(Re)Defining success in epilepsy surgery: The importance of relative seizure reduction in patient‐reported quality of life

Sheikh, Shehryar; Thompson, Nic; Bingaman, William; González-Martínez, Jorge; Najm, Imad; Jehi, Lara

doi:10.1111/epi.16327

Cited by 30 publications

(22 citation statements)

References 32 publications

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“…CC1 and CC2 are comparable, which agrees with current data suggesting that lesional and temporal lobe epilepsy have the highest rates of surgical success [55,56,57,58]. Extratemporal (CC4) and multi-focal (CC4) patients tend to have lower success rates due to insufficient localizations and thus the neural fragility confidence in those SOZ localizations should be low [55,59,60,61]. Finally, we examine the success probability differences based on gender, handedness, onset age and surgery age to show that there are no relevant differences (Supplemental Figure 19).…”

Section: Fragility Correlates With Clinical Complexity and Treatment supporting

confidence: 90%

“…Challenges in validating iEEG features as SOZ markers Many features have been proposed as potential biomarkers for the SOZ, but none have successfully translated into the clinical workflow [27,26,28,62,63,55,31]. Current limitations for evaluating computational approaches to localization can be largely attributed to i) the lack of ground-truth labels for the true underlying SOZ (it cannot be observed in practice because there is no biomarker), ii) insufficient benchmarking to other iEEG features and iii) a lack in sufficient sampling across epilepsy etiologies.…”

Section: Discussionmentioning

confidence: 99%

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Neural Fragility as an EEG Marker of the Seizure Onset Zone

Huynh

Fitzgerald

et al. 2019

Preprint

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Epilepsy is a global epidemic and 30% of the 60 million patients do not respond to medication treatment. The only treatment options for patients with medically refractory epilepsy are surgical removal or electrical stimulation of the epileptogenic zone (EZ) i.e. the source of their seizures. Despite extensive evaluations with neuroimaging, visual EEG analysis and clinical testing, surgical success rates vary between 30-70%. Currently, no computational methods have been translated into the clinic to assist in localizing the EZ. Here, we applied a dynamical network model that quantifies the fragility of nodes within a patient's intracranial EEG (iEEG) brain network. Fragility is quantified as the minimal amount of perturbation that must to be applied to a node's influence on a "balanced" network to cause imbalance. Here, a balanced network is one in which the connectivity between excitatory and inhibitory nodes render a stable system, and an imbalanced network is unstable and hence can generate seizures. Using iEEG data from 91 patients treated across 5 epilepsy centers (44 successes, 47 failures), we demonstrated that nodal fragility is greater in electrodes within the EZ. In addition, we compared fragility of iEEG nodes to 7 frequency-based and 14 graph theoretic features of the EZ in both seizure (n=91) and non-seizure data (n=54). We calculated a confidence statistic, defined as the ratio of the value of a given feature averaged across electrodes in the clinically annotated seizure onset zone to its average across all other electrodes. Fragility has a significantly greater effect size difference between surgical outcomes when compared to other features. This novel feature, outperformed the most popular iEEG features when comparing across surgical outcomes, possibly defining a superior network-based EEG fingerprint for the EZ.1 Also reachable at adam2392 at gmail dot com. For more information, visit the NCSL website: https://sarmalab.icm.jhu.edu/.

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Section: Fragility Correlates With Clinical Complexity and Treatment supporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Huynh

Fitzgerald

et al. 2019

Preprint

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“…Furthermore, few patients in our study had high-grade gliomas (5) and meningiomas (2). These patients showed favorable outcome during the rst-year post epilepsy surgery (60% and 100%, respectively).…”

Section: Discussionmentioning

confidence: 69%

“…Seizures have negative impact on quality of life, particularly in social, economic and cognitive domains and increases the risk of sudden unexpected death (SUDEP) in epilepsy has been established, [1] however post epilepsy surgery seizure reduction and/or freedom has been shown to improve quality of life. [2] While approximately 30-50% of patients with brain tumors have epilepsy as an initial presentation, [3] 6-45% of patients with brain tumors develop seizures later in their life. [4,5] Although the exact mechanism of development of seizures in patients with brain tumors is not clearly understood, recent studies have identi ed that some changes in the peritumoral regions play a role in the release of neurotransmitters that lead to the development of seizures.…”

Section: Introductionmentioning

confidence: 99%

Tumour - Related Epilepsy and Post-Surgical Outcome: Tertiary Hospital Experience in Saudi Arabia

