensations in the mouth and mild apraxia of the hand, were observed. Results:,At a follow-up time of 8 to 31 months (mean, 19 months), 15% of the patients became seizure free, 40% experienced a ,80% reduction of their seizure frequency, and 45% were not significantly improved. Conclusions:,SEEG-guided RF thermolesions is a safe technique. Our preliminary results indicate that such lesions can lead to a significant reduction of seizure frequency and could be proposed as a palliative procedure if no resective surgery is possible. A randomized controlled trial is needed to determine which patients are likely to respond to SEEG-guided RF thermolesions. [source] fMRI Activation in Continuous and Spike-triggered EEG,fMRI Studies of Epileptic SpikesEPILEPSIA, Issue 10 2003Abdulla Al-Asmi Summary:,Purpose: To evaluate functional magnetic resonance imaging (fMRI) with simultaneous EEG for finding metabolic sources of epileptic spikes. To find the localizing value of activated regions and factors influencing fMRI responses. Methods: Patients with focal epilepsy and frequent spikes were subjected to spike-triggered or continuous fMRI with simultaneous EEG. Results were analyzed in terms of fMRI activation, concordance with the location of EEG spiking and anatomic MRI abnormalities, and other EEG and clinical variables. In four patients, results also were compared with those of intracerebral EEG. Results: Forty-eight studies were performed on 38 patients. Seventeen studies were not analyzed, primarily because no spikes occurred during scanning. Activation was obtained in 39% of 31 studies, with an activation volume of 2.55 ± 4.84 cc. Activated regions were concordant with EEG localization in almost all studies and confirmed by intracerebral EEG in four patients. Forty percent of patients without an MRI lesion showed activation; 37.5% of patients with a lesion had an activation; the activation was near or inside the lesion. Bursts of spikes were more likely to generate an fMRI response than were isolated spikes (76 vs. 11%; p < 0.05). Conclusions: Combining EEG and fMRI in focal epilepsy yields regions of activation that are presumably the source of spiking activity. These regions are highly linked with epileptic foci and epileptogenic lesions in a significant number of patients. Activation also is found in patients with no visible MRI lesion. Intracerebral recordings largely confirm that these activation regions represent epileptogenic areas. It is still unclear why many patients show no activation. [source] Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRIEPILEPSIA, Issue 4 2010Verena Brodbeck Summary Purpose:, Patients with magnetic resonance (MR),negative focal epilepsy (MRN-E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60,90%). Patients with extratemporal MRN-E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI. Methods:, We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow-up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring. Results:, ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes. Discussion:, The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process. [source] ,-[11C]methyl-L-tryptophan uptake in patients with periventricular nodular heterotopia and epilepsyEPILEPSIA, Issue 5 2008Jun Natsume Summary Background:,-[11C]methyl-L-tryptophan (,-MTrp) positron emission tomography (PET) is a promising tool in the localization of the epileptogenic area in selected group of focal epilepsy patients. Electrophysiological evidence suggests the involvement of the neocortex in periventricular nodular heterotopia (PVNH). Purpose: To determine whether ,-MTrp PET can detect neocortical changes in patients with PVNH. Methods: Four patients (2 male, mean age 28, range 23,35 years) with PVNH and intractable seizures were studied. The functional image in each patient was compared with those from 21 healthy controls (mean age 34.6 ± 14.2 years) by using statistical parametric mapping (SPM). The location of increased ,-MTrp uptake was compared with the location of the EEG focus. A significant cluster was defined as a cluster with a height p = 0.005 and an extent threshold 100. Results:,-MTrp PET revealed increased cortical uptake in two of four patients. The area of increased ,-MTrp uptake in one patient was widespread. In the other patient, the area of increased uptake did not include the region where most seizures were generated on EEG. ,-MTrp PET did not show increased uptake in the heterotopic nodules in any of the patients. Conclusions:,-MTrp PET suggests abnormal metabolism of tryptophan in the neocortex. The increased uptake may be diffuse and may not co-localize with the