Multimodality imaging in the surgical treatment of children with nonlesional epilepsy

Seo, Joo Hee; Holland, Katherine D.; Rose, Douglas F.; Rozhkov, Leonid; Fujiwara, Hisako; Byars, Anna W.; Arthur, Todd M.; deGrauw, Ton J.; Leach, James; Gelfand, Michael J.; Miles, Lili; Mangano, Francesco T.; Horn, Paul S.; Lee, K.H.

doi:10.1212/wnl.0b013e318204a380

Cited by 110 publications

(137 citation statements)

References 27 publications

(28 reference statements)

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“…The patient had a greater than 50% reduction of seizure frequency postoperatively and had an ILAE outcome score of 4, at 757 days of follow-up. successfully performing surgery on nonlesional cases, 29 likely reducing the natural selection bias for lesional cases that might exist at other institutions.…”

Section: Discussionmentioning

confidence: 99%

“…11,23,29 In brief, our standard presurgical evaluation included a detailed history and clinical examination, scalp video-EEG monitoring, MRI, PET, ictal/interictal SPECT with SISCOM, and MEG. All patients underwent scalp video-EEG monitoring and MRI, but not all patients necessarily received all the noninvasive functional tests.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Additionally, to reflect clinical practice, the resection region was also classified as "lesional" or "nonlesional" based on all imaging features as previously detailed. 29 Lesional classification was made if the combination of imaging features was strongly suggestive of CD and could potentially direct the resection (typically at least two MRI features of CD). Nonlesional classification was made if the MRI features were normal or if there were only nonspecific, nonlocalizing findings (for example, only small foci of abnormal white matter signal, only volume loss) that could not direct a potential resection.…”

Section: Mri Technique and Evaluationmentioning

confidence: 99%

“…Although better outcome was noted in our study in patients with MRI abnormalities, previous studies have demonstrated good results in MRInegative cases with careful selection. 6,29 Increased reliance on multimodality functional imaging and more extensive EEG evaluation is often necessary in these patients.…”

Section: Patient Outcomesmentioning

confidence: 99%

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Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Leach¹,

Miles²,

Henkel³

et al. 2014

PED

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Object The authors conducted a study to correlate histopathological features, MRI findings, and postsurgical outcomes in children with cortical dysplasia (CD) by performing a novel resection site–specific evaluation. Methods The study cohort comprised 43 children with intractable epilepsy and CD. The MR image review was blinded to pathology but with knowledge of the resection location. An MRI score (range 0–7) was calculated for each resection region based on the number of imaging features of CD and was classified as “lesional” or “nonlesional” according to all imaging features. Outcome was determined using the International League Against Epilepsy (ILAE) scale. The determination of pathological CD type was based on the ILAE 2011 consensus classification system, and the cortical gliosis pattern was assessed on GFAP staining. Results There were 89 resection regions (50 ILAE Type I, 29 Type IIa, and 10 Type IIb). Eleven (25.6%) of 43 children had more than one type of CD. The authors observed MRI abnormalities in 63% of patients, characteristic enough to direct resection (lesional) in 42%. Most MRI features, MRI score ≥ 3, and lesional abnormalities were more common in patients with Type II CD. Increased cortical signal was more common in those with Type IIb (70%) rather than Type IIa (17.2%) CD (p = 0.004). A good outcome was demonstrated in 39% of children with Type I CD and 72% of those with Type II CD (61% in Type IIa and 100% in Type IIb) (p = 0.03). A lesional MRI abnormality and an MRI score greater than 3 correlated with good outcome in 78% and 90% of patients, respectively (p < 0.03). Diffuse cortical gliosis was more prevalent in Type II CD and in resection regions exhibiting MRI abnormalities. Complete surgical exclusion of the MRI abnormality was associated with a better postoperative outcome. Conclusions This study provides a detailed correlation of MRI findings, neuropathological features, and outcomes in children with intractable epilepsy by using a novel resection site–specific evaluation. Because 25% of the patients had multiple CD subtypes, a regional analysis approach was mandated. Those children with lesional MRI abnormalities, Type II CD, and surgical exclusion of the MRI abnormality had better outcomes. Type II CD is more detectable by MRI than other types, partly because of the greater extent of associated gliosis in Type II. Although MRI findings were correlated with the pathological CD type and outcome in this study, the majority of patients (58%) did not have MRI findings that could direct surgical therapy, underscoring the need for improved MRI techniques for detection and for the continued use of multimodal evaluation methods in patient selection.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Mri Technique and Evaluationmentioning

