Surgical Treatment of Pediatric Epilepsy

Ojemann, Jeffrey G.

doi:10.1055/s-2002-35249

Cited by 10 publications

(10 citation statements)

References 79 publications

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“…Recent developments in neuroimaging have had significant impact on the strategy for selecting patients for epilepsy surgery. Of particular import has been improvement of magnetic resonance (MR) technologies, with >60% of all current epilepsy surgeries being performed on patients with structural lesions identified through magnetic resonance imaging (MRI) (Awad et al., 1991; Kuzniecky et al., 1993; Cascino, 1996; Ojemann, 1996). In cases where electroencephalography (EEG) data are concordant with identified structural lesions, the curative success of surgery is high (Wyllie et al., 1987; Cascino et al., 1992b; Haglund & Ojemann, 1993; Piepgras et al., 1993; Garcia et al., 1994; Salanova et al., 1999).…”

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confidence: 99%

“…In cases where electroencephalography (EEG) data are concordant with identified structural lesions, the curative success of surgery is high (Wyllie et al., 1987; Cascino et al., 1992b; Haglund & Ojemann, 1993; Piepgras et al., 1993; Garcia et al., 1994; Salanova et al., 1999). In patients with unilateral mesial temporal sclerosis and concordant scalp EEG findings, a seizure‐free outcome can be achieved in >80% of cases (Wyllie et al., 1987; Awad et al., 1991; Haglund & Ojemann, 1993; Garcia et al., 1994; Cascino, 1996; Ojemann, 1996; Salanova et al., 1999; Iwasaki et al., 2002). Unfortunately, surgical treatment of patients with neocortical epilepsy remains a difficult challenge because routine clinical MRI often fails to identify structural lesions (Schwartz et al., 1989; Cascino et al., 1992a; Olivier & Awad, 1993).…”

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confidence: 99%

“…However, when MRI is reported as normal or without focal pathology, MEG findings alone are generally considered inadequate to guide surgical intervention. Hence, even when MEG indicates a focal zone of epileptiform activity, when no concordant MR lesion has been identified, most epilepsy teams seek additional concordant data through positron emission tomography (PET), single photon emission computer tomography (SPECT), ictal scalp EEG, or intracranial monitoring with subdural grids or depth electrodes (Cascino, 1996; Ojemann, 1996; Schwartz et al., 1989; Olivier & Awad, 1993). As demonstrated herein, our investigative team has found that it is useful to reevaluate MR data in specific light of MEG findings, as this can reveal previously unappreciated structural lesions.…”

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The role of magnetoencephalography in “nonlesional” epilepsy

et al. 2011

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SUMMARYThe surgical management of neocortical epilepsy is challenging because many patients are without obvious structural lesions, or lesions are small and easily overlooked during routine clinical interpretation of magnetic resonance imaging (MRI) data. Even when functional imaging data suggest focal epileptiform pathology, in the absence of a concordant structural lesion, invasive monitoring is often required to confirm that an appropriate surgical target has been identified. This study sought to determine the extent to which knowledge of magnetoencephalography (MEG) data can augment the MRI-based detection of structural brain lesions. MRI and whole-head MEG data were obtained from 40 patients with neocortical epilepsy. As a result of MEG data, 29 cases were sent for MRI reevaluation. In seven of these cases, MEG-guided review led to specification of now clear, but previously unidentified, lesions. There were two additional cases for which follow-up high-resolution imaging did not confirm structural abnormalities. In patients with neocortical epilepsy, MEG is a useful adjunct to MRI for the identification of structural lesions.

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The role of magnetoencephalography in “nonlesional” epilepsy

et al. 2011

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“…A margin of up to 2 cm (or one gyrus) is routinely left for resections of seizure foci near motor or language areas. 17 Positive ICS occurred in four (40%) of 10 patients without statistically significant PET activation. Although not statistically significant, t-statistic peaks were observed in the contralateral central region in eight of the 10 patients.…”

Section: Methodological Issuesmentioning

confidence: 94%

Localization of somatosensory function by using positron emission tomography scanning: a comparison with intraoperative cortical stimulation

Bittar¹,

Olivier²,

Sadikot³

et al. 2000

FOC

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Object To investigate the utility of [15O]H2O positron emission tomography (PET) activation studies in the presurgical mapping of primary somatosensory cortex, the authors compared the magnitude and location of activation foci obtained using PET scanning with the results of intraoperative cortical stimulation (ICS). Methods The authors used PET scanning and vibrotactile stimulation (of the face, hand, or foot) to localize the primary somatosensory cortex before surgical resection of mass lesions or epileptogenic foci affecting the central area in 20 patients. With the aid of image-guided surgical systems, the locations of significant activation foci on PET scanning were compared with those of positive ICS performed at craniotomy after the patient had received a local anesthetic agent. In addition, the relationship between the magnitude and statistical significance of blood flow changes and the presence of positive ICS was examined. In 22 (95.6%) of 23 statistically significant (p < 0.05) PET activation foci, spatially concordant sites on ICS were also observed. Intraoperative cortical stimulation was positive in 40% of the PET activation studies that did not result in statistically significant activation. In the patients showing these results, there was a clearly identifiable t-statistic peak that was spatially concordant with the site of positive ICS in the sensorimotor area. All PET activation foci with a t statistic greater than 4.75 were associated with spatially concordant sites of positive ICS. All PET activation foci with a t statistic less than 3.2 were associated with negative ICS. Conclusions Positron emission tomography is an accurate method for mapping the primary somatosensory cortex before surgery. The need for ICS, which requires local anesthesia, may be eliminated when PET foci with high (> 4.75) or low (< 3.20) t-statistic peaks are elicited by vibrotactile stimulation.

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“…Other options for therapy, such as additional medication, polytherapy, and vagus nerve stimulation, may be palliative but have a much lower seizure cure rate than surgery in patients with focal onset. 27 Surgical treatment of tumors for epilepsy may use electrophysiology to maximize seizure outcomes 28,29 though this is not always employed. 16 Patients with high-grade tumors are less often operated on solely for control of their seizure disorder, perhaps because of the decreased length of expected survival.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy surgery after treatment of pediatric malignant brain tumors

Ojemann

Hersonskey

Abeshaus

et al. 2012

Seizure

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Epilepsy surgery is common in the face of benign brain tumors, but rarely for patients with a history of malignant brain tumors. Seizures are a common sequelae in survivors of malignant pediatric brain tumors. Medical management alone may not adequately treat epilepsy, including in this group. We report four cases of patients who previously underwent gross total resection, radiation therapy, and chemotherapy for successful treatment of malignant brain neoplasia, yet suffered from medically intractable seizures. All underwent surgery for treatment of epilepsy with extension of the original resection. Despite the aggressive primary treatment of the neoplasm, and the potential for diffuse cerebral insults, all benefited from focal surgical resection. Aggressive surgical management of intractable epilepsy can be considered in survivors of malignant brain tumors.

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Surgical Treatment of Pediatric Epilepsy

Cited by 10 publications

References 79 publications

The role of magnetoencephalography in “nonlesional” epilepsy

The role of magnetoencephalography in “nonlesional” epilepsy

Localization of somatosensory function by using positron emission tomography scanning: a comparison with intraoperative cortical stimulation

Epilepsy surgery after treatment of pediatric malignant brain tumors

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