Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data

Sokolov, Elisaveta; Sisterson, Nathaniel D; Hussein, Helweh; Plummer, Cheryl; Corson, Danielle; Antony, Arun; Mettenburg, Joseph; Ghearing, Gena; Pan, Jullie W.; Urban, Alexandra; Bagić, Anto; Richardson, R. Mark; Kokkinos, Vasileios

doi:10.1002/epi4.12483

Cited by 8 publications

(5 citation statements)

References 51 publications

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“…As a clinical treatment for lung cancer and other serious lung diseases, lobectomy could effectively remove the focus and save the patient's life. Lobectomy has the disadvantages of considerable trauma, long operation time, and surgical solid stress response, which might seriously affect the patient's respiratory function and bring many complications [23].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy

Zhao

Wang

Ding

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the effect of dexmedetomidine on postoperative cognitive function and delirium in elderly patients undergoing thoracoscopic lobectomy. Methods. 109 elderly patients (age is more than 65 years) who underwent thoracoscopic lobectomy in our hospital from June 2020 to Feb 2022 were randomly divided into the dexmedetomidine (DEX) group (n = 54) and the control group (n = 55). The patients in the experimental group were given dexmedetomidine by intravenous pump, intravenous pump 0.5 μg/kg within 10 minutes, and maintained the speed of 0.5 μg/(kg. h) to 30 min before the operation was ended. The control group was given the same amount of normal saline. Delirium assessment-severity (CAM-S) assessment and Mini-Cog were used to assess the severity levels of POD and POCD 24 h before, 6 hours after, one day after the operation, three days after the operation, and 1 week after the operation. Serum TNF-αα and NSE levels were assessed by using enzyme-linked immunosorbent assay. NRS pain marks were assessed in the DEX group at postanesthesia care unit (PACU) and 24 postoperation. Surgical pierhysmographic index (SPI) evaluation was performed at five time points. Results. The Mini-Cog scores in the DEX group were markedly enhanced compared with those in the saline group 6 and 24 hours after the operation. The SPI values in the DEX group were markedly reduced within 2 min after intubation and at surgical sutures. Moreover, the CAM scores in the DEX group were markedly reduced 24 hours after the operation. Tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) levels were significantly decreased in the DEX group at T1∼T3. Conclusion. The use of dexmedetomidine in the thoracoscopic lobectomy in elderly patients could reduce the occurrence and severity of postoperative cognitive dysfunction and delirium.

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Section: Discussionmentioning

confidence: 99%

Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy

Zhao

Wang

Ding

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Similar outcomes have been found in other stereo-EEG-guided ablation cohorts (see Barot et al 7 for review), although few of these have focused on laser ablation for mTLE. 6,33 Comparing these outcomes to historical outcomes in stereo-EEG-guided ATL, 34,35 this cohort performed worse at 2 years. However, given the potential benefits of SLAH over ATL, there is a clinical need to develop biomarkers to identify ideal candidates.…”

Section: Discussionmentioning

confidence: 95%

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2023

Epilepsia

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Objective Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo‐EEG) may miss seizure onset elsewhere. We hypothesized that stereo‐EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2‐year outcomes of patients who underwent single‐fiber SLAH after stereo‐EEG and evaluated whether stereo‐EEG SOPs predict postoperative seizure freedom. Methods This retrospective five‐center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo‐EEG followed by single‐fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2‐year Engel I classification or recurrent seizures before then, stratified by SOP category. Results Fifty‐eight patients were included, with a mean follow‐up duration of 39 ± 12 months after SLAH. Overall 1‐, 2‐, and 3‐year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low‐voltage fast activity or low‐frequency repetitive spiking, had a 46% 2‐year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log‐rank test, p = .00015). Significance Patients who underwent SLAH after stereo‐EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

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“…Similar outcomes have been found in other sEEG-guided ablation cohorts (see Barot 2022 for review), though few of these have focused on laser ablation for mTLE. 5,32 Comparing these outcomes to historical outcomes in sEEG-guided ATL, 33,34 these cohorts performed worse at two years. However, given the potential benefits of SLAH over larger open resection, identifying predictive biomarkers will help identify ideal candidates.…”

Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2022

Preprint

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Objective: Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (sEEG) may miss seizure onset elsewhere. We hypothesized that sEEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the two-year outcomes of patients who underwent single-probe SLAH after sEEG and evaluated whether sEEG SOPs predict postoperative seizure freedom. Methods: This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent sEEG followed by single probe SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. A SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was two-year Engel I classification or recurrent seizures before then, stratified by SOP category. Results: 58 patients were included with a mean follow-up duration of 39 ± 12 months after SLAH. Overall one-, two, and three-year Engel I seizure freedom probability was 54%, 36%, and 33% respectively. Patients with SOPs including low voltage fast activity or low frequency repetitive spiking had a 46% two-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log rank test, p = 0.00015). Significance: Patients who underwent SLAH after sEEG had a low probability of seizure freedom at two years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

show abstract

Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data

Cited by 8 publications

References 51 publications

Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy

Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

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