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William Harkness - One of the best experts on this subject based on the ideXlab platform.
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outcome following Multiple Subpial Transection in landau kleffner syndrome and related regression
Epilepsia, 2015Co-Authors: Michelle Downes, Rebecca Greenaway, Maria Clark, Helen J Cross, Nicola Jolleff, William HarknessAbstract:Summary Objective To determine whether Multiple Subpial Transection in the posterior temporal lobe has an impact on long-term outcome in children who have drug-resistant Landau-Kleffner syndrome (LKS) or other “electrical status epilepticus during sleep” (ESES)-related regression. Given the wide variability in outcomes reported in the literature, a secondary aim was to explore predictors of outcome. Methods The current study includes a surgery group (n = 14) comprising patients who underwent Multiple Subpial Transection of the posterior temporal lobe and a nonsurgery comparison group (n = 21) comprising patients who underwent presurgical investigations for the procedure, but who did not undergo surgery. Outcomes were assessed utilizing clinical note review as well as direct assessment and questionnaires. Results The distribution of nonclassical cases was comparable between groups. There were some differences between the surgery and nonsurgery groups at presurgical investigation including laterality of discharges, level of language impairment, and age; therefore, follow-up analyses focused on change over time and predictors of outcome. There were no statistically significant differences between the groups in language, nonverbal ability, adaptive behavior, or quality of life at follow-up. There was no difference in the proportion of patients showing improvement or deterioration in language category over time for either group. Continuing seizures and an earlier age of onset were most predictive of poorer quality of life at long-term follow-up (F2,23 = 26.2, p = <0.001, R2 = 0.714). Significance Both surgery and nonsurgery groups had similar proportions of classic LKS and ESES-related regression. Because no significant differences were found in the changes observed from baseline to follow-up between the two groups, it is argued that there is insufficient evidence to suggest that Multiple Subpial Transection provides additional benefits over and above the mixed recovery often seen in LKS and related regressive epilepsies.
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Outcome following Multiple Subpial Transection in Landau-Kleffner syndrome and related regression.
Epilepsia, 2015Co-Authors: Michelle Downes, Rebecca Greenaway, Maria Clark, Nicola Jolleff, William Harkness, J. Helen Cross, Marios Kaliakatsos, Stewart Boyd, Steve White, Brian G. R. NevilleAbstract:Summary Objective To determine whether Multiple Subpial Transection in the posterior temporal lobe has an impact on long-term outcome in children who have drug-resistant Landau-Kleffner syndrome (LKS) or other “electrical status epilepticus during sleep” (ESES)-related regression. Given the wide variability in outcomes reported in the literature, a secondary aim was to explore predictors of outcome. Methods The current study includes a surgery group (n = 14) comprising patients who underwent Multiple Subpial Transection of the posterior temporal lobe and a nonsurgery comparison group (n = 21) comprising patients who underwent presurgical investigations for the procedure, but who did not undergo surgery. Outcomes were assessed utilizing clinical note review as well as direct assessment and questionnaires. Results The distribution of nonclassical cases was comparable between groups. There were some differences between the surgery and nonsurgery groups at presurgical investigation including laterality of discharges, level of language impairment, and age; therefore, follow-up analyses focused on change over time and predictors of outcome. There were no statistically significant differences between the groups in language, nonverbal ability, adaptive behavior, or quality of life at follow-up. There was no difference in the proportion of patients showing improvement or deterioration in language category over time for either group. Continuing seizures and an earlier age of onset were most predictive of poorer quality of life at long-term follow-up (F2,23 = 26.2, p =
C E Polkey - One of the best experts on this subject based on the ideXlab platform.
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Multiple Subpial Transection in landau kleffner syndrome
Developmental Medicine & Child Neurology, 2001Co-Authors: Kate Irwin, C E Polkey, C D Binnie, Janet A Lees, Gonzalo Alarcon, Martin Smedley, Gillian Baird, Richard O RobinsonAbstract:: We have considered Multiple Subpial Transection (MST) as a treatment option for Landau-Kleffner syndrome (LKS) for the past 6 years. The effect of this technique on language and cognitive ability, behaviour, seizures, and EEG abnormalities is analysed here. Five children (4 males, 1 female; aged 5.5 to 10 years) underwent MST with sufficiently detailed pre- and postoperative data for analysis. Behaviour and seizure frequency improved dramatically after surgery in all children. Improvement in language also occurred in all children, although none improved to an age-appropriate level. All five had electrical status epilepticus in sleep (ESES) before surgery, which was eliminated by the procedure. One child has had an extension of his MST due to the recurrence of ESES and accompanying clinical deterioration with good effect. An attempt is made to set the effect of MST against the natural history of the condition. MST is an important treatment modality in LKS, although the timing of this intervention and its effect on final language outcome remains to be defined.