EEG focus. This preliminary study suggests that ,-MTrp PET may be useful, in conjunction with other evaluations, in localizing epileptic focus in patients with PVNH and refractory seizures. [source] Cognitive Deficits during Status Epilepticus and Time Course of Recovery: A Case ReportEPILEPSIA, Issue 10 2007Wim Van Paesschen Summary:, We describe a young woman with progressive cognitive and neurological deficits during a parietal lobe status epilepticus (SE). Ictal FDG-PET showed left parietal lobe hypermetabolism and frontal lobe hypometabolism with concomitant EEG slowing. Cognitive and neurological deficits fully reversed more than 1 year after seizure remission, and were associated with normalization of FDG-PET and EEG. Our findings suggest that ictal hypometabolism and EEG delta activity at a distance from the epileptic focus were seizure-related phenomena, possibly representing inhibition in seizure propagation pathways, which could be responsible for the epileptic encephalopathy. [source] Neuronal Disconnection for the Surgical Treatment of Pediatric EpilepsyEPILEPSIA, Issue 2000Hiroyuki Shimizu Summary: The surgical methods and results of disconnective surgery for pediatric epilepsy were retrospectively analyzed. The techniques of neuronal disconnection included multiple subpial resection (MST), corpus callosotomy, and functional hemisphercctomy by disconnection. Of 158 total pediatric operations, disconnective techniques were employed in more than 60% of the cases. MST was applied when the epileptic focus was located in unresectable cortices such as speech or motor areas. MST was also instrumental when the epileptogenic zone was extensive and was widely disseminated, as is often observed in cases of neocortical epilepsy. Of 25 patients who underwent MST, surgical outcomes after > 1 year follow-up showed Engel Class I or II in 10 cases, Class III in 12, and Class IV in 3. No mortality or morbidity was encountered during surgery or postoperatively. Corpus callosotomy was applied to cases of disabling generalized seizures and showed a marked effect in alleviating potentially injurious drop attacks. Of 34 patients with drop attacks, 29 became free from this type of seizure, 4 had infrequent attacks, and only 1 showed no beneficial effect. Postoperative improvement of cognition and speech was recognized in 77% of the cases. We developed a new method of functional hemispherectomy by fiber disconnection and applied this less invasive technique to 23 cases of hemispheric lesions. Of the 17 cases with > 1 year follow-up, 13 were in Class I or II, and 3 in Class III, and 2 in Class IV. Development partially normalized in infants with good seizure outcomes. [source] Noninvasive dynamic imaging of seizures in epileptic patientsHUMAN BRAIN MAPPING, Issue 12 2009Louise Tyvaert Abstract Epileptic seizures are due to abnormal synchronized neuronal discharges. Techniques measuring electrical changes are commonly used to analyze seizures. Neuronal activity can be also defined by concomitant hemodynamic and metabolic changes. Simultaneous electroencephalogram (EEG)-functional MRI (fMRI) measures noninvasively with a high-spatial resolution BOLD changes during seizures in the whole brain. Until now, only a static image representing the whole seizure was provided. We report in 10 focal epilepsy patients a new approach to dynamic imaging of seizures including the BOLD time course of seizures and the identification of brain structures involved in seizure onset and discharge propagation. The first activation was observed in agreement with the expected location of the focus based on clinical and EEG data (three intracranial recordings), thus providing validity to this approach. The BOLD signal preceded ictal EEG changes in two cases. EEG-fMRI may detect changes in smaller and deeper structures than scalp EEG, which can only record activity form superficial cortical areas. This method allowed us to demonstrate that seizure onset zone was limited to one structure, thus supporting the concept of epileptic focus, but that a complex neuronal network was involved during propagation. Deactivations were also found during seizures, usually appearing after the first activation in areas close or distant to the activated regions. Deactivations may correspond to actively inhibited regions or to functional disconnection from normally active regions. This new noninvasive approach should open the study of seizure generation and propagation mechanisms in the whole brain to groups of patients with focal epilepsies. Hum Brain Mapp, 2009. © 2009 Wiley-Liss, Inc. [source] 3T versus 1.5T phased-array MRI in the presurgical work-up