Epilepsy & Surgery

1. Focused Ultrasound in the Treatment of Epilepsy: Current Applications and Future Directions

   Epilepsy is the fourth most common neurological disorder, affecting nearly 1% of the global population. Despite recent advancements in medical therapies, approximately one-third of patients remain refractory to treatment, necessitating consideration of surgical intervention. Historically, epilepsy surgery has been invasive and maximalist in nature, involving extensive brain resections with significant risk for morbidity. However, emerging approaches offer promising, less-invasive alternatives....

2. The role of robots in epilepsy surgery

   BACKGROUND: Epilepsy is a prevalent chronic neurological disease affecting millions. Many patients respond to medical therapies, but a third of patients does not and potentially requires neurosurgical procedures. These can be used to localize the onset of seizures and subsequently treat patients. Robotic technologies have emerged over the last decades to increase the efficacy and safety of epilepsy surgery. We therefore wanted to describe the role that robotics in epilepsy surgery have taken...

3. Restoration of blood brain barrier integrity post neurosurgical resection in drug resistant epilepsy

   Surgery for temporal lobe epilepsy (TLE) is a well-recognised therapy for drug resistant seizures which occur in more than 50 % of patients with TLE. Blood-brain barrier (BBB) dysfunction is commonly observed in resected brain tissue from patients with treatment resistant epilepsy however, no studies have documented the recovery of BBB function following surgery. We firstly prospectively performed dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on seven patients scheduled for...

4. Long-term musculoskeletal outcomes in pediatric hemispherotomy

   CONCLUSIONS: Our study demonstrates that children who undergo HS experience minimal long-term impact on broad measures of functional mobility but may still require intervention for management of spasticity, muscle contractures, and bony deformities.

5. Increased Immunoglobulin and Proteoglycan Synthesis in Resected Hippocampal Tissue Predicts Post-Surgical Seizure Recurrence in Human Temporal Lobe Epilepsy

   Background/Objectives: For patients with medically refractory temporal lobe epilepsy (TLE), surgery is an effective strategy. However, post-operative seizure recurrence occurs in 20-30% of patients, and it remains challenging to predict outcomes solely based on clinical variables. Here, we ask to what extent differences in gene expression in epileptic tissue can predict the outcome after resective epilepsy surgery. Methods: We performed RNAseq on hippocampal tissue resected from eight patients...

6. Intracranial neuromodulation for pediatric drug-resistant epilepsy: early institutional experience

   CONCLUSION: In the early Stanford experience, DBS was used as a palliatively for generalized or mixed DRE refractory to other resective or modulatory approaches. RNS was used for multifocal DRE with a clear seizure focus on stereo-EEG and no prior surgical interventions. Both modalities reduced seizure burden across all patients. RNS offers the additional benefit of providing data to guide future surgical planning.

7. Epilepsy and Employment in Europe: A Systematic Review of Literature

   CONCLUSION: Developing specific legislation and programs to include PwE in the workplace could help their social integration. Moreover, seizure control seems to be the most relevant factor influencing the possibility of getting and maintaining a good job, demonstrating the importance of providing continuous follow-up and the best medical care to all PwE.

8. Change in Structural Connectivity Following Stereotactic Thermocoagulation in Mesial Temporal Lobe Epilepsy Patients

   CONCLUSIONS: Our study shows that a higher ablation of both the amygdala and rhinal cortex led to improved structural connectivity and was associated with better outcomes. Our results provide insight into some essential elements of brain connectivity networks in MTLE and might contribute to the generation of novel evidence that could improve SEEG-guided RFTC interventions in MTLE patients.

9. From abnormal fetal movements to neonatal seizures: A literature review

   Fetal seizures (FS) are underestimated and underdiagnosed events with a poor prognosis that could precede neonatal seizures. FS diagnosis could be clinical or by means of ultrasound. FS causes are heterogenic. After a PubMed, Google Scholar and SCOPUS research, aimed to find publications concerning FS, we selected 23 studies, mainly case reports with literature reviews, for a total of 29 patients. We evaluated the method of diagnosis, gestational age at diagnosis of FS, FS etiology, time of...

10. Frequency-specific alterations in brain connectivity induced by pulvinar stimulation

    OBJECTIVE: Deep brain stimulation (DBS) is emerging as a promising therapy for patients with drug-resistant epilepsy, particularly those who are either unsuitable for or unresponsive to resective surgery. The potential benefit of DBS in these patients may stem from its ability to reduce excessive brain functional connectivity (FC). Given that patients undergoing presurgical evaluation in our institution are implanted with stereoelectroencephalographic (SEEG) electrodes in the thalamus,...

