Presurgical evaluation and epilepsy surgery in MRI negative resistant epilepsy of childhood with good outcome

Abstract

Magnetic resonance imaging (MRI)-negative epilepsy may be successfully solved with a multidisciplinary approach using invasive recordings, image and signal analysis. The whole methodology used by the epilepsy surgery team is systematically described based on an resistant epilepsy case with all steps and rationale of choosing different investigation methods from surface electroencephalography (EEG) to invasive recordings. Due to negative MRI and non-concordant ictal surface EEG with clinical semiology, the patient was investigated with stereo-EEG (SEEG), aiming to delimitate epileptogenic and eloquent cerebral areas. Implantation strategy, seizures recordings, stimulation, resection planning using quantitative EEG analysis, and the surgery plan are presented. The patient has been seizure-free for 14 months so far, with improved behavior and daily life quality. Post-operative examination revealed focal cortical dysplasia type II B.KeywOrds: Epilepsy surgery, Focal cortical dysplasia, MRI-negative postsurgical outcome, Resistant epilepsy, Stereo-EEG ÖZManyetik rezonans görüntüleme (MRG)-negatif epilepsi, invaziv kayıt alma, görüntü ve sinyal analizini kapsayan mültidisipliner bir yaklaşımla başarılı bir şekilde tedavi edilebilir. Dirençli bir epilepsi olgusu temelinde epilepsi cerrahisi ekibinde kullanılan tüm metodoloji tüm basamakları ile, yüzey elektroensefalografisinden (EEG) invaziv kayıt almaya kadar değişik inceleme teknikleri arasından uygun olanı seçilerek, tanımlanmıştır. Olgu MRG negatif olduğu ve klinik tablo ile iktal yüzey EEG uyumsuz olduğu için stereo-EEG (SEEG) kullanılarak epileptojenik bölgeler ile fonksiyonel beyin alanlarının ayırt edilmesi hedeflenmiştir. Bu olgunun implantasyon stratejisi, nöbet kayıtları, stimülasyon, kantitatif EEG analizi ile rezeksiyon planlaması ve cerrahi planı sunulmuştur. Hastada 14 ay boyunca nöbet izlenmemiştir, davranışları ve günlük yaşam kalitesi düzelmiştir. Postoperatif inceleme Tip II B fokal kortikal displazi olduğunu göstermiştir.AnAhtAr sÖZCÜKler: Epilepsi cerrahisi, Fokal kortikal displazi, MRG-negatif cerrahi sonrası sonuç, Dirençli epilepsi, Stereo-EEG

Ecological Dynamics: An Inspiration for Triggering Epilepsy

“…Surgical removal of ictogenic zones is necessary for patients with refractory epilepsy [104]. In the United States, there are 4 x 10 5 to 6 x 10 5 patients with refractory epilepsy and only 2-3% epileptic patients are off ered surgery [105,106]. In 97-98% patients, it is diffi cult to localize ictogenic zone [83] whereas 66% patients are found seizure free after temporal lobe resections, 27% after frontal lobe resections and 46% after occipital and parietal resections [65].…”

High Frequency Neuromagnetic Signals: A New Biomarker for Localizing Epileptic Areas Running Title: High-Frequency Neuromagnetic Signals in Epilepsy

“…Unfortunately, epilepsy surgery is offered to only 2-3% of potential surgical candidates in the United States [7][8][9]. This is because many patients are not considered candidates for surgical management because a single region causing the seizures (ictogenic zone) cannot be identified [4,8,9]. Although epilepsy surgery is expensive and the overall costs of surgical or medical management are similar in the first 2 years, patients who achieve seizure freedom after surgery have significantly lower costs compared with those treated with medication over the long-term [1,10].…”

A Stacked Sparse Autoencoder-Based Detector for Automatic Identification of Neuromagnetic High Frequency Oscillations in Epilepsy

“…The current clinical practice to estimate the epileptogenic zones replies on a variety of diagnostic indicators. With existing methods using epileptic spikes (typically < 70 Hz), surgery is ultimately unsuccessful in controlling seizures in approximately 50% of the cases [3][4][5][6][7][8]. However, recent reports [8][9][10][11][12] show that about 80% of patients with epilepsy could be seizure free if high frequency oscillations (HFOs, typically > 70 Hz) are used to localize ictogenic zones.…”