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Dennis D Spencer, Jason L Gerrard, Hitten P Zaveri
Intracranial electrophysiological recording in patients with refractory focal epilepsy is the gold standard for defining epileptogenic tissue. Although the concordance of intracranial electrophysiology, structural MRI, and pathology can identify brain regions for resection, complete seizure control after surgery is not achieved in all patients with focal epilepsy. Repetitive identical behavioural seizures suggest one onset area, but epileptogenesis might be distributed and connected by functional and structural brain networks outside the seizure onset area, which could explain poor postsurgical outcomes in some patients...
April 2018: Lancet Neurology
Aaron F Struck, M Brandon Westover, Lance T Hall, Gina M Deck, Andrew J Cole, Eric S Rosenthal
BACKGROUND: Ictal-interictal continuum (IIC) continuous EEG (cEEG) patterns including periodic discharges and rhythmic delta activity are associated with poor outcome and in the appropriate clinical context, IIC patterns may represent "electroclinical" status epilepticus (SE). To clarify the significance of IIC patterns and their relationship to "electrographic" SE, we investigated FDG-PET imaging as a complementary metabolic biomarker of SE among patients with IIC patterns...
June 2016: Neurocritical Care
Saurabh Sinha, Shabbar F Danish
The history of epilepsy surgery is generally noted to have begun in 1886 with Victor Horsley's first report of craniotomies for posttraumatic epilepsy. With increased understanding of brain function and development of electroencephalographic methods, nonlesional epilepsy began to be treated with resection in the 1950s. Methodological improvements and increased understanding of pathophysiology followed, and the advent of stereotaxy and ablative technology in the 1960s and 1970s heralded a new era of minimally invasive, targeted procedures for lesional and nonlesional epilepsy...
January 2016: Neurosurgery Clinics of North America
Robert E Gross, Jon T Willie, Daniel L Drane
Stereotactic laser amygdalohippocampotomy (SLAH) uses laser interstitial thermal therapy guided by magnetic resonance thermography. This novel intervention can achieve seizure freedom while minimizing collateral damage compared to traditional open surgery, in patients with mesial temporal lobe epilepsy. An algorithm is presented to guide treatment decisions for initial and repeat procedures in patients with and without mesial temporal sclerosis. SLAH may improve access by medication-refractory patients to effective surgical treatments and thereby decrease medical complications, increase productivity, and minimize socioeconomic consequences in patients with chronic epilepsy...
January 2016: Neurosurgery Clinics of North America
Iris Unterberger, Richard Bauer, Gerald Walser, Gerhard Bauer
PURPOSE: Corpus callosum (CC) is the largest forebrain commissure. This review focuses on the significance of CC for seizure disorders, the role of CC in seizure spread and the surgical disruption of callosal fibers (callosotomy) for treatment of patients with drug-resistant epilepsy. METHODS: Personal experience/extensive literature review. RESULTS: Structural CC pathologies comprise developmental abnormalities, callosal involvement in identified disorders, transient imaging findings and microstructural changes...
April 2016: Seizure: the Journal of the British Epilepsy Association
Sima I Patel, Page B Pennell
The clinical management of women with epilepsy on antiepileptic drugs (AEDs) during pregnancy presents unique challenges. The goal of treatment is optimal seizure control with minimal in utero fetal exposure to AEDs in an effort to reduce the risk of structural and neurodevelopmental teratogenic effects. This paper reviews the following key issues pertaining to women with epilepsy during pregnancy: AED pharmacokinetics; clinical management of AEDs; seizure frequency; major congenital malformation; neurodevelopmental outcomes; perinatal complications; and breast feeding...
March 2016: Therapeutic Advances in Neurological Disorders
Gislaine Baroni, Vitoria Piccinini, William Alves Martins, Luciano de Paola, Eliseu Paglioli, Regina Margis, André Palmini
PURPOSE: Epileptic seizures (ES) have many mimickers, perhaps the most relevant being psychogenic nonepileptic seizures (PNES). The picture is even more challenging when PNES are associated with ES in a given patient. The aim of this research paper was to delineate the demographic, epileptological and psychiatric profile of that specific population. METHODS: A systematic review was carried out from 2000 to 2015 for articles in English, French, Italian, Spanish and Portuguese in PUBMED and EMBASE...
