Hippocampal transection for stereo-electroencephalography–proven dominant mesial temporal lobe epilepsy in a child: a detailed case report and critical review

Park, Jun; Vaca, Guadalupe Fernández Baca; Tangen, Rachel; Miller, Jonathan P.

doi:10.3171/2018.5.peds1896

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…In addition, the later the clinical stage and the higher the degree of differentiation, the more the cytoplasmic expression of CEACAM1, which provides a theoretical basis for the early diagnosis and clinical treatment of lung cancer. In future related studies, CEACAM1 can be used to regulate lung cancer tumor, and the expression level of CEACAM1 can be used as the criteria for early diagnosis and the basis for middle and late treatment of lung cancer [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Serum Level of CEACAM1 in Patients with Nonsmall Cell Lung Cancer and Its Clinical Significance in Cancer Tissue

Liu

2022

Journal of Healthcare Engineering

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Objective. To analyze the expression of CEACAM1 in serum of patients with nonsmall cell lung cancer (NSCLC) and to explore the correlation and clinical significance between the expression of CEACAM1 and pathological parameters of NSCLC tissue. Methods. A total of 100 patients with NSCLC who underwent tumor resection were screened. Another 100 healthy patients in physical examination department were selected as control group. Venous blood and cancer tissue samples were collected. The expression of CEACAM1, TGF-β, VEGF-A, and IL-8 was detected. Results. The results of various indicators in the lung cancer group were much higher than those in the healthy group; CEACAM1 was significantly positively correlated with TGF-β expression. The later the clinical stage and the higher the degree of differentiation of cancer tissue specimens, the more the expression of CEACAM1 in serum samples. Conclusions. The expression level of CEACAM1 in the serum of NSCLC patients is strongly correlated with TGF-β, VEGF-A, and IL-8, indicating that serum CEACAM1 and TGF-β levels can predict the occurrence, progression, and prognosis of lung cancer and provide a target for future targeted therapy of lung cancer.

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Section: Discussionmentioning

confidence: 99%

Serum Level of CEACAM1 in Patients with Nonsmall Cell Lung Cancer and Its Clinical Significance in Cancer Tissue

Liu

2022

Journal of Healthcare Engineering

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“…In this study, we focus on the role of electric fields in the recruitment of seizure-like activity that could explain how seizures can cross a transection as previously observed in the human brain. 12,13 We reproduced these effects by showing that seizure-like activity can propagate beyond a surgical transection in an acute in vivo model of mesial TLE. With a transection by a 130-µm-diameter tungsten wire key-like activity could still travel through the cut (Figure 2).…”

Section: Discussionmentioning

confidence: 85%

“…9,[43][44][45] Furthermore, electric field coupling could explain why surgical transections are ineffective in isolating an epileptogenic zone. 46 Although hippocampal transection can block propagation in both patients with epilepsy 13 and chronic animal experiment, 47 its success is highly dependent on the amount of tissue removed and the damage generated by the surgery. Our experiments show that large gaps will block the activity but smaller gaps still allow propagation.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it has been shown that secondarily generalized cortical seizures in the hippocampus arise from the synchronization of epileptiform activity along the longitudinal pathway 10,11 . Therefore, as an alternative to surgical resections, multiple transections are made to isolate the epileptogenic zone 12–16 . However, the outcome of single or multiple transections is poor in some cases, with the epileptogenic zone often expanding beyond the transection area, and the long‐term effects are still questionable 12,14–16 .…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Therefore, as an alternative to surgical resections, multiple transections are made to isolate the epileptogenic zone. [12][13][14][15][16] However, the outcome of single or multiple transections is poor in some cases, with the epileptogenic zone often expanding beyond the transection area, and the long-term effects are still questionable. 12,[14][15][16] Only 33% of patients are seizure-free after receiving multiple subpial transection treatment in adults, and about 33%-42% of patients are seizure-free in children.…”

