Surgery for epilepsy in the primary motor cortex: A critical review

Ostergard, Thomas; Miller, Jonathan P.

doi:10.1016/j.yebeh.2018.06.036

Cited by 17 publications

(13 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other four cases had no NPMD. This reflected the possible stronger plasticity in the developing brain [12,13]. Our study also showed that seven (8%) patients had NPMD postoperatively, while CMAP was stable intraoperatively.…”

Section: Discussionsupporting

confidence: 69%

Surgical treatment of children with drug‐resistant epilepsy involving the Rolandic area

Wang

Zhang

Liu

et al. 2021

Epileptic Disorders

View full text Add to dashboard Cite

Objective. We retrospectively analysed the clinical features and prognostic factors of surgery in children with drug-resistant epilepsy involving the Rolandic area, and the relationship between the stable compound muscle action potentials (CMAPs) of intraoperative neurophysiological monitoring (IONM) and good motor function outcomes postoperatively. Methods. A study was conducted on the clinical data of 91 patients with epilepsy who underwent epilepsy surgery involving the Rolandic area and IONM from November 2015 to February 2019. Results. In total, 91 patients were included in this study. The median age at seizure onset was 1.3 years old. The median age at surgery was 4.4 years old. Twenty-seven patients (29.7%), with age at onset below three years old, had epileptic spasms. The central operculum was the most common surgical region in 52 patients (57.1%). The most common pathology was focal cortical dysplasia (FCD) in 67 patients. At the last follow-up visit, 69 patients (75.8%) were seizure-free. Interictal epileptiform discharges in the Rolandic area were associated with good seizure outcome (p=0.016). Out of 91 patients, successful IONM was performed in 88 patients (96.7%). Stable CMAP was seen in 79 of 88 patients (89.8%), and irreversible disappearance of CMAP was seen in nine patients (10.2%). New permanent motor deficit was observed in 13 of 88 patients (14.8%). There was a significant correlation between stable CMAP and good motor function outcome (p<0.001). Significance. This is the largest reported cohort of children with drug-resistant epilepsy involving the Rolandic area who received surgery from a single centre. Epileptic spasms were only observed in young children with age at onset below three years old. The major aetiology was FCD. The rate of seizure freedom was 75.8%. Epileptiform discharges in the Rolandic area were the main prognostic factor affecting surgical outcome. Stable CMAP can predict good motor function outcome postoperatively.

show abstract

Section: Discussionsupporting

confidence: 69%

Surgical treatment of children with drug‐resistant epilepsy involving the Rolandic area

Wang

Zhang

Liu

et al. 2021

Epileptic Disorders

View full text Add to dashboard Cite

show abstract

“…PG also comprises part of the supplementary motor cortex, which is responsible for the control of voluntary muscle contraction of the upper and lower limbs (33). When PG lesions occur, patients show dysfunction of the upper motor neurons with associated muscle weakness, abnormal muscle tone, contralateral paralysis (facial, leg, and arm paralysis), and pathological muscle stretch reflexes (such as Babinski sign) (34). Combining the above evidence with the decreased PG PerAF in this study, we can speculate that the extending terminal branches of the carotid artery may, to some extent, be compressed and cause PG dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Altered Spontaneous Brain Activities in Patients With Moyamoya Disease Using Percent Amplitude of Fluctuation Method: A Resting-State Functional MRI Study

