Getting the best outcomes from epilepsy surgery

Vakharia, Vejay N.; Duncan, John S.; Witt, Juri‐Alexander; Elger, Christian E.; Staba, Richard J.; Engel, Jerome

doi:10.1002/ana.25205

Cited by 178 publications

(152 citation statements)

References 120 publications

(228 reference statements)

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“…[1][2][3][4] Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation. [1][2][3][4] Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation.…”

Section: Introductionmentioning

confidence: 99%

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NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

et al. 2019

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Objective: Interictal epileptiform anomalies such as epileptiform discharges or highfrequency oscillations show marked variations across the sleep-wake cycle. This study investigates which state of vigilance is the best to localize the epileptogenic zone (EZ) in interictal intracranial electroencephalography (EEG). Methods: Thirty patients with drug-resistant epilepsy undergoing stereo-EEG (SEEG)/sleep recording and subsequent open surgery were included; 13 patients (43.3%) had good surgical outcome (Engel class I). Sleep was scored following standard criteria. Multiple features based on the interictal EEG (interictal epileptiform discharges, high-frequency oscillations, univariate and bivariate features) were used to train a support vector machine (SVM) model to classify SEEG contacts placed in the EZ. The performance of the algorithm was evaluated by the mean area under the receiver-operating characteristic (ROC) curves (AUCs) and positive predictive values (PPVs) across 10-minute sections of wake, non-rapid eye movement sleep (NREM) stages N2 and N3, REM sleep, and their combination.Results: Highest AUCs were achieved in NREM sleep stages N2 and N3 compared to wakefulness and REM (P < .01). There was no improvement when using a combination of all four states (P > .05); the best performing features in the combined state were selected from NREM sleep. There were differences between good (Engel I) and poor (Engel II-IV) outcomes in PPV (P < .05) and AUC (P < .01) across all states. The SVM multifeature approach outperformed spikes and high-frequency oscillations (P < .01) and resulted in results similar to those of the seizure-onset zone (SOZ; P > .05). Significance: Sleep improves the localization of the EZ with best identification obtained in NREM sleep stages N2 and N3. Results based on the multifeature classification in 10 minutes of NREM sleep were not different from the results achieved by the SOZ based on 12.7 days of seizure monitoring. This finding might ultimately result in a more time-efficient intracranial presurgical investigation of focal epilepsy. K E Y W O R D Sconnectivity, drug-resistant epilepsy, high-frequency oscillations, machine learning, sleep-wake cycle | 2405 KLIMES Et aL.

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Section: Introductionmentioning

confidence: 99%

“…Surgery is the treatment of choice in patients with drugresistant focal epilepsy. [1][2][3][4] Epilepsy surgery foremost requires the identification of the epileptogenic zone (EZ), defined as the brain area indispensable for seizure generation. 5 The current gold standard for identification of the EZ is the seizure-onset zone (SOZ).…”

Section: Introductionmentioning

confidence: 99%

NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

et al. 2019

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“…Surgical interventions in patients with intractable epilepsy are planned based on a variety of diagnostic measures, including electrophysiological testing and neuroimaging procedures (1)(2)(3). The results of epilepsy surgery are very promising, with high chance of cure, especially in temporal lobe epilepsy, resulting in significant higher seizure freedom postoperatively compared to medical treatment (4,5).…”

Section: Introductionmentioning

confidence: 99%

Utility of Absolute Quantification in Non-lesional Extratemporal Lobe Epilepsy Using FDG PET/MR Imaging

et al. 2020

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“…While most patients with epilepsy achieve seizure control with antiepileptic drugs (AEDs), approximately 30% of patients have drug-resistant epilepsy [2,3]. Temporal lobe epilepsy (TLE) is the most common type of drug-resistant epilepsy in adults [4] and surgical resection of the epileptogenic focus is often the appropriate treatment to achieve seizure control [5,6].…”

Section: Introductionmentioning

confidence: 99%

Clinical practice of language fMRI in epilepsy centers: a European survey and conclusions by the ESNR Epilepsy Working Group

et al. 2020

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Purpose To assess current clinical practices throughout Europe with respect to acquisition, implementation, evaluation, and interpretation of language functional MRI (fMRI) in epilepsy patients. Methods An online survey was emailed to all European Society of Neuroradiology members (n = 1662), known associates (n = 6400), and 64 members of European Epilepsy network. The questionnaire featured 40 individual items on demographic data, clinical practice and indications, fMRI paradigms, radiological workflow, data post-processing protocol, and reporting. Results A total of 49 non-duplicate entries from European centers were received from 20 countries. Of these, 73.5% were boardcertified neuroradiologists and 69.4% had an in-house epilepsy surgery program. Seventy-one percent of centers performed fewer than five scans per month for epilepsy. The most frequently used paradigms were phonemic verbal fluency (47.7%) and auditory comprehension (55.6%), but variants of 13 paradigms were described. Most centers assessed the fMRI task performance (75.5%), ensured cognitive-task adjustment (77.6%), trained the patient before scanning (85.7%), and assessed handedness (77.6%), but only 28.6% had special paradigms for patients with cognitive impairments. fMRI was post-processed mainly by neuroradiologists (42.1%), using open-source software (55.0%). Reporting was done primarily by neuroradiologists (74.2%). Interpretation was done mainly by visual inspection (65.3%). Most specialists (81.6%) were able to determine the hemisphere dominance for language in more than 75% of exams, attributing failure to the patient not performing the task correctly. Conclusion This survey shows that language fMRI is firmly embedded in the preoperative management of epilepsy patients. The wide variety of paradigms and the use of non-CE-marked software underline the need for establishing reference standards.

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Getting the best outcomes from epilepsy surgery

Cited by 178 publications

References 120 publications

NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

NREM sleep is the state of vigilance that best identifies the epileptogenic zone in the interictal electroencephalogram

Utility of Absolute Quantification in Non-lesional Extratemporal Lobe Epilepsy Using FDG PET/MR Imaging

Clinical practice of language fMRI in epilepsy centers: a European survey and conclusions by the ESNR Epilepsy Working Group

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