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Elizabeth J Donner - One of the best experts on this subject based on the ideXlab platform.
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incidence of sudden unexpected death in Epilepsy in Children is similar to adults
Neurology, 2018Co-Authors: Anne E Keller, Robyn Whitney, Michael S Pollanen, Elizabeth J DonnerAbstract:Objective To determine the incidence of sudden unexpected death in Epilepsy (SUDEP) in Children in Ontario, Canada. Methods Cases of suspected pediatric SUDEP occurring between January 1, 2014, and December 31, 2015, in Ontario, Canada, were eligible for inclusion. Potential cases were identified through 3 sources: a national pediatrician surveillance program, child neurologist report, and screening of provincial forensic autopsies. Cases were classified as definite, definite plus, probable, possible, and near/near plus according to criteria described by Nashef et al. ( Epilepsia 2012). Overall crude pediatric SUDEP incidence and the incidence of definite or probable pediatric SUDEP were calculated using estimates of the prevalence of pediatric Epilepsy in Canada drawn from government survey data and the number of Children living in Ontario. Capture-recapture analysis was used to estimate the number of missing cases and determine an adjusted definite/probable SUDEP incidence. Results Seventeen cases of pediatric SUDEP resulted in an overall incidence of 1.17 (95% confidence interval 0.68–1.88) per 1,000 pediatric Epilepsy person-years. The definite/probable incidence, including definite (n = 11), definite plus (n = 2), or probable (n = 3) SUDEP cases, was 1.11 (0.63–1.79). Capture-recapture analysis indicated an estimated 21 (16–39) definite/probable SUDEP cases occurred during the study period, giving an adjusted incidence of definite/probable SUDEP of 1.45 (0.90–2.22) per 1,000 pediatric Epilepsy person-years. Conclusion SUDEP may be more common in Children than widely reported, with the incidence rate of definite/probable SUDEP in Children being similar to rates reported in adults.
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occipital lobe Epilepsy in Children characterization evaluation and surgical outcomes
Epilepsy Research, 2012Co-Authors: George M Ibrahim, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Aria Fallah, Shelly K Weiss, Gregory W Albert, Teresa Withers, Tomoyuki Akiyama, Carter O SneadAbstract:Summary introduction Occipital lobe Epilepsy (OLE) poses a diagnostic challenge to clinicians. Here, we present our experience in the surgical management of OLE in Children using magnetoencephalography (MEG) in the pre-operative evaluation. Methods Retrospective chart review was performed from 2000 to 2010 to identify patients with OLE. Patients were analyzed in two categories: isolated OLE (11 patients) and extended OLE (parietooccipital, temporooccipital, and temporoparietooccipital; 30 patients). Survival analysis and multivariate Cox proportional hazards regression were used to identify independent predictors of seizure outcome. Results Forty-one patients with a mean follow-up of 3.1 years were identified with an overall 68% rate of satisfactory seizure outcome. Patients with extended OLE had younger ages at seizure onset and different seizure semiologies compared with those with isolated OLE. None of the latter underwent insertion of subdural grid electrodes for localization of the epileptogenic zone compared with 77% of the former ( p Conclusion Here, we find similar seizure outcomes for isolated and extended OLE foci despite the use of less invasive strategies for the former. Furthermore, we describe the role of MEG in evaluation, surgical planning and prognostication of Children with OLE.
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neurosurgical management of intractable rolandic Epilepsy in Children role of resection in eloquent cortex clinical article
Journal of Neurosurgery, 2009Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Shelly K Weiss, James M Drake, Francesco Sala, John A Jane, Ayataka Fujimoto, Stephanie HolowkaAbstract:Object The authors undertook this study to review their experience with cortical resections in the rolandic region in Children with intractable Epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 Children with intractable Epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. in 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperativ...