Shu

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Background: Moyamoya disease (MMD) is a chronic progressive cerebrovascular abnormality characterized by chronic occlusion of large intracranial vessels with smoky vascular development at the base of the skull. In patients with MMD, abnormal spontaneous brain activity would be expected.Purpose: To assess the brain activity changes in patients with MMD by resting-state functional MRI (rs-fMRI), using the percent amplitude of fluctuation (PerAF) analysis method.Materials and Methods: A total of 17 patients with MMD (3 males and 14 females) and 17 healthy control (HC) subjects with matched gender and age were recruited for this study. We used rs-fMRI to scan all the patients with MMD. Spontaneous neural activity was evaluated using the PerAF approach. The receiver operating characteristic (ROC) curve analysis was used to assess the ability of the PerAF to distinguish patients with MMD from HCs. The Hospital Anxiety and Depression Scale (HADS) tests were performed to assess the emotional status of patients with MMD and retinal nerve fiber layer thickness (RNFLT) was measured using high-resolution optical coherence tomography (hr-OCT). The relationship between the HADS scores, RNFLT values, and the PerAF signals was assessed using the Pearson's correlation analysis.Results: Compared with HCs, the PerAF signals in patients with MMD were decreased in the Frontal_Sup_Medial_R and Precentral_L, whereas those in the Caudate_L were increased. The areas under the ROC curves indicated that signals in these brain regions could distinguish between patients with MMD and HCs. The PerAF value of Frontal_Sup_Medial_R was positively correlated with the left and right eye RNFLT values and negatively correlated with the HADS scores.Conclusion: In patients with MMD, reduced PerAF signals in the Frontal_Sup_Medial_R, Precentral_L, and Caudate_L may be associated with psychiatric diseases including anxiety and depression and decreased RNFLT may be associated with ophthalmic complications due to the compression of terminal branches of the internal carotid artery in the retinal fiber layer. The PerAF can be used as an effective indicator of ocular complications of MMD and to study the neural mechanism underpinning emotional complications in patients with MMD.

show abstract

“…Seizure semiology is the key to differentiating types of FLE. 3,32 The prefrontal cortex is involved in emotion processing, moral behavior, executive functions, working memory, and learning, and seizures typically arising from this area are hypermotor seizures, which are associated with the preservation of consciousness, usually occur during sleep, and are preceded by an aura. 3 Their complex semiology may be caused by the disruption of neuronal synchrony between different cerebral regions.…”

Section: Discussionmentioning

confidence: 99%

Unilateral prefrontal lobotomy for epilepsy: technique and surgical anatomy

Cossu

González-López

Pralong

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVESurgery for frontal lobe epilepsy remains a challenge because of the variable seizure outcomes after surgery. Disconnective procedures are increasingly applied to isolate the epileptogenic focus and avoid complications related to extensive brain resection. Previously, the authors described the anterior quadrant disconnection procedure to treat large frontal lobe lesions extending up to but not involving the primary motor cortex. In this article, they describe a surgical technique for unilateral disconnection of the prefrontal cortex, while providing an accurate description of the surgical and functional anatomy of this disconnective procedure.METHODSThe authors report the surgical treatment of a 5-month-old boy who presented with refractory epilepsy due to extensive cortical dysplasia of the left prefrontal lobe. In addition, with the aim of both describing the subcortical intrinsic anatomy and illustrating the different connections between the prefrontal lobe and the rest of the brain, the authors dissected six human cadaveric brain hemispheres. These dissections were performed from lateral to medial and from medial to lateral to reveal the various tracts sectioned during the three different steps in the surgery, namely the intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection.RESULTSThe first step of the dissection involves cutting the U-fibers. During the anterior intrafrontal disconnection, the superior longitudinal fasciculus in the depth of the middle frontal gyrus, the uncinate fasciculus, and the inferior frontooccipital fasciculus in the depth of the inferior frontal gyrus at the level of the anterior insular point are visualized and sectioned, followed by sectioning of the anterior limb of the internal capsule. Once the frontal horn is reached, the anterior callosotomy can be performed to disconnect the genu and the rostrum of the corpus callosum. The intrafrontal disconnection is deepened toward the falx, and at the medial surface, the cingulum is sectioned. The frontobasal disconnection involves cutting the anterior limb of the anterior commissure.CONCLUSIONSThis technique allows selective isolation of the epileptogenic focus located in the prefrontal lobe to avoid secondary propagation. Understanding the surface and white matter fiber anatomy is essential to safely perform the procedure and obtain a favorable seizure outcome.

show abstract

Surgery for epilepsy in the primary motor cortex: A critical review

Cited by 17 publications

References 63 publications

Surgical treatment of children with drug‐resistant epilepsy involving the Rolandic area

Surgical treatment of children with drug‐resistant epilepsy involving the Rolandic area

Investigation of Altered Spontaneous Brain Activities in Patients With Moyamoya Disease Using Percent Amplitude of Fluctuation Method: A Resting-State Functional MRI Study

Unilateral prefrontal lobotomy for epilepsy: technique and surgical anatomy

Contact Info

Product

Resources

About