11. Facilitators and barriers to neurologist referral of patients for epilepsy surgery evaluation

    OBJECTIVE: Epilepsy surgery offers a potential cure for drug-resistant epilepsy (DRE), yet surgery is underutilized. An estimated 5% of patients with DRE undergo long-term EEG monitoring (LTM) annually, the requisite first step of evaluation for surgical candidacy. Much of the variation in LTM referral may be attributable to individual neurologist practice rather than patient characteristics. We explored neurologist behaviors and practices in epilepsy surgery referral to guide future...

12. Impact of Reducing Time Lived With Colostomies on Social Stigma Affecting Children With Anorectal Malformations in Southwestern Uganda

    CONCLUSION: Adopting a 1-stage ARM repair for the select types, which avoids colostomy creation, significantly reduces the experience of stigma and ability to live without fear/abuse. Designing cheap reusable colostomy bags in LMIC settings and increasing access to colostomy appliances should be the goal.

13. Risk factors for post-stroke epilepsy and seizures among stroke survivors: a qualitative aggregate analysis of more than 82 000 cases

    CONCLUSION: This meta-analysis identifies several risk factors for post-stroke seizures and epilepsy among stroke survivors. The findings enhance clinical awareness for early identification of high-risk individuals and may guide interventions to improve outcomes.

14. Quantitative Cortex-Based Mapping With Hybrid (18)F-FDG-PET/MR Images in MRI-Negative Epilepsy

    OBJECTIVES: Localization of the network underlying drug-resistant focal epilepsy in individuals considering surgical treatment with unremarkable MRI is challenging. Concordance rates of 40%-69% have been reported with FDG-PET image statistical parametric mapping (SPM). We investigated the efficacy of postprocessing specific to cortices by cortex-based mapping (CBM) on hybrid PET/MR images with healthy subjects to localize sites of seizure onset.

15. A series of 309 awake surgeries with transcortical approach for IDH-mutant low-grade glioma involving the insula: long-term onco-functional outcomes in 253 consecutive patients

    CONCLUSIONS: This is the largest homogeneous surgical experience of LGGs involving the insula that were resected through the opercula based on awake mapping. The results show a high percentage of functional preservation and return to work, with a high overall survival rate.

16. High-Density Electroencephalography Detects Spatiotemporal Abnormalities in Brain Networks in Patients With Glioma-Related Epilepsy

    CONCLUSION: The current study revealed specific brain network abnormalities in GRE patients based on graph theory and microstate analyses of resting-state high-density EEG data. These findings can enhance our comprehension of the mechanisms behind GRE and offer potential biomarkers for improving individualized management of glioma patients.

17. UK Medical Cannabis Registry: A Clinical Outcomes Analysis for Epilepsy

    CONCLUSION: Initiation of CBMPs was associated with an improvement across all PROMs. CBMPs were well tolerated across the cohort. However, randomized controlled trials are needed to help determine causality.

18. The excitatory milieu in glioma: mechanisms and therapeutic avenues

    Gliomas are the most common primary malignant brain tumors. Their electrobiologic properties drive disease development, and in select tumors, aberrant neurosignaling is situated at the crux of gliomagenesis and glioma-related epilepsy (GRE). Tumor microtubes and the neuronal-glioma synapse are defined components of the glioma circuitry. The nidus of cortical hyperexcitability-the peri-glioma-undergoes severe alterations during disease progression and is influenced by genetic mutations, anomalous...

19. Evolution of epilepsy comorbidities in seizure free patients: Is no seizure a synonym of no epilepsy?

    Epilepsy is a prevalent neurological disorder, with most patients achieving seizure freedom through antiseizure medications (ASM). However, being seizure-free does not necessarily equate to being free from epilepsy-related comorbidities. This review explores the persistence of psychiatric, cognitive, and social challenges in seizure-free patients and their impact on quality of life (QoL). Seizure-free patients generally report a better QoL than those with active epilepsy, with scores approaching...

20. Long-term seizure and quality of life outcomes of an epilepsy surgery program in Cape Town, South Africa

    OBJECTIVE: To determine long-term seizure and quality-of-life related outcomes of an epilepsy surgery (ES) program in South Africa.