Epilepsy research
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To study postoperative seizure control of hemispherectomy in adults with epilepsy and evaluate changes of movement and speech function, intelligence quotient (IQ) and quality of life (QOL) after hemispherectomy. ⋯ Hemispherectomy presented good seizure control and improvement in QOL and IQ, and impairment on motor and speech function were mild. Furthermore, patients with early seizure onset could maintain movement function of upper limb and speech function improvement. Therefore, it is worth pursuing hemispherectomy in well-selected adults with severe unilateral epilepsy and hemiplegia.
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Asymmetry of hippocampal internal architecture (HIA) has been reported to be a frequent imaging finding in epilepsy patients with temporal lobe epilepsy (TLE) who exhibit other signs of hippocampal sclerosis. HIA asymmetry may also be an independent predictor of the side of seizure onset in patients with otherwise normal MRI scans. The study of HIA asymmetry and its relationship to the laterality of TLE would benefit from a reliable method of assessing the clarity of HIA in MRI scans. We propose a visual scoring system that rates HIA clarity from 1 (imperceptible) to 4 (excellent) and report the inter-rater reliability (IRR) of this system. ⋯ The proposed HIA scoring system has a substantial degree of inter-rater reliability among experienced neuroimaging reviewers. Training improves the detection of asymmetries in HIA score in particular. Non-expert reviewers can employ the system with a moderate degree of reliability, and training has an even greater impact on the improvement of scoring reliability.
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To investigate the validity of magnetic source imaging (MSI) to localize seizure-onset zone using 3D analysis of pre-operative MSI source imaging coregistered to post-resection MRI following neocortical epilepsy surgery. ⋯ Number and density of clustered spike dipole sources within the surgical resection volume is not associated with postoperative seizure-free outcome. MSI successfully localized the perilesional epileptogenic zone in cases with localized MRI lesions, but not in cases with normal MRI in this study. Even if MEG localizes spikes to a single focal region, confirmation of epilepsy localization with intracranial EEG is still recommended in cases with non-lesional MRI.