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temporal lobe surgery for intractable Epilepsy in Children an analysis of outcomes in 126 Children
Neurosurgery, 2006Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Sylvester H Chuang, Shelly K Weiss, Manohar Shroff, Cynthia Hawkins, James M Drake, Irene ElliottAbstract:OBJECTIVE: Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe Epilepsy. in this study, we conducted a retrospective review of Children with drug-resistant temporal lobe Epilepsy to evaluate seizure outcome after temporal lobe surgery. METHODS: We reviewed the medical records of 126 Children who had surgery for temporal lobe Epilepsy at The Hospital for Sick Children between 1983 and 2003. The records were examined for preoperative and intraoperative factors that could predict patient outcome after surgery. RESULTS: The mean age at seizure onset was 5.9 years. The mean seizure duration before surgery was 5.6 years. All patients had preoperative computed tomographic scans, magnetic resonance imaging scans, or both. The mean age at the time of surgery was 13.5 years. Sixty-two patients underwent left temporal resections and 64 patients underwent right temporal resections. The histopathology of the temporal resections revealed low-grade brain tumors in 65 Children (52%) and cavernous malformations in four Children. Ganglioglioma and astrocytoma were the most common tumors encountered. Mesial temporal sclerosis was found in 16 patients (13%), astrogliosis in 15 patients (12%), and cortical dysplasia in eight patients (7%). Postoperative follow-up of at least 2 years was available for 106 patients and ranged up to 13.0 years. Seventy-four percent of patients had an Engel Class I or II outcome. Patients with temporal lobe lesions had better outcomes compared with those without lesions (P < 0.05). Patients without a history of secondary generalization of seizures also had a better outcome when compared with those with secondary generalization. Complications in the form of contralateral homonymous hemianopsia, dysphasia, and infection were found in 5% of patients. Twelve patients had a second temporal lobe procedure for intractable recurrent seizures. After a second procedure, seven patients returned to a seizure-free state. CONCLUSION: Temporal lobe resections for Epilepsy in Children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to Children.
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vagal nerve stimulation for refractory Epilepsy in Children indications and experience at the hospital for sick Children
Childs Nervous System, 2006Co-Authors: Mony Benifla, William J Logan, James T. Rutka, Elizabeth J DonnerAbstract:Objectives The management of intractable Epilepsy in Children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for Epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in Children who underwent VNS implantation. Methods Forty-one Children underwent VNS implantation for Epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) Children failed to respond to the VNS treatment. The device was removed in five Children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances. Conclusions Our results show that VNS implantation can be a safe and effective alternative therapy for Children with drug-resistant Epilepsy who are not candidates for Epilepsy surgery.
Ayako Ochi - One of the best experts on this subject based on the ideXlab platform.
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temporal plus Epilepsy in Children a connectomic analysis in magnetoencephalography
Epilepsia, 2020Co-Authors: Daniel J Martire, Mary Lou Smith, Hiroshi Otsubo, Ayako Ochi, Simeon M Wong, Adriana Workewych, Elizabeth W Pang, Sarah Boutros, Roy Sharma, Elysa WidjajaAbstract:Objective Seizure recurrence following surgery for temporal lobe (TL) Epilepsy may be related to extratemporal epileptogenic foci, so-called temporal-plus (TL+) Epilepsy. Here, we sought to leverage whole brain connectomic profiling in magnetoencephalography (MEG) to identify neural networks indicative of TL+ Epilepsy in Children. Methods Clinical and MEG data were analyzed for 121 Children with TL and TL+ Epilepsy spanning 20 years at the Hospital for Sick Children. Resting-state connectomes were derived using the weighted phase lag index from neuromagnetic oscillations. Multidimensional associations between patient connectomes, TL versus TL+ Epilepsy, seizure freedom, and clinical covariates were performed using a partial least squares (PLS) analysis. Bootstrap resampling statistics were performed to assess statistical significance. Results A single significant latent variable representing 66% of the variance in the data was identified with significant contributions from extent of Epilepsy (TL vs TL+), duration of illness, and underlying etiology. This component was associated with significant bitemporal and frontotemporal connectivity in the theta, alpha, and beta bands. By extracting a brain score, representative of the observed connectivity profile, patients with TL Epilepsy were dissociated from those with TL+, independent of their postoperative seizure outcome. Significance By analyzing 121 connectomes derived from MEG data using a PLS approach, we find that connectomic profiling could dissociate TL from TL+ Epilepsy. These findings may inform patient selection for resective procedures and guide decisions surrounding invasive monitoring.