confidence: 99%

Section: Patient Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Leach¹,

Miles²,

Henkel³

et al. 2014

PED

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“…23,[38][39][40] In one study, 23 the results for two methods of PET interpretation-visual analysis (V) and statistical parametric mapping (SPM)-were reported. SPM using a threshold of p < 0.001 provided a sensitivity of 86% when measured against intracranial EEG.…”

Section: Diagnostic Accuracymentioning

confidence: 99%

The Utility of Positron Emission Tomography in Epilepsy

Burneo

Poon

Kellett

et al. 2015

Can. J. Neurol. Sci.

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The role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. In adult patients, PET hypometabolism showed a 56 to 90% agreement with seizure onset localized by intracranial electroencephalogram (pediatric: 21 to 86%). In temporal lobe epilepsy patients with good surgical outcome, PET displayed moderate to high sensitivity in localizing the seizure focus (range: 71 to 89%). The sensitivity increased by 8 to 23% when PET results were combined with magnetic resonance imaging or electroencephalogram. PET has been shown to affect patient management by improving the guidance of intracranial electrodes placement, altering the decision to perform surgery, or excluding patients from further evaluation.RÉSUMÉ: Utilité de la tomographie par émission de positons dans l'épilepsie. Le rôle de la tomographie par émission de positons (PET scan) au 18F fluodésoxyglucose (18F-FDG) dans l'évaluation préchirurgicale de patients présentant une épilepsie réfractaire au traitement médical est constamment raffiné. Le but de cette étude était de revoir systématiquement la littérature afin d'évaluer la précision du diagnostic et l'utilité du PET scan dans ce contexte. Nous avons identifié 39 études dans les bases de données MEDLINE et EMBASE qui rencontraient nos critères d'inclusion. Chez les patients adultes, un hypométabolisme au PET scan concordait entre 56 et 90% avec le début de la crise localisé par l'électroencéphalographie intracrânienne (patients pédiatriques: entre 21 et 86%). Chez les patients atteints d'épilepsie temporale chez qui le résultat chirurgical avait été favorable, le PET scan avait une sensibilité de modérée à élevée pour localiser le foyer épileptogène (écart : 71 à 89%). La sensibilité augmentait de 8 à 23% quand les résultats du PET scan étaient combinés à l'imagerie par résonance magnétique ou à l'électroencéphalographie. Il est démontré que le PET scan influence le traitement du patient en améliorant le guidage lors de la mise en place des électrodes intracrâniennes, en modifiant la décision de procéder à une chirurgie ou en évitant de procéder à des examens plus poussés chez certains patients.

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Advanced Treatments for Childhood Epilepsy

Joshi

Singh

Shellhaas³

2013

JAMA Pediatr

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A substantial minority of children with epilepsy have continued seizures despite adequate trials of standard antiseizure medications. To maximize seizure control and thereby optimize their neurodevelopmental outcomes, alternate nonmedication therapies should be considered for these patients. Dietary therapies, including the ketogenic diet and its variations, have been available for years. With a recent resurgence in popularity and expansion of indications, these treatments can lead to freedom from seizures or a significantly reduced seizure burden for a large number of patients. For carefully selected individuals, resective epilepsy surgery may offer the best hope for a cure. For others, palliation may be achieved through additional surgical approaches, such as corpus callosotomy and multiple subpial transections, or through neurostimulation techniques, such as the vagus nerve stimulator. In this review, we present these nonmedication approaches to treatment-resistant childhood epilepsy, with attention to patient selection and the potential risks and benefits.

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Multimodality imaging in the surgical treatment of children with nonlesional epilepsy

Cited by 110 publications

References 27 publications

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

The Utility of Positron Emission Tomography in Epilepsy

Advanced Treatments for Childhood Epilepsy

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