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Multiple Subpial Transection a clinical assessment
International Review of Neurobiology, 2001Co-Authors: C E PolkeyAbstract:Publisher Summary Multiple Subpial Transection is a surgical technique applied both in the laboratory and in the operating theater, whereby a number of thin cuts are made through the depth of the cortical ribbon to produce a disconnection of the horizontal fibers. It was proposed by Frank Morrell, who had a long and distinguished career investigating experimental models of both epilepsy and behavior in the laboratory and was an astute and careful neurologist with a special interest in epilepsy. Because of this interest in the electrophysiological and molecular mechanisms of epilepsy, in both the experimental situation and the clinical setting, it was inevitable that Frank Morrell should become involved in surgical strategies for the treatment of drug-resistant epilepsy. Any physician or surgeon, who spends time in assessing patients with chronic epilepsy for surgery, and following their treatment, will be fascinated by the interactions of brain pathology, maturation, and pathophysiology. They will also realize that although procedures can be divided into resective and functional operations, the mechanisms by which they exert their effects are a mixture of structural changes and physiological changes. Once one retreats from the “simple” cases, it may be necessary to use a variety of techniques for treating one particular patient either in combination or sequentially and in considering the application of Multiple Subpial Transection, these strategies will have to be borne in mind.
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Multiple Subpial Transection
Advances and technical standards in neurosurgery, 2000Co-Authors: C E PolkeyAbstract:Surgical procedures used to treat chronic drug-resistant epilepsy fall into two groups. The first group, resective surgery, comprises procedures in which cerebral tissue is removed on the basis that the patient’s epilepsy arises within that area, which can be safely removed. It is necessary to show that the seizure semiology, any structural abnormality demonstrated by brain imaging, usually MRI, and the results of appropriate neurophysiological investigations are all concordant and indicate that the epilepsy originates from an epileptogenic zone within the area. In these circumstances up to 80% of patients will have a significant reduction in the seizure frequency, with a high proportion free of seizures, and a concomitant improvement in other areas such as education, employment and quality of life. The second group of surgical procedures, functional surgery, is made up of operations which aim to modify the way in which the brain deals with the pathophysiology associated with chronic epilepsy. In various ways these operations try to modify the effect of the epileptic discharges so as to reduce this activity and thus reduce the clinical seizure manifestations in the patient. Whereas the rationale behind resective surgery is fairly simple, namely, that an epileptogenic zone is identified which can be safely resected, that underlying functional surgery is more complex.
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Multiple Subpial Transection a review of 21 cases
Journal of Neurology Neurosurgery and Psychiatry, 1995Co-Authors: I M Sawhney, C E Polkey, I J A Robertson, C D Binnie, R D C ElwesAbstract:Multiple Subpial Transection (MST) is a novel technique in surgery for epilepsy, employed in patients where some or all of the epileptogenic zone cannot be resected because it lies in a vital cortical area. Twenty one patients subjected to MST were reviewed. Eighteen patients had medically intractable epilepsy and three patients had Landau-Kleffner syndrome. Their ages ranged from 6 to 47 (mean 15-9) and duration of epilepsy ranged from 0.33 to 42 (mean 8.6) years. Preoperative MRI showed focal abnormalities in eight cases. Detailed electrophysiological examination was carried out on all patients. Brain resection was performed in addition to MST in 12 patients. A further six patients underwent brain biopsy. Three patients with Landau-Kleffner syndrome were subjected neither to resection nor to biopsy. Histopathological examination showed Rasmussen's syndrome in six patients, cortical dysplasia in six, cerebral tumour in one, and non-specific changes in five. Multiple Subpial Transection was carried out mainly in precentral and postcentral regions. Eighteen patients have been followed up for one to five years, and three for 10 months. The three patients with Landau-Kleffner syndrome were mute before operation and have shown substantial recovery of speech. Of the other 18, 11 showed a worthwhile decrease in seizure frequency. None of the patients developed chronic neurological deficits attributable to MST. It is concluded that MST leads to worthwhile seizure control without major neurological deficit in patients who would otherwise be inoperable.
Joann B Hoeppner - One of the best experts on this subject based on the ideXlab platform.