April 2016: Seizure: the Journal of the British Epilepsy Association
Moshe Herskovitz, Yitzhak Schiller
BACKGROUND: Resective epilepsy surgery is an accepted treatment option for patients with drug-resistant epilepsy (DRE). Presurgical evaluation consists of a phase 1 non-invasive evaluation and a phase 2 invasive evaluation, when necessary. OBJECTIVES: To assess the results of phase 1 evaluation in patients with focal DRE. METHODS: This observational retrospective study was performed in all consecutive DRE patients admitted to our clinic from January 2001 to July 2010, and who underwent a presurgical evaluation which included at least magnetic resonance imaging (MRI) scan and long-term video EEG monitoring (LTVEM)...
February 2016: Israel Medical Association Journal: IMAJ
Franz Fürbass, Johannes Herta, Johannes Koren, M Brandon Westover, Manfred M Hartmann, Andreas Gruber, Christoph Baumgartner, Tilmann Kluge
OBJECTIVE: To develop a computational method to detect and quantify burst suppression patterns (BSP) in the EEGs of critical care patients. A multi-center validation study was performed to assess the detection performance of the method. METHODS: The fully automatic method scans the EEG for discontinuous patterns and shows detected BSP and quantitative information on a trending display in real-time. The method is designed to work without setting any patient specific parameters and to be insensitive to EEG artifacts and periodic patterns...
April 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Puneet Jain, Suvasini Sharma, Tarun Dua, Corrado Barbui, Rashmi Ranjan Das, Satinder Aneja
OBJECTIVES: To explore the existing evidence for anti-convulsant drugs and their routes of administration in treating acute seizures in children and adults when intravenous access is not available. METHODS: All major databases including Medline via Ovid, PubMed, Cochrane CENTRAL, Embase, and Google Scholar were searched till May 2015. Randomized and quasi-randomized controlled trials comparing two anti-convulsant drugs (at least one comparator being administered through non-intravenous route) for treatment of acute seizures were included...
May 2016: Epilepsy Research
Jan Cimbalnik, Michal T Kucewicz, Greg Worrell
PURPOSE OF REVIEW: Localization of focal epileptic brain is critical for successful epilepsy surgery and focal brain stimulation. Despite significant progress, roughly half of all patients undergoing focal surgical resection, and most patients receiving focal electrical stimulation, are not seizure free. There is intense interest in high-frequency oscillations (HFOs) recorded with intracranial electroencephalography as potential biomarkers to improve epileptogenic brain localization, resective surgery, and focal electrical stimulation...
April 2016: Current Opinion in Neurology
Ryan P Williams, Brenda Banwell, Robert A Berg, Dennis J Dlugos, Maureen Donnelly, Rebecca Ichord, Sudha Kilaru Kessler, Jane Lavelle, Shavonne L Massey, Jennifer Hewlett, Allison Parker, Alexis A Topjian, Nicholas S Abend
OBJECTIVES: We aimed to determine whether implementation of a structured multidisciplinary electroencephalography (EEG) monitoring pathway improved the timeliness of administration of antiseizure medication in response to electrographic seizures in encephalopathic critically ill children. METHODS: A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizure onset to antiseizure medication administration...
May 2016: Epilepsia
Rei Enatsu, Nobuhiro Mikuni
Invasive evaluations play important roles in identifying epileptogenic zones and functional areas in patients with intractable focal epilepsy. This article reviews the usefulness, methods, and limitations of invasive evaluations for epilepsy surgery. Invasive evaluations include various types of intracranial electrodes such as stereotactically implanted intracranial depth electrodes (stereo-EEG), chronic subdural electrodes, and intraoperative electrocorticography. Scalp EEG is distorted by the skull, meninges, and skin...
May 15, 2016: Neurologia Medico-chirurgica
Simona Lattanzi, Claudia Cagnetti, Nicoletta Foschi, Leandro Provinciali, Mauro Silvestrini
OBJECTIVE: To evaluate the efficacy and safety of the new antiepileptic drug brivaracetam (BRV) as add-on treatment for drug-resistant partial epilepsy using meta-analytical techniques. METHODS: Randomized, placebo-controlled, single- or double-blind, add-on trials of BRV in adult patients with drug-resistant partial epilepsy were identified through a systematic literature search. The following outcomes were assessed: 50% or greater reduction in seizure frequency, seizure freedom, incidence of treatment-emergent adverse events (TEAEs), and treatment withdrawal...
