Epilepsy research
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Surgical resection of the seizure onset zone (SOZ) requires that this region of the cortex is accurately localized. The onset of a seizure may be marked by transient discharges, but it also may be accompanied by oscillatory, sinusoidal electrographic activity, such as the EEG theta rhythm. However, because of the superposition of the seizure signal with other electrical signals, including noise artifacts and non-seizure brain activity, noninvasive Electrical Source Imaging (ESI) of the ictal EEG activity at seizure onset remains a challenging task for surgical planning. ⋯ For the lateralization measure, the results from HD-EEG with interictal spikes (8/10) and with ictal onset (10/10) were more accurate than international 10-20 EEG for interictal spikes (5/10) and ictal onset (5/10). ESI from HD-EEG with ictal onset (9/10) had greater concordance to the clinical criteria than HD-EEG with interictal spikes (6/10). Noninvasive ESI of oscillatory features at ictal onset using 256-channel HD-EEG and high-resolution individual head models can make a useful contribution to the clinical localization of the SOZ in presurgical planning.
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The analysis of circadian rhythm of heart rate variability in patients with drug-resistant epilepsy.
The aim of this study was to investigate the variations and the circadian rhythm of multi-domain parameters of heart rate variability (HRV) in patients with drug-resistant epilepsy. ⋯ The significant suppression of HRV parameters in patients with refractory epilepsy may reflect the inhibitions of both sympathetic and parasympathetic activities. This is notably the first time that marked circadian diversity of HRV measurments between the patient and control groups were found and quantified by cosinor fit method. The difference in amplitude increased during night with peak occurrence between 5:00 or 6:00 a.m. These findings may be linked to cardiac autonomic dysfunction and subsequent sudden unexpected death in epilepsy (SUDEP), which is reported to often occur during night or early morning. Taken together, HRV parameters may be potential bio-markers for predicting SUDEP.
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About 2.8 million TBI-related emergency department visits, hospitalizations and deaths occurred in 2013 in the United States. Post-traumatic epilepsy (PTE) can be a disabling, life-long outcome of TBI. ⋯ The probability of developing PTE increased within the study period. The risk of developing PTE significantly increased with age, early seizure and TBI severity. Most of the individuals did not receive AED after TBI. There was no evidence suggesting AEDs helped to prevent PTE with the possible exception of acetazolamide. However, further studies may be needed to test the efficacy of acetazolamide in preventing PTE.
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Despite the fact that epilepsy surgery is both safe and effective, a considerable "surgical treatment gap" remains in that most persons who are eligible for surgery do not receive it. It has been argued that epilepsy surgery is one of the most underutilized of all accepted medical treatments in the world. In this article, we review the epidemiology of the epilepsy surgery treatment gap, and consider the role minimally-invasive epilepsy surgery may play in reducing this gap.
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Review Historical Article
A neurosurgeon`s view: Laser interstitial thermal therapy of mesial temporal lobe structures.
Stereotactic laser ablation of mesial temporal structures is a promising new surgical intervention for patients with mesial temporal lobe epilepsy (MTLE). Since this procedure was first used to treat MTLE in 2010, the literature contains reports of 37 patients that underwent MR-guided stereotactic laser amygdalohippocampotomy (SLAH) using Laser Interstitial Thermal Therapy (LITT) with at least 1year of follow-up. ⋯ Finally, evidence is accruing that SLAH is associated with lower overall risk of neuropsychological deficits compared to open surgery. Thus, LITT constitutes a novel minimally invasive tool in the neurosurgeon's armamentarium for managing medically refractory seizures that may draw eligible patients to consider surgical interventions to manage their seizures.