Diagnostic utility of invasive <scp>EEG</scp> for epilepsy surgery: Indications, modalities, and techniques

Jayakar, Prasanna; Gotman, Jean; Harvey, A. Simon; Palmini, André; Tassi, Laura; Schomer, Donald L.; Dubeau, François; Bartolomei, Fabricē; Yu., A Belova; Kršek, Pavel; Velis, Demetrios N.; Kahane, Philippe

doi:10.1111/epi.13515

Cited by 218 publications

(231 citation statements)

References 73 publications

Supporting

Mentioning

217

Contrasting

Unclassified

Order By: Relevance

“…Despite advancements in the presurgical noninvasive workup, a number of patients still undergo intracranial electroencephalography. 13,16,17,19,21,22 Stereoelectroencephalography (SEEG) is one of the most prominent methods for direct recording of brain electrical activity and has recently spread beyond the European borders. …”

mentioning

confidence: 99%

A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

Cardinale¹,

Rizzi

d’Orio³

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEThe purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG).METHODSThe authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was aimed at testing the noninferiority of the Neurolocate system. The analysis of the surgical series compared Neurolocate-based SEEG implantations with a frame-based historical control group.RESULTSThe mean localization errors (LE) ± standard deviations (SD) for Neurolocate-based and frame-based trajectories were 0.67 ± 0.29 mm and 0.76 ± 0.34 mm, respectively, in the phantom study (p = 0.35). The median entry point LE was 0.59 mm (interquartile range [IQR] 0.25–0.88 mm) for Neurolocate-registration–based trajectories and 0.78 mm (IQR 0.49–1.08 mm) for frame-registration–based trajectories (p = 0.00002) in the clinical study. The median target point LE was 1.49 mm (IQR 1.06–2.4 mm) for Neurolocate-registration–based trajectories and 1.77 mm (IQR 1.25–2.5 mm) for frame-registration–based trajectories in the clinical study. All the surgical procedures were successful and uneventful.CONCLUSIONSThe results of the phantom study demonstrate the noninferiority of Neurolocate frameless registration. The results of the retrospective surgical series analysis suggest that Neurolocate-based procedures can be more accurate than the frame-based ones. The safety profile of Neurolocate-based registration should be similar to that of frame-based registration. The Neurolocate system is comfortable, noninvasive, easy to use, and potentially faster than other registration devices.

show abstract

mentioning

confidence: 99%

A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

Cardinale¹,

Rizzi

d’Orio³

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…We believe that this protocol is fully consistent with the recent International League Against Epilepsy (ILAE) guidelines for invasive EEG. 4 Rikir et al also commented on our finding of improved localization in the temporal versus extratemporal dipoles with low-resolution three-dimensional (3D)-ESI. We typically place electrodes beyond standard channels only after reviewing all patient data, including semiology, EEG, and MRI data.…”

Section: To the Editorsmentioning

confidence: 88%

“…Ironically, ECT has been employed as a treatment for refractory epilepsy and status epilepticus in a few anecdotal reports, sometimes successfully. [2][3][4] In addition, ECT has not been found to cause epilepsy in two large studies. 5,6 In one study of 166 patients who had received ECT, the prevalence of epilepsy did not differ significantly from that in the general population.…”

Section: To the Editorsmentioning

confidence: 99%

Response: Added value and limitations of electrical source localization

et al. 2017

Self Cite

View full text Add to dashboard Cite

REFERENCES1. Russo A, Jayakar P, Lallas M, et al. The diagnostic utility of 3D electroencephalography source imaging in pediatric epilepsy surgery. Epilepsia 2016;57:24-31. 2. Russo A, Lallas M, Jayakar P, et al. The diagnostic utility of 3D-ESI rotating and moving dipole methodology in the pre-surgical evaluation of MRI-negative childhood epilepsy due to focal cortical dysplasia. Response: Added value and limitations of electrical source localization To the Editors:In their commentary on our two articles 1,2 Rikir et al. offer several insightful observations and pose a series of questions regarding the reliability of electrical source imaging (ESI). The respondents suggest that a negative outcome in patients whose three-dimensional electroencephalographic source imaging localizes within the surgical resection cavity (SRC) implies mis-localization, We believe this conclusion could also logically apply to every localizing tool utilized in the epilepsy presurgical evaluation including ictal single-photon emission computed tomography (SPECT), interictal fluorodeoxyglucosepositron emission tomography (FDG-PET), subtraction ictal SPECT co-registered to magnetic resonance imaging (MRI) (SISCOM), and magnetoencephalography (MEG). It is now well accepted that no single methodology is perfectly localizing and that a concordance of different data is required before offering epilepsy surgery to patients.Rikir et al. underline their previous prospective study, 3 in the adult population demonstrating concordance of ESI with stereo electroencephalography (SEEG) in the epilepsy surgical evaluation. In particular they showed a better concordance with the SEEG-defined ictal-onset zone in MRI-negative than in MRI-positive cases (respectively, 64% in MRI-negative subjects versus 18% in MRIpositive cases, considering the fully concordant data). However, the authors do not provide sufficient postsurgical data to allow a comparison of their results with ours. In fact, of their 28 subjects reported, 10 did not undergo resection, many for functional reasons, and 4 remaining subjects had a poor outcome (Engel class III or IV). We previously pointed out in our first publication that not all the operated patients were significantly improved (Engel class I or II). Furthermore, although delineation of the EZ and mapping are listed in their study, all of their patients with malformations of cortical development (MCDs) underwent SEEG, although the indication for SEEG was not well defined. We typically do not implant electrodes in MRI-positive patients unless there is a need to map nearby eloquent cortex or there are discordant data. We believe that this protocol is fully consistent with the recent International League Against Epilepsy (ILAE) guidelines for invasive EEG. Rikir et al. also commented on our finding of improved localization in the temporal versus extratemporal dipoles with low-resolution three-dimensional (3D)-ESI. We typically place electrodes beyond standard channels only after reviewing all patient data, including semiology, E...