Section: Introductionmentioning

confidence: 99%

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Neural recruitment by ephaptic coupling in epilepsy

et al. 2021

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Objective: One of the challenges in treating patients with drug-resistant epilepsy is that the mechanisms of seizures are unknown. Most current interventions are based on the assumption that epileptic activity recruits neurons and progresses by synaptic transmission. However, several experimental studies have shown that neural activity in rodent hippocampi can propagate independently of synaptic transmission. Recent studies suggest these waves are self-propagating by electric field (ephaptic) coupling.In this study, we tested the hypothesis that neural recruitment during seizures can occur by electric field coupling. Methods: 4-Aminopyridine was used in both in vivo and in vitro preparation to trigger seizures or epileptiform activity. A transection was made in the in vivo hippocampus and in vitro hippocampal and cortical slices to study whether the induced seizure activity can recruit neurons across the gap. A computational model was built to test whether ephaptic coupling alone can account for neural recruitment across the transection. The model prediction was further validated by in vitro experiments. Results: Experimental results show that electric fields generated by seizure-like activity in the hippocampus both in vitro and in vivo can recruit neurons locally and through a transection of the tissue. The computational model suggests that the neural recruitment across the transection is mediated by electric field coupling. With in vitro experiments, we show that a dielectric material can block the recruitment of epileptiform activity across a transection, and that the electric fields measured within the gap are similar to those predicted by model simulations. Furthermore, this nonsynaptic neural recruitment is also observed in cortical slices, suggesting that this effect is robust in brain tissue. Significance: These results indicate that ephaptic coupling, a nonsynaptic mechanism, can underlie neural recruitment by a small electric field generated by seizure activity and could explain the low success rate of surgical transections in epilepsy patients.

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Multiple hippocampal transections for refractory pediatric mesial temporal lobe epilepsy: seizure and neuropsychological outcomes

Marashly

Koop²,

Loman³

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVETemporal lobe epilepsy (TLE) is the most common focal epilepsy across adult and pediatric age groups. It is also the most amenable to surgery, with excellent long-term seizure outcome. Most TLE cases have an epileptogenic zone in the mesial temporal structures, namely the hippocampus. Resecting the dominant hippocampus has been shown to be associated with significant verbal memory deficits, especially in patients with intact verbal memory scores presurgically. Multiple hippocampal transection (MHT) is a relatively new surgical technique designed to interrupt the longitudinal hippocampal circuitry involved in seizure propagation yet preserve the circular fibers involved in memory function. This technique has been used to treat mesial TLE in both dominant- and nondominant-hemisphere cases, almost exclusively in adults. It has been applied to normal and sclerotic hippocampi.METHODSIn this study, information on 3 pediatric patients who underwent MHT for mesial TLE at Children’s Wisconsin between 2017 and 2018 is included. Clinical, electroencephalographic, and neuropsychological features and outcomes are described in detail.RESULTSMRI revealed a tumor in the amygdala with a normal hippocampus in 1 patient and hippocampal sclerosis in 2 patients. All patients underwent stereoelectroencephalography confirming the involvement of the hippocampus in seizure onset. MHTs were completed under intraoperative monitoring, with amygdala and temporal tip resection in all patients due to early spread to these regions. All patients had excellent seizure outcomes at 1 year, and 2 of the 3 patients remain seizure free at last follow-up (range 20–36 months), all with stable or improved neuropsychological profiles, including verbal memory.CONCLUSIONSMHT is a relatively new surgical procedure designed to preserve essential memory circuitry while disrupting seizure propagation pathways in the hippocampus. A growing body of literature shows good seizure and neuropsychological results, but mainly in adults. This is the first series of MHTs used exclusively in children at one medical center, showcasing excellent seizure control and preservation of neuropsychological functioning. One of the patients is also the first described to have MHT in the setting of an amygdalar tumor abutting the hippocampus, further expanding the pathological setting in which MHT can be used effectively.

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Hippocampal transection for stereo-electroencephalography–proven dominant mesial temporal lobe epilepsy in a child: a detailed case report and critical review

Cited by 4 publications

References 12 publications

Serum Level of CEACAM1 in Patients with Nonsmall Cell Lung Cancer and Its Clinical Significance in Cancer Tissue

Serum Level of CEACAM1 in Patients with Nonsmall Cell Lung Cancer and Its Clinical Significance in Cancer Tissue

Neural recruitment by ephaptic coupling in epilepsy

Multiple hippocampal transections for refractory pediatric mesial temporal lobe epilepsy: seizure and neuropsychological outcomes

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