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increased subcortical oligodendroglia like cells in pharmacoresistant focal Epilepsy in Children correlate with extensive epileptogenic zones
Epilepsia, 2016Co-Authors: Satoru Sakuma, Elysa Widjaja, William Halliday, Ruka Nomura, Shiro Baba, Yosuke Sato, Kazuo Okanari, Midori Nakajima, Cyrus Boelman, Ayako OchiAbstract:SummaryObjective Cortical resections in Epilepsy surgery tend to involve multiple lobes in Children, compared to adults, partly due to underlying pathology. Oligodendroglia-like cells (OLCs) have been observed in surgical specimens from Children with pharmacoresistant Epilepsy. We hypothesize that OLCs recruit multiple-lobe epileptogenic zones in pediatric pharmacoresistant focal Epilepsy. Methods We examined the surgical specimens from 30 Children who underwent Epilepsy surgery (1.8- to 16.9-years-old; mean age 9.7 years). Immunohistochemical assays of OLCs were performed using Olig2, which is a marker of OLC. OLC populations in three sites (gray matter, gray–white matter junction, and white matter) were counted. We also performed immunohistochemical staining with neuronal nuclear antigen (NeuN) and glial fibrillary acidic protein (GFAP) for neuronal and astroglial markers, respectively. NeuN- and GFAP-positive cells were distinguished from OLCs. OLC results were compared with seizure types, scalp and intracranial video–electroencephalography (EEG), magnetic resonance imaging (MRI), surgical resection area, histopathologic diagnosis, and seizure outcome. Results Histopathologic diagnosis consisted of 14 cases of focal cortical dysplasia (FCD; type I; 4, type II; 9, type III; one); 6 cases of oligodendrogliosis; 6 cases of astrocytic gliosis; 2 cases of hyaline protoplasmic astrocytopathy; and 2 cases of tuberous sclerosis. Fifteen Children (50%) underwent multiple-lobe resections after intracranial video-EEG. There was a positive correlation between the number of resected electrodes and the OLC population in the white matter (correlation coefficient 0.581, p = 0.001) and at the gray–white matter junction– (correlation coefficient 0.426, p = 0.027). OLC populations in both areas were increased significantly in nine Children with epileptic spasms (ES) (gray–white matter junction [p = 0.021] and white matter [p = 0.025]), and nine nonfocal ictal scalp EEG findings (gray–white matter junction [p = 0.04] and white matter [p = 0.042]). The OLC population in white matter was significantly increased in Children with 11 nonfocal interictal scalp EEG findings (p = 0.01), with 15 multiple-lobe resections (p = 0.028). Significance Pharmacoresistant Epilepsy in Children with increased OLCs presented with nonfocal epileptiform discharges on scalp EEG and ES, and they required multiple-lobe resections. We found increased populations of subcortical OLCs in the extensive epileptogenic zone.
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occipital lobe Epilepsy in Children characterization evaluation and surgical outcomes
Epilepsy Research, 2012Co-Authors: George M Ibrahim, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Aria Fallah, Shelly K Weiss, Gregory W Albert, Teresa Withers, Tomoyuki Akiyama, Carter O SneadAbstract:Summary introduction Occipital lobe Epilepsy (OLE) poses a diagnostic challenge to clinicians. Here, we present our experience in the surgical management of OLE in Children using magnetoencephalography (MEG) in the pre-operative evaluation. Methods Retrospective chart review was performed from 2000 to 2010 to identify patients with OLE. Patients were analyzed in two categories: isolated OLE (11 patients) and extended OLE (parietooccipital, temporooccipital, and temporoparietooccipital; 30 patients). Survival analysis and multivariate Cox proportional hazards regression were used to identify independent predictors of seizure outcome. Results Forty-one patients with a mean follow-up of 3.1 years were identified with an overall 68% rate of satisfactory seizure outcome. Patients with extended OLE had younger ages at seizure onset and different seizure semiologies compared with those with isolated OLE. None of the latter underwent insertion of subdural grid electrodes for localization of the epileptogenic zone compared with 77% of the former ( p Conclusion Here, we find similar seizure outcomes for isolated and extended OLE foci despite the use of less invasive strategies for the former. Furthermore, we describe the role of MEG in evaluation, surgical planning and prognostication of Children with OLE.