April 5, 2016: Neurology
Clare M Galtrey, Marco Mula, Hannah R Cock
People with epilepsy report that stress is their most common trigger for seizures and some believe it caused their epilepsy in the first place. The extensive preclinical, epidemiological and clinical studies examining the link between stress and epilepsy have given confusing results; the clinical studies in particular are fraught with confounders. However stress is clearly bad for health, and we now have substantial preclinical evidence suggesting that chronic stress worsens epilepsy; in selected cases it may even be a causal factor for epilepsy...
August 2016: Practical Neurology
Irene Wang, Andreas Alexopoulos
PURPOSE OF REVIEW: Advanced MRI postprocessing techniques are increasingly used to complement visual analysis and elucidate structural epileptogenic lesions. This review summarizes recent developments in MRI postprocessing in the context of epilepsy presurgical evaluation, with the focus on patients with unremarkable MRI by visual analysis (i.e. 'nonlesional' MRI). RECENT FINDINGS: Various methods of MRI postprocessing have been reported to show additional clinical values in the following areas: lesion detection on an individual level; lesion confirmation for reducing the risk of over reading the MRI; detection of sulcal/gyral morphologic changes that are particularly difficult for visual analysis; and delineation of cortical abnormalities extending beyond the visible lesion...
April 2016: Current Opinion in Neurology
John S Duncan, Gavin P Winston, Matthias J Koepp, Sebastien Ourselin
Brain imaging has a crucial role in the presurgical assessment of patients with epilepsy. Structural imaging reveals most cerebral lesions underlying focal epilepsy. Advances in MRI acquisitions including diffusion-weighted imaging, post-acquisition image processing techniques, and quantification of imaging data are increasing the accuracy of lesion detection. Functional MRI can be used to identify areas of the cortex that are essential for language, motor function, and memory, and tractography can reveal white matter tracts that are vital for these functions, thus reducing the risk of epilepsy surgery causing new morbidities...
April 2016: Lancet Neurology
Amy L Jones, Gregory D Cascino
IMPORTANCE: Surgery is an effective treatment for drug-resistant focal epilepsy. Neuroimaging studies are considered essential in the diagnostic evaluation of individuals with medically refractory focal seizures being considered for surgical treatment. OBJECTIVES: To review the evidence for the use of neuroimaging studies in the selection of patients with drug-resistant temporal lobe epilepsy for focal cortical resection and discuss the prognostic importance of selected techniques...
April 2016: JAMA Neurology
Henrik Klitgaard, Alain Matagne, Jean-Marie Nicolas, Michel Gillard, Yves Lamberty, Marc De Ryck, Rafal M Kaminski, Karine Leclercq, Isabelle Niespodziany, Christian Wolff, Martyn Wood, Jonas Hannestad, Sophie Kervyn, Benoit Kenda
Despite availability of effective antiepileptic drugs (AEDs), many patients with epilepsy continue to experience refractory seizures and adverse events. Achievement of better seizure control and fewer side effects is key to improving quality of life. This review describes the rationale for the discovery and preclinical profile of brivaracetam (BRV), currently under regulatory review as adjunctive therapy for adults with partial-onset seizures. The discovery of BRV was triggered by the novel mechanism of action and atypical properties of levetiracetam (LEV) in preclinical seizure and epilepsy models...
April 2016: Epilepsia
Churl-Su Kwon, Jonathan Neal, Jose Telléz-Zenteno, Amy Metcalfe, Kathryn Fitzgerald, Lizbeth Hernandez-Ronquillo, Walter Hader, Samuel Wiebe, Nathalie Jetté
OBJECTIVE: No standard, widely accepted criteria exist to determine who should be referred for an epilepsy surgical evaluation. As a result, indications for epilepsy surgery evaluation vary significantly between centers. We review the literature to assess what criteria have been used to select patients for resective epilepsy surgery and examine whether these have changed since the publication of the first epilepsy surgery randomized controlled trial in 2001. METHODS: A systematic review was conducted using PubMed and EMBASE, bibliographies of reviews and book chapters identifying focal epilepsy resective series...
May 2016: Epilepsy Research
2016-03-02 20:43:05
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