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Brain Sciences
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Surgical Management of Medically Intractable Epilepsy
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Surgical Management of Medically Intractable Epilepsy

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurosurgery and Neuroanatomy".

Deadline for manuscript submissions: closed (20 April 2021) | Viewed by 11065

Special Issue Editor

Prof. Dr. Kostas Fountas

E-Mail Website
Guest Editor
Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
Interests: neuroocology; epilepsy surgery; functional imaging; diffusion tensor imaging; electrophysiology; cortical mapping; subcortical mapping; epileptogenesis; gliomas

Special Issue Information

Dear Colleagues,

Epilepsy surgery constitutes a rapidly evolving scientific field. Advanced imaging techniques, hybrid imaging and electrophysiological modalities, and innovative invasive electrophysiological methods have been employed in the evaluation of patients suffering from medically intractable epilepsy of various etiologies. Moreover, novel surgical strategies have been implemented in the management of these patients with promising results. All these emerging surgical treatment options along with respective and disconnecting surgical methods represent valuable tools in the management of these patients. The overall seizure outcome, along with the cognitive and the neuropsychological outcome, have to be accurately evaluated in order to further increase the safety and efficacy of each surgical method.

Topics:

  • Preoperative evaluation of patients with medically intractable epilepsy;
  • Complications of the preoperative evaluation of patients with medically intractable epilepsy;
  • Emerging surgical strategies including but not limited to: Focal cortical cooling, optogenetics and chemogenetics, DBS, closed-loop stimulation, stereotactic radiosurgery, LASER interstitial thermal therapy (LITT);
  • Long-term outcome of the surgical treatment of medically intractable epilepsy;
  • Complications of the surgical treatment of medically intractable epilepsy.

Prof. Dr. Kostas Fountas
Guest Editor

Manuscript Submission Information

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Keywords

  • complications
  • closed-loop stimulation
  • chemogenetics
  • cortical cooling
  • deep brain stimulation
  • epilepsy
  • LASER interstitial thermal therapy
  • optogenetics
  • outcome
  • preoperative evaluation
  • stereotactic radiosurgery
  • surgery

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Published Papers (4 papers)

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Research

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7 pages, 217 KiB  
Article
Nutritional Intervention Facilitates Food Intake after Epilepsy Surgery
by Rika Suzumura, Ayataka Fujimoto, Keishiro Sato, Shimpei Baba, Satoko Kubota, Sayuri Itoh, Isamu Shibamoto, Hideo Enoki and Tohru Okanishi
Brain Sci. 2021, 11(4), 514; https://doi.org/10.3390/brainsci11040514 - 17 Apr 2021
Cited by 1 | Viewed by 1782
Abstract
Background: We investigated whether nutritional intervention affected food intake after epilepsy surgery and if intravenous infusions were required in patients with epilepsy. We hypothesized that postoperative food intake would be increased by nutritional intervention. The purpose of this study was to compare postoperative [...] Read more.
Background: We investigated whether nutritional intervention affected food intake after epilepsy surgery and if intravenous infusions were required in patients with epilepsy. We hypothesized that postoperative food intake would be increased by nutritional intervention. The purpose of this study was to compare postoperative food intake in the periods before and after nutritional intervention. Methods: Between September 2015 and October 2020, 124 epilepsy surgeries were performed. Of these, 65 patients who underwent subdural electrode placement followed by open cranial epilepsy surgery were studied. Postoperative total food intake, rate of maintenance of food intake, and total intravenous infusion were compared in the periods before and after nutritional intervention. Results: A total of 26 females and 39 males (age range 3–60, mean 27.1, standard deviation (SD) 14.3, median 26 years) were enrolled. Of these, 18 females and 23 males (3–60, mean 28.2, SD 15.1, median 26 years) were in the pre-nutritional intervention period group, and eight females and 16 males (5–51, mean 25.2, SD 12.9, median 26.5 years) were in the post-nutritional intervention period group. The post-nutritional intervention period group showed significantly higher food intake (p = 0.015) and lower total infusion (p = 0.006) than the pre-nutritional intervention period group. Conclusion: The nutritional intervention increased food intake and also reduced the total amount of intravenous infusion. To identify the cut-off day to cease the intervention and to evaluate whether the intervention can reduce the complication rate, a multicenter study with a large number of patients is warranted. Full article
(This article belongs to the Special Issue Surgical Management of Medically Intractable Epilepsy)
17 pages, 18387 KiB  
Article
Single-Institutional Experience of Chronic Intracranial Electroencephalography Based on the Combined Usage of Subdural and Depth Electrodes
by Yutaro Takayama, Naoki Ikegaya, Keiya Iijima, Yuiko Kimura, Suguru Yokosako, Norihiro Muraoka, Kenzo Kosugi, Yuu Kaneko, Tetsuya Yamamoto and Masaki Iwasaki
Brain Sci. 2021, 11(3), 307; https://doi.org/10.3390/brainsci11030307 - 28 Feb 2021
Cited by 6 | Viewed by 3199
Abstract
Implantation of subdural electrodes on the brain surface is still widely performed as one of the “gold standard methods” for the presurgical evaluation of epilepsy. Stereotactic insertion of depth electrodes to the brain can be added to detect brain activities in deep-seated lesions [...] Read more.
Implantation of subdural electrodes on the brain surface is still widely performed as one of the “gold standard methods” for the presurgical evaluation of epilepsy. Stereotactic insertion of depth electrodes to the brain can be added to detect brain activities in deep-seated lesions to which surface electrodes are insensitive. This study tried to clarify the efficacy and limitations of combined implantation of subdural and depth electrodes in intractable epilepsy patients. Fifty-three patients with drug-resistant epilepsy underwent combined implantation of subdural and depth electrodes for long-term intracranial electroencephalography (iEEG) before epilepsy surgery. The detectability of early ictal iEEG change (EIIC) were compared between the subdural and depth electrodes. We also examined clinical factors including resection of MRI lesion and EIIC with seizure freedom. Detectability of EIIC showed no significant difference between subdural and depth electrodes. However, the additional depth electrode was useful for detecting EIIC from apparently deep locations, such as the insula and mesial temporal structures, but not in detecting EIIC in patients with ulegyria (glial scar). Total removal of MRI lesion was associated with seizure freedom. Depth electrodes should be carefully used after consideration of the suspected etiology to avoid injudicious usage. Full article
(This article belongs to the Special Issue Surgical Management of Medically Intractable Epilepsy)
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Review