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the role of magnetoencephalography in Children undergoing hemispherectomy
Journal of Neurosurgery, 2011Co-Authors: Cristina V Torres, Hiroshi Otsubo, Ayako Ochi, Aria Fallah, George M Ibrahim, Samuel H Cheshier, Sylvester H Chuang, Carter O Snead, Stephanie Holowka, James T. RutkaAbstract:Object Hemispherectomy is an established neurosurgical procedure for medication-resistant Epilepsy in Children. Despite the effectiveness of this technique, there are patients who do not achieve an optimum outcome after surgery; possible causes of suboptimal results include the presence of bilateral independent epileptogenic foci. Magnetoencephalography (MEG) is an emerging tool that has been found to be useful in the management of lesional and nonlesional Epilepsy. The authors analyzed the relative contribution of MEG in patient selection for hemispherectomy. Methods The medical records of Children undergoing hemispherectomy at the Hospital for Sick Children were reviewed. Those patients who underwent MEG as part of the presurgical evaluation were selected. Results Thirteen patients were included in the study. Nine patients were boys. The mean age at the time of surgery was 66 months (range 10–149 months). Seizure etiology was Rasmussen encephalitis in 6 patients, hemimegalencephaly in 2 patients, and co...
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neurosurgical management of intractable rolandic Epilepsy in Children role of resection in eloquent cortex clinical article
Journal of Neurosurgery, 2009Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Shelly K Weiss, James M Drake, Francesco Sala, John A Jane, Ayataka Fujimoto, Stephanie HolowkaAbstract:Object The authors undertook this study to review their experience with cortical resections in the rolandic region in Children with intractable Epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 Children with intractable Epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. in 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperativ...
Gary W. Mathern - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of competing treatment strategies for drug resistant Epilepsy in Children with tuberous sclerosis complex
Epilepsy & Behavior, 2016Co-Authors: Aria Fallah, Alexander G Weil, Shelly Wang, Evan J H Lewis, Christine B Baca, Gary W. MathernAbstract:Abstract Background The management of drug-resistant Epilepsy in Children with Tuberous Sclerosis Complex (TSC) is challenging because of the multitude of treatment options, wide range of associated costs, and uncertainty of seizure outcomes. The most cost-effective approach for Children whose Epilepsy has failed to improve with first-line medical therapy is uncertain. Methods A review of MEDLinE from 1990 to 2015 was conducted. A cost-utility analysis, from a third-party payer perspective, was performed for Children with drug-resistant Epilepsy that had failed to improve with 2 antiseizure drugs (ASDs) and that was amenable to resective Epilepsy surgery, across a time-horizon of 5 years. Four strategies were included: (1) resective Epilepsy surgery, (2) vagus nerve stimulator (VNS) implantation, (3) ketogenic diet, and (4) addition of a third ASD (specifically, carbamazepine). The incremental cost per quality-adjusted life year (QALY) gained was analyzed. Results Given a willingness-to-pay (WTP) of $100,000 per QALY, the addition of a third ASD ($6600 for a gain of 4.14 QALYs) was the most cost-effective treatment strategy. in a secondary analysis, if the child whose Epilepsy had failed to improve with 3 ASDs, ketogenic diet, addition of a fourth ASD, and resective Epilepsy surgery were incrementally cost-effective treatment strategies. Vagus nerve stimulator implantation was more expensive yet less effective than alternative strategies and should not be prioritized. Conclusions The addition of a third ASD is a universally cost-effective treatment option in the management of Children with drug-resistant Epilepsy that has failed to improve with 2 ASDs. For Children whose Epilepsy has failed to improve with 3 ASDs, the most cost-effective treatment depends on the health-care resources available reflected by the WTP.
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intimal thickening of meningeal arteries after serial corticectomies for Rasmussen encephalitis.
Human Pathology, 2012Co-Authors: Aaron S. Wagner, Spencer Tung, Gary W. Mathern, Harry V. VintersAbstract:Summary Rasmussen encephalitis is a rare cause of intractable Epilepsy in Children. Between 2008 and 2010, 4 patients had second cortical resections performed after a primary corticectomy for Rasmussen encephalitis. in each case, we observed some degree of vessel wall change in leptomeningeal arteries, consisting of moderate to moderately severe intimal hyperplasia. The intervals between original resection and second operation ranged from 8 months to 10 years. Ages of the patients ranged from 9 to 12 years at their first resection and from 10 to 19 years at the time of revision. Four other Rasmussen encephalitis cases operated upon in the years 2006 to 2010 and 2 surgical revisions for severe cortical dysplasia, 1 for mild cortical dysplasia and 1 for recurrent dysembryoplastic neuroepithelial tumor, did not show significant vascular abnormalities (with surgical intervals of 10 months to 16 years). Leptomeningeal intimal hyperplasia appears to develop in the interval between repeated cortical resections for Rasmussen encephalitis, an inflammatory disorder. The pathogenesis of this vascular change may be related to meningeal inflammation in Rasmussen encephalitis. This finding in Children undergoing surgical resection for Rasmussen encephalitis may itself lead to "secondary" ischemic change that contributes to worsening of Epilepsy.