show abstract

“…This approach has resulted in favorable rates of postoperative seizure-freedom, infrequent use of extraoperative ECoG, and a presumptive bias toward larger resections of well-defined lesions (Hemb et al, 2010; Hussain et al, 2016; Wu et al, 2010a; Wu et al, 2010b). We acknowledge that the ideal approach to epilepsy surgery in children is the subject of ongoing debate (Cross et al, 2006; Harvey et al, 2008; Jayakar et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

Intraoperative fast ripples independently predict postsurgical epilepsy outcome: Comparison with other electrocorticographic phenomena

et al. 2017

View full text Add to dashboard Cite

In the surgical management of epilepsy, the resection of cortex exhibiting interictal fast ripples (250–500 Hz) on electrocorticography has been linked to postoperative seizure-freedom. Although fast ripples appear to accurately identify the epileptogenic zone—the minimum tissue that must be removed at surgery to achieve seizure-freedom—it has not been established that fast ripples are a superior biomarker in comparison with multimodal presurgical neuroimaging and other electrocorticography abnormalities. Hence, in the prediction of postoperative seizure-freedom, we compared the value of fast ripples with other intraoperative electocorticography abnormalities including focal slowing, paroxysmal fast activity, intermittent spike discharges, continuous epileptiform discharges, focal attenuation, and intraoperative seizures, as well as complete resection of the lesion defined by MRI and other neuroimaging. In a cohort of 60 children with lesional epilepsy and median postsurgical follow-up exceeding 4 years, who underwent resective epilepsy surgery with intraoperative electrocorticography, we evaluated the extent to which removal of each intraoperative electrocorticography abnormality impacts time to first postoperative seizure using the Kaplan-Meier method and Cox proportional hazards regression. Secondly, we contrasted the predictive value of resection of each competing electrocorticography abnormality using standard test metrics (sensitivity, specificity, positive predictive value, and negative predictive value). In contrast with all other intraoperative electrocorticography abnormalities, fast ripples demonstrated the most favorable combination of positive predictive value (100%) and negative predictive value (76%) in the prediction of postoperative seizures. Among all candidate electrocorticography features, time to first postoperative seizure was most strongly associated with incomplete resection of fast ripples (hazard ratio = 19.8, p <0.001). In multivariate survival analyses, postoperative seizures were independently predicted by incomplete resection of cortex generating fast ripples (hazard ratio = 25.4, 95%CI 6.71 – 96.0, p < 0.001) and focal slowing (hazard ratio = 5.79, 95%CI 1.76 – 19.0, p = 0.004), even after adjustment for the impact of an otherwise complete resection. All children with incomplete resection of interictal FR-generating cortex exhibited postoperative seizures within six months. Notably, this cohort included many patients with large resections and thus limited opportunity to exhibit unresected fast ripples. Future study in a cohort with small resection volume, or a clinical trial in which resection margins are guided by fast ripple distribution, would likely yield a more precise estimate of the risk posed by unresected fast ripples. With a high detection rate during brief intraoperative electrocorticography and favorable positive and negative predictive value, interictal fast ripple characterization during surgery is a feasible and useful adjunct to standard methods for epilepsy surgery...

show abstract

Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques

Cited by 218 publications

References 73 publications

A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

Response: Added value and limitations of electrical source localization

Intraoperative fast ripples independently predict postsurgical epilepsy outcome: Comparison with other electrocorticographic phenomena

Contact Info

Product

Resources

About