of patients with partial epilepsy of uncertain focusJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2009Maeike Zijlmans MD Abstract Purpose To study 3T compared to 1.5T phased array magnetic resonance imaging (MRI) in the presurgical work-up of patients with epilepsy with complex focus localization. Materials and Methods In all, 37 patients (>10 years) in preoperative work-up for epilepsy surgery were offered 3T in addition to 1.5T MRI if ambiguity existed about the epileptic focus. Scans were randomly reviewed by two observers, blinded for prior imaging, patient-identifying information, and each other's assessments, followed by a consensus meeting. The number of abnormal scans, detected lesions, and interobserver agreement were calculated and compared. The final consensus was compared to original scan reports. Results One observer identified 22 lesions in both 3 and 1.5T scans, while the second identified more lesions in 1.5T scans (28 vs. 20). 3T MRI had better interobserver agreement. 3T revealed more dysplasias, while 1.5T revealed more tissue loss and mesial temporal sclerosis (MTS). The final consensus yielded 29 lesions, whereas original reports identified only 17 lesions. Conclusion The 3T scans revealed different lesions compared to 1.5T. Patients can benefit most from 3T scans when a dysplasia is suspected. Reevaluation by another experienced neuroradiologist is advised in case of negative or equivocal MRIs. J. Magn. Reson. Imaging 2009;30:256,262. © 2009 Wiley-Liss, Inc. [source] The intracarotid amobarbital or Wada test: unilateral or bilateral?ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009S. G. Uijl Objective,,, In the Netherlands, presurgical screening for temporal lobe epilepsy (TLE) includes the intracarotid amobarbital procedure (IAP), consisting of two consecutive injections of amobarbital, ipsilateral and contralateral to the epileptic focus. We studied whether a bilateral IAP has added value to a unilateral, ipsilateral IAP. Methods,,, This population-based study included 183 consecutive patients referred for screening for TLE surgery who underwent bilateral IAP. Using multivariable modeling, we assessed the added value of bilateral IAP on the decision for surgery, resection size, amygdalohippocampectomy, post-operative seizure freedom, memory performance, and IQ change. Results,,, Given the results from the unilateral IAP, the bilateral IAP had added prognostic value for postoperative change in verbal memory (P < 0.01) and verbal IQ (P < 0.01), especially if patients had a left-sided focus. In contrast, information provided by the contralateral IAP was not associated with decision-making or surgical strategy. Conclusions,,, A bilateral IAP has added value in predicting post-operative verbal memory and IQ. A bilateral IAP is currently not used to guide surgical strategy, but may be used for this purpose when verbal capacity is of particular concern in patients with a left-sided focus. In other cases, IAP is best performed unilaterally. [source] Presurgical lateralization of seizure focus and language dominant hemisphere with O-15 water PET imagingACTA NEUROLOGICA SCANDINAVICA, Issue 2 2000R. Tatlidil Objectives, The purpose of this study was to assess the value of same day blood flow PET in both the identification of the language dominant hemisphere and in the lateralization of the epileptic focus in patients who were preoperatively evaluated for complex partial seizures. Methods, The charts of 24 patients who had temporal lobectomies for seizures were retrospectively reviewed. All PET scans were acquired by using O-15 water tracer (H215O) in both resting and language activation conditions. PET language laterality results were compared to Intracarotid amytal procedure (IAP) results. For epileptic focus lateralizations, regions of interest (ROI) analysis of temporal lobes was performed on resting scans. Results, IAP testing was discordant with PET language mapping in 1 out of 24 cases. This patient had a decline in cognitive abilities as measured by postoperative neuropsychologic testing. For epileptic focus lateralization, the PET was highly sensitive (87%) and specific (100%). Lateralizations with the PET were in agreement with surgical sites in all cases. Eighteen patients (75%) were seizure free and 4 patients (17%) were significantly improved after surgery. Conclusion, The results suggest that O-15 water PET is sensitive and specific in both the lateralization of epileptic focus and the language dominant hemisphere and can be a cost-effective and noninvasive method in presurgical evaluation of patients with complex partial seizures. [source] | ||||||||||