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vagal nerve stimulation for pharmacoresistant Epilepsy in Children
Surgical Neurology International, 2012Co-Authors: Jason S Hauptman, Gary W. MathernAbstract:Vagus nerve stimulation (VNS) is an adjunctive treatment for adult patients with pharmacoresistant Epilepsy. Little is known about VNS therapy for Children with Epilepsy. This article will: (1) Review the contemporary medical literature related to VNS therapy in Children with Epilepsy, (2) describe the experience of VNS treatment in 153 Children less than 18 years of age, in the University of California, Los Angeles (UCLA) Pediatric Epilepsy Surgery Program, from 1998 to 2012, and (3) describe the surgical technique used for VNS implantation at UCLA. Review of the literature finds that despite different etiologies and Epilepsy syndromes in Children, VNS appears to show a similar profile of efficacy for seizure control compared to adults, and low morbidity and mortality. The UCLA experience is similar to that reported in the literature for Children. VNS constitutes about 21% of our pediatric Epilepsy surgery volume. We have implanted VNS in infants as young as six months of age and the most common etiology is the Lennox-Gastaut Syndrome. About 5% of the patients are seizure-free with VNS therapy and there is a low rate of surgically related complications. The UCLA surgical approach emphasizes minimal direct manipulation of the vagus nerve and adequate wire loops, to prevent a lead fracture. in summary, VNS is a viable palliative treatment for medically refractory Epilepsy in Children, with outcomes and complications equal to adult patients. Being a small child is not a contraindication for VNS therapy, if needed for refractory Epilepsy.
Hiroshi Otsubo - One of the best experts on this subject based on the ideXlab platform.
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temporal plus Epilepsy in Children a connectomic analysis in magnetoencephalography
Epilepsia, 2020Co-Authors: Daniel J Martire, Mary Lou Smith, Hiroshi Otsubo, Ayako Ochi, Simeon M Wong, Adriana Workewych, Elizabeth W Pang, Sarah Boutros, Roy Sharma, Elysa WidjajaAbstract:Objective Seizure recurrence following surgery for temporal lobe (TL) Epilepsy may be related to extratemporal epileptogenic foci, so-called temporal-plus (TL+) Epilepsy. Here, we sought to leverage whole brain connectomic profiling in magnetoencephalography (MEG) to identify neural networks indicative of TL+ Epilepsy in Children. Methods Clinical and MEG data were analyzed for 121 Children with TL and TL+ Epilepsy spanning 20 years at the Hospital for Sick Children. Resting-state connectomes were derived using the weighted phase lag index from neuromagnetic oscillations. Multidimensional associations between patient connectomes, TL versus TL+ Epilepsy, seizure freedom, and clinical covariates were performed using a partial least squares (PLS) analysis. Bootstrap resampling statistics were performed to assess statistical significance. Results A single significant latent variable representing 66% of the variance in the data was identified with significant contributions from extent of Epilepsy (TL vs TL+), duration of illness, and underlying etiology. This component was associated with significant bitemporal and frontotemporal connectivity in the theta, alpha, and beta bands. By extracting a brain score, representative of the observed connectivity profile, patients with TL Epilepsy were dissociated from those with TL+, independent of their postoperative seizure outcome. Significance By analyzing 121 connectomes derived from MEG data using a PLS approach, we find that connectomic profiling could dissociate TL from TL+ Epilepsy. These findings may inform patient selection for resective procedures and guide decisions surrounding invasive monitoring.