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language outcome following Multiple Subpial Transection for landau kleffner syndrome
Brain, 1999Co-Authors: Christopher L Grote, Patricia Van Slyke, Joann B HoeppnerAbstract:Landau-Kleffner syndrome is an acquired epileptic aphasia occurring in normal children who lose previously acquired speech and language abilities. Although some children recover some of these abilities, many children with Landau-Kleffner syndrome have significant language impairments that persist. Multiple Subpial Transection is a surgical technique that has been proposed as an appropriate treatment for Landau-Kleffner syndrome in that it is designed to eliminate the capacity of cortical tissue to generate seizures or subclinical epileptiform activity, while preserving the cortical functions subserved by that tissue. We report on the speech and language outcome of 14 children who underwent Multiple Subpial Transection for treatment of Landau-Kleffner syndrome. Eleven children demonstrated significant postoperative improvement on measures of receptive or expressive vocabulary. Results indicate that early diagnosis and treatment optimize outcome, and that gains in language function are most likely to be seen years, rather than months, after surgery. Since an appropriate control group was not available, and that the best predictor of postoperative improvements in language function was that of length of time since surgery, these data might best be used as a benchmark against other Landau-Kleffner syndrome outcome studies. We conclude that Multiple Subpial Transection may be useful in allowing for a restoration of speech and language abilities in children diagnosed with Landau-Kleffner syndrome.
Christian Raftopoulos - One of the best experts on this subject based on the ideXlab platform.
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Clinical Outcome of Radiating Multiple Subpial Transections Alone for Drug Resistant Epilepsy After More Than 5 Years Follow-Up.
World Neurosurgery, 2019Co-Authors: P. Finet, Susana Ferrao Santos, Riem El Tahry, Laura Pradini Santos, Christian RaftopoulosAbstract:Objective Multiple Subpial Transection (MST) is a possible surgical treatment for patients with epileptogenic foci located in eloquent cortical areas. Commonly, it is performed in addition to other surgical techniques. In some cases, however, it is performed alone. We report the clinical results of 12 patients who received solely radiating MST with a minimal follow-up of 5 years. Methods All patients who underwent a surgical intervention between 2003 and 2012 for refractory epilepsy were studied. Among them, 12 had radiating MST (rMST) as the only surgical treatment with a follow-up of at least 5 years. Results At 5-year follow-up, 50% of the patients were Engel class I, 25% were Engel class II, 0% were Engel class III, and 25% were Engel class IV. At last follow-up, 8 patients (67%) were free of seizures, 1 patient (8%) had an over 75% decrease, and 3 patients (25%) did not improve after the procedure. None of the Engel I patients had seizure recurrence, and those belonging to an intermediate class improved during follow-up, in some cases in association with an antiepileptic drug modification. Two patients (17%) had a minor transient complication, and 1 patient (8%) had a minor permanent complication. Conclusions rMST performed alone gives a favorable outcome in 75% of the patients at a minimum 5-year follow-up with few minor complications. This procedure appears to be effective even with a prolonged follow-up in drug resistant epilepsy with the epileptogenic foci located in eloquent areas.
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Multiple Subpial Transections and magnetic resonance imaging.
Neurochirurgie, 2017Co-Authors: P. Finet, Cécile Grandin, K. Van Rijckevorsel, Christian RaftopoulosAbstract:Abstract Introduction Multiple Subpial Transection (MST) has been applied to the treatment of refractory epilepsy when epileptogenic zone involves eloquent areas since 1989. However, there is a lack of data evaluating the effect of this surgical technique on the cortex as measured by Magnetic Resonance Imaging (MRI). Patients and methods Ten consecutive patients (3F/7 M, average age: 18.5 years) were operated on using radiating MST (average: 39; min: 19, max: 61) alone (n = 3) or associated with another technique (n = 7). Seven patients underwent a post-operative 3.0 T MRI while 3 had a 1.5 T MRI. Three patients had an early post-operative MRI and 7 a late MRI, among which 3 previously had an intraoperative MRI. Results The MR sequences that allowed the best assessment of MST-induced changes were T2 and T2*. The traces of MST are more visible on late MRI. These discrete non-complicated stigmas of MST were observed in all 10 studied patients: on the intraoperative MRI they are seen as micro-hemorrhagic spots (hypo-T2), on the early postoperative MRI as a discreet and limited cortical edema whether associated or not with micro-hemorrhagic spots and on the late MRI as liquid micro-cavities (hyper-T2) surrounded with a fine border of hemosiderin. Conclusions MST-induced cerebral lesions are best visualized in T2-sequences, mainly on the late postoperatively MRIs. On all the MRI examinations in this study, the MST are only associated with limited modifications of the treated cortical regions.