Al-Attas¹,

Alhindi²,

AbaAlkhail³

et al. 2020

Preprint

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Background Some studies have suggested that tumor pathology significantly influence freedom from seizures post epilepsy surgery; however, there is no consensus among researchers regarding this issue. This study aims to retrospectively look for different types of tumor- related epilepsy and their outcomes in the first-year post epilepsy surgery among both adults and children. Methods In this hospital-based retrospective study, patients with drug resistant epilepsy due to brain tumor who underwent epilepsy surgery were included. Our patients underwent a thorough presurgical evaluation in an Epilepsy Monitoring Unit (EMU) before deciding to undergo surgical intervention, according to an epilepsy case-management conference. Four outcomes of interest were investigated during the first-year post epilepsy surgery.Results One hundred patients with brain tumors were included in this study (male: female = 3:2); 45 patients were children. Most of the patients (93) had low-grade gliomas or glioneuronal tumors (G/GNT). No significant differences in outcome were observed between sex, age, or histopathological categories. However, during the first year after epilepsy surgery most of the low-grade G/GNT cases showed favorable outcomes of International League Against Epilepsy (ILAE) class 1 and 2 (61.3% and 9.7%, respectively), while high-grade gliomas and meningothelial tumors showed outcomes of ILAE class 1 (40% and 100%, respectively). Conclusions One-year favorable outcome of post epilepsy surgery of different brain tumors have been achieved among both children and adults. Adequate presurgical evaluation in EMU (for long-term video-electroencephalography monitoring) to plan appropriate surgical strategy is advised. Tumor Pathology does not influence seizure outcome one-year post epilepsy surgery.

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“…The existence of DRE is the main motivation to continue the development of new drugs and for surgical epilepsy therapies with the stated goal of eliminating all seizures, regardless of their type. Although worthwhile efforts at finding a “cure” should continue, recent data highlight the benefits of seizure reduction in patients undergoing epilepsy surgery, even when seizure‐freedom is not accomplished 9 . This observation opens the door for several currently unanswered clinical questions: What are the benefits of seizure reduction—by itself—in the larger population of medically treated patients with DRE, and are these benefits influenced by seizure characteristics, particularly seizure type?…”

Section: Introductionmentioning

confidence: 99%

Quantifying the burden of generalized tonic‐clonic seizures in patients with drug‐resistant epilepsy

et al. 2020

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Objective: Compared to other seizure types, generalized tonic-clonic (GTC) seizures may be disproportionately related to increased morbidity, and reducing seizure frequency could translate into improvements across measures of morbidity in medically treated patients with drug-resistant epilepsy (DRE). The primary objective of this analysis was to quantify the burden of patients with DRE who experience GTC seizures (GTC+) compared to patients with DRE who do not experience GTC seizures (GTC−). Methods: Adult patients from the Cleveland Clinic Epilepsy Center-Neurological Institute from 2012-2016 with DRE with epilepsy for at least 1 year were eligible for inclusion and were divided into GTC ± groups based on whether the patient had experienced a GTC seizure in the year preceding the first visit. Epilepsy duration, comorbidities, antiepileptic drug use, patient-reported outcomes (PROs) and seizure type, frequency, and etiology were captured. Generalized linear models, negative binomial regression, logistic regression, and linear regression were used as appropriate for multivariate analyses. Results: A total of 379 patients met inclusion criteria and had data at 1-year followup after their baseline visit (192 GTC+ and 187 GTC−). Although DRE patients experiencing GTC seizures had fewer seizures per day over the preceding 6 months than those not experiencing GTC seizures, seizure severity and levels of depression and anxiety were greater. GTC+ patients who reported five or more seizures in the preceding 4 weeks had 82% lower odds (1−0.18 = 0.82) of working than patients with no seizures. Significance: Patients with DRE experience a significant burden and decreased quality of life. Multivariate analysis is necessary to understand the complex relationship between seizure type, frequency, and impact on health-related quality of life (HRQoL) and changes over time. Effective treatments to reduce the burden for DRE patients who experience GTC seizures continue to be needed.

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(Re)Defining success in epilepsy surgery: The importance of relative seizure reduction in patient‐reported quality of life

Cited by 30 publications

References 32 publications

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Tumour - Related Epilepsy and Post-Surgical Outcome: Tertiary Hospital Experience in Saudi Arabia

Quantifying the burden of generalized tonic‐clonic seizures in patients with drug‐resistant epilepsy

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