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occipital lobe Epilepsy in Children characterization evaluation and surgical outcomes
Epilepsy Research, 2012Co-Authors: George M Ibrahim, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Aria Fallah, Shelly K Weiss, Gregory W Albert, Teresa Withers, Tomoyuki Akiyama, Carter O SneadAbstract:Summary introduction Occipital lobe Epilepsy (OLE) poses a diagnostic challenge to clinicians. Here, we present our experience in the surgical management of OLE in Children using magnetoencephalography (MEG) in the pre-operative evaluation. Methods Retrospective chart review was performed from 2000 to 2010 to identify patients with OLE. Patients were analyzed in two categories: isolated OLE (11 patients) and extended OLE (parietooccipital, temporooccipital, and temporoparietooccipital; 30 patients). Survival analysis and multivariate Cox proportional hazards regression were used to identify independent predictors of seizure outcome. Results Forty-one patients with a mean follow-up of 3.1 years were identified with an overall 68% rate of satisfactory seizure outcome. Patients with extended OLE had younger ages at seizure onset and different seizure semiologies compared with those with isolated OLE. None of the latter underwent insertion of subdural grid electrodes for localization of the epileptogenic zone compared with 77% of the former ( p Conclusion Here, we find similar seizure outcomes for isolated and extended OLE foci despite the use of less invasive strategies for the former. Furthermore, we describe the role of MEG in evaluation, surgical planning and prognostication of Children with OLE.
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the role of magnetoencephalography in Children undergoing hemispherectomy
Journal of Neurosurgery, 2011Co-Authors: Cristina V Torres, Hiroshi Otsubo, Ayako Ochi, Aria Fallah, George M Ibrahim, Samuel H Cheshier, Sylvester H Chuang, Carter O Snead, Stephanie Holowka, James T. RutkaAbstract:Object Hemispherectomy is an established neurosurgical procedure for medication-resistant Epilepsy in Children. Despite the effectiveness of this technique, there are patients who do not achieve an optimum outcome after surgery; possible causes of suboptimal results include the presence of bilateral independent epileptogenic foci. Magnetoencephalography (MEG) is an emerging tool that has been found to be useful in the management of lesional and nonlesional Epilepsy. The authors analyzed the relative contribution of MEG in patient selection for hemispherectomy. Methods The medical records of Children undergoing hemispherectomy at the Hospital for Sick Children were reviewed. Those patients who underwent MEG as part of the presurgical evaluation were selected. Results Thirteen patients were included in the study. Nine patients were boys. The mean age at the time of surgery was 66 months (range 10–149 months). Seizure etiology was Rasmussen encephalitis in 6 patients, hemimegalencephaly in 2 patients, and co...
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neurosurgical management of intractable rolandic Epilepsy in Children role of resection in eloquent cortex clinical article
Journal of Neurosurgery, 2009Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Shelly K Weiss, James M Drake, Francesco Sala, John A Jane, Ayataka Fujimoto, Stephanie HolowkaAbstract:Object The authors undertook this study to review their experience with cortical resections in the rolandic region in Children with intractable Epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 Children with intractable Epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. in 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperativ...
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meg predicts outcome following surgery for intractable Epilepsy in Children with normal or nonfocal mri findings
Epilepsia, 2007Co-Authors: Rajesh Ramachandrannair, Hiroshi Otsubo, Ayako Ochi, James T. Rutka, Shelly K Weiss, Manohar Shroff, Carter O SneadAbstract:Summary: Purpose: To identify the predictors of postsurgical seizure freedom in Children with refractory Epilepsy and normal or nonfocal MRI findings. Methods: We analyzed 22 Children with normal or subtle and nonfocal MRI findings, who underwent surgery for intractable Epilepsy following extraoperative intracranial EEG. We compared clinical profiles, neurophysiological data (scalp EEG, magnetoencephalography (MEG) and intracranial EEG), completeness of surgical resection and pathology to postoperative seizure outcomes. Results: Seventeen Children (77%) had a good postsurgical outcome (defined as Engel class IIIA or better), which included eight (36%) seizure-free Children. All Children with postsurgical seizure freedom had an MEG cluster in the final resection area. Postsurgical seizure freedom was obtained in none of the Children who had bilateral MEG dipole clusters (3) or only scattered dipoles (1). All five Children in whom ictal onset zones were confined to ≤5 adjacent intracranial electrodes achieved seizure freedom compared to three of 17 Children with ictal onset zones that extended over >5 electrodes (p = 0.002). None of six Children with more than one type of seizure became seizure-free, compared to eight of 16 Children with a single seizure type (p = 0.04). Complete resection of the preoperatively localized epileptogenic zone resulted in seizure remission in 63% (5/8) and incomplete resections, in 21% (3/14) (p = 0.06). Age of onset, duration of Epilepsy, number of lobes involved in resection, and pathology failed to correlate with seizure freedom. Conclusions: Surgery for intractable Epilepsy in Children with normal MRI findings provided good postsurgical outcomes in the majority of our patients. As well, restricted ictal onset zone predicted postoperative seizure freedom. Postoperative seizure freedom was less likely to occur in Children with bilateral MEG dipole clusters or only scattered dipoles, multiple seizure types and incomplete resection of the proposed epileptogenic zone. Seizure freedom was most likely to occur when there was concordance between EEG and MEG localization and least likely to occur when these results were divergent.