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patients with refractory epilepsy treated using a modified Multiple Subpial Transection technique
Neurosurgery, 2013Co-Authors: Marieagnes Docquier, Germaine Van Rijckevorsel, Christian RaftopoulosAbstract:BACKGROUND: : Multiple Subpial Transection (MST) is a potential surgical treatment for patients with epileptogenic foci located in cortical areas with higher functions. As neurosurgical teams have become more experienced with MST, the original technique has adapted. OBJECTIVE: : To report our 6-year experience with a modified MST technique. METHODS: : The population included 62 consecutive patients with medically refractory epilepsy treated by MST, with a follow-up period ranging from 2 to 9 years. MST was performed on gyri under neuronavigation and guided by intraoperative electrocorticography. We performed radiating MST from a single cortical entry point. The MST technique was described according to the number of Transections performed and the Brodmann areas (BAs) involved. Any MST-related complications were registered and followed up. Clinical outcome was described in terms of seizure suppression or reduction according to the Engel modified classification. RESULTS: : Twelve patients underwent MST alone (MSTa), and 50 had MST with another procedure. The main MST sites were BA 4 (61%) and 3, 1, 2 (58%); in 22% of cases, MST was performed in BA 44, 22, 39, and 40. Permanent neurological deficits were observed in 4 (6.4%) patients; 2 minor deficits were MST related (3.2%). A reduction in the seizure rate of at least 50% was seen in 79% of patients (MSTa group, 75%), and 42% became seizure free (MSTa group, 33%). CONCLUSION: : This study demonstrates the efficacy and low morbidity of radiating MST performed under neuronavigation and intraoperative electrocorticography. ABBREVIATIONS: : BA, Brodmann areaEEG, electroencephalogramFDG, 18-fluorodeoxyglucoseioECoG, intraoperative electrocorticographyMRE, medically refractory epilepsyMST, Multiple Subpial TransectionMSTa, Multiple Subpial Transection aloneMST+, Multiple Subpial Transection with other procedures.
Orrin Devinsky - One of the best experts on this subject based on the ideXlab platform.
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Multiple Subpial Transection for intractable partial epilepsy an international meta analysis
Epilepsia, 2002Co-Authors: Susan S Spencer, Johannes Schramm, Christian E Elger, Orrin Devinsky, Allen R Wyler, Michael J Oconnor, Darren B Orbach, Gregory L Krauss, Michael R Sperling, Ronald P LesserAbstract:Summary: Purpose: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed Multiple Subpial Transections (MSTs) for medically intractable epilepsy were collected. Methods: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection. Results: In patients with MST plus resection, excellent outcome (>95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%). Conclusions: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome.
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Multiple Subpial Transection for intractable partial seizures seizure outcome
Journal of Epilepsy, 1997Co-Authors: Steven V Pacia, Orrin Devinsky, Kenneth Perrine, Daniel J Luciano, B Vazquez, Werner Doyle, Michael Dogali, Helene S AbramsonAbstract:We studied 21 patients who underwent Multiple Subpial Transections (MST) for the surgical treatment of intractable partial-onset seizures in whom the epileptogenic focus overlapped with primary sensorimotor or language cortex All patients had intracranial EEG localization of seizures and functional mapping with electrical stimulation before surgery. Eighteen patients had cortical resections in addition to MST. At an average follow-up of 21 months, 13 patients either are seizure-free or are experiencing auras or simple partial seizures (SPS) only, 6 patients have had greater than 50% reduction in seizure frequency, 1 patient has had a modest reduction in seizures, and 1 patient is unchanged. MST in the 3 patients who did not undergo cortical resections reduced seizure frequency in all 3, although none are seizure-free. MST, combined with cortical resection, appears to be a safe and effective alternative to subtotal resection of the epileptogenic zone. MST alone, although not curative, reduced seizure frequency in all patients who underwent the procedure.
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invasive intracranial monitoring cortical resection and Multiple Subpial Transection for the control of intractable complex partial seizure of cortical onset
Stereotactic and Functional Neurosurgery, 1994Co-Authors: Michael Dogali, Orrin Devinsky, Daniel J Luciano, Kenneth PerrineAbstract:Invasive intracranial monitoring with subdural grids has led to a greater appreciation of cortical function and the discovery of ictal onset either independently or in conjunction with deep structures