Mony Benifla - One of the best experts on this subject based on the ideXlab platform.
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neurosurgical management of intractable rolandic Epilepsy in Children role of resection in eloquent cortex clinical article
Journal of Neurosurgery, 2009Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Shelly K Weiss, James M Drake, Francesco Sala, John A Jane, Ayataka Fujimoto, Stephanie HolowkaAbstract:Object The authors undertook this study to review their experience with cortical resections in the rolandic region in Children with intractable Epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 Children with intractable Epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. in 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperativ...
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temporal lobe surgery for intractable Epilepsy in Children an analysis of outcomes in 126 Children
Neurosurgery, 2006Co-Authors: Mony Benifla, Hiroshi Otsubo, Ayako Ochi, Elizabeth J Donner, Sylvester H Chuang, Shelly K Weiss, Manohar Shroff, Cynthia Hawkins, James M Drake, Irene ElliottAbstract:OBJECTIVE: Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe Epilepsy. in this study, we conducted a retrospective review of Children with drug-resistant temporal lobe Epilepsy to evaluate seizure outcome after temporal lobe surgery. METHODS: We reviewed the medical records of 126 Children who had surgery for temporal lobe Epilepsy at The Hospital for Sick Children between 1983 and 2003. The records were examined for preoperative and intraoperative factors that could predict patient outcome after surgery. RESULTS: The mean age at seizure onset was 5.9 years. The mean seizure duration before surgery was 5.6 years. All patients had preoperative computed tomographic scans, magnetic resonance imaging scans, or both. The mean age at the time of surgery was 13.5 years. Sixty-two patients underwent left temporal resections and 64 patients underwent right temporal resections. The histopathology of the temporal resections revealed low-grade brain tumors in 65 Children (52%) and cavernous malformations in four Children. Ganglioglioma and astrocytoma were the most common tumors encountered. Mesial temporal sclerosis was found in 16 patients (13%), astrogliosis in 15 patients (12%), and cortical dysplasia in eight patients (7%). Postoperative follow-up of at least 2 years was available for 106 patients and ranged up to 13.0 years. Seventy-four percent of patients had an Engel Class I or II outcome. Patients with temporal lobe lesions had better outcomes compared with those without lesions (P < 0.05). Patients without a history of secondary generalization of seizures also had a better outcome when compared with those with secondary generalization. Complications in the form of contralateral homonymous hemianopsia, dysphasia, and infection were found in 5% of patients. Twelve patients had a second temporal lobe procedure for intractable recurrent seizures. After a second procedure, seven patients returned to a seizure-free state. CONCLUSION: Temporal lobe resections for Epilepsy in Children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to Children.
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vagal nerve stimulation for refractory Epilepsy in Children indications and experience at the hospital for sick Children
Childs Nervous System, 2006Co-Authors: Mony Benifla, William J Logan, James T. Rutka, Elizabeth J DonnerAbstract:Objectives The management of intractable Epilepsy in Children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for Epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in Children who underwent VNS implantation. Methods Forty-one Children underwent VNS implantation for Epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) Children failed to respond to the VNS treatment. The device was removed in five Children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances. Conclusions Our results show that VNS implantation can be a safe and effective alternative therapy for Children with drug-resistant Epilepsy who are not candidates for Epilepsy surgery.
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vagal nerve stimulation for refractory Epilepsy in Children indications and experience at the hospital for sick Children
Childs Nervous System, 2006Co-Authors: Mony Benifla, William J Logan, James T. Rutka, Elizabeth J DonnerAbstract:The management of intractable Epilepsy in Children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for Epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in Children who underwent VNS implantation. Forty-one Children underwent VNS implantation for Epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) Children failed to respond to the VNS treatment. The device was removed in five Children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances. Our results show that VNS implantation can be a safe and effective alternative therapy for Children with drug-resistant Epilepsy who are not candidates for Epilepsy surgery.