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14 pages, 8829 KiB  
Review
The Role of KRAS Mutations in Cortical Malformation and Epilepsy Surgery: A Novel Report of Nevus Sebaceous Syndrome and Review of the Literature
by Chiara Pepi, Luca de Palma, Marina Trivisano, Nicola Pietrafusa, Francesca Romana Lepri, Andrea Diociaiuti, Francesca Diomedi Camassei, Giusy Carfi-Pavia, Alessandro De Benedictis, Camilla Rossi-Espagnet, Federico Vigevano, Carlo Efisio Marras, Antonio Novelli, Ingmar Bluemcke and Nicola Specchio
Brain Sci. 2021, 11(6), 793; https://doi.org/10.3390/brainsci11060793 - 16 Jun 2021
Cited by 14 | Viewed by 3386
Abstract
The rare nevus sebaceous (NS) syndrome (NSS) includes cortical malformations and drug-resistant epilepsy. Somatic RAS-pathway genetic variants are pathogenetic in NS, but not yet described within the brain of patients with NSS. We report on a 5-year-old boy with mild psychomotor delay. A [...] Read more.
The rare nevus sebaceous (NS) syndrome (NSS) includes cortical malformations and drug-resistant epilepsy. Somatic RAS-pathway genetic variants are pathogenetic in NS, but not yet described within the brain of patients with NSS. We report on a 5-year-old boy with mild psychomotor delay. A brown-yellow linear skin lesion suggestive of NS in the left temporo-occipital area was evident at birth. Epileptic spasms presented at aged six months. EEG showed continuous left temporo-occipital epileptiform abnormalities. Brain MRI revealed a similarly located diffuse cortical malformation with temporal pole volume reduction and a small hippocampus. We performed a left temporo-occipital resection with histopathological diagnosis of focal cortical dysplasia type Ia in the occipital region and hippocampal sclerosis type 1. Three years after surgery, he is seizure-and drug-free (Engel class Ia) and showed cognitive improvement. Genetic examination of brain and skin specimens revealed the c.35G > T (p.Gly12Val) KRAS somatic missense mutation. Literature review suggests epilepsy surgery in patients with NSS is highly efficacious, with 73% probability of seizure freedom. The few histological analyses reported evidenced disorganized cortex, occasionally with cytomegalic neurons. This is the first reported association of a KRAS genetic variant with cortical malformations associated with epilepsy, and suggests a possible genetic substrate for hippocampal sclerosis. Full article
(This article belongs to the Special Issue Surgical Management of Medically Intractable Epilepsy)
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Other

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6 pages, 850 KiB  
Case Report
Speech Analysis Using Artificial Intelligence as a Peri-Operative Evaluation: A Case Report of a Patient with Temporal Lobe Epilepsy Secondary to Tuberous Sclerosis Complex Who Underwent Epilepsy Surgery
by Keiko Niimi, Ayataka Fujimoto, Yoshinobu Kano, Yoshiro Otsuki, Hideo Enoki and Tohru Okanishi
Brain Sci. 2021, 11(5), 568; https://doi.org/10.3390/brainsci11050568 - 29 Apr 2021
Viewed by 1954
Abstract
Background: Improved conversational fluency is sometimes identified postoperatively in patients with epilepsy, but improvements can be difficult to assess using tests such as the intelligence quotient (IQ) test. Evaluation of pre- and postoperative differences might be considered subjective at present because of the [...] Read more.
Background: Improved conversational fluency is sometimes identified postoperatively in patients with epilepsy, but improvements can be difficult to assess using tests such as the intelligence quotient (IQ) test. Evaluation of pre- and postoperative differences might be considered subjective at present because of the lack of objective criteria. Artificial intelligence (AI) could possibly be used to make the evaluations more objective. The aim of this case report is thus to analyze the speech of a young female patient with epilepsy before and after surgery. Method: The speech of a nine-year-old girl with epilepsy secondary to tuberous sclerosis complex is recorded during interviews one month before and two months after surgery. The recorded speech is then manually transcribed and annotated, and subsequently automatically analyzed using AI software. IQ testing is also conducted on both occasions. The patient remains seizure-free for at least 13 months postoperatively. Results: There are decreases in total interview time and subjective case markers per second, whereas there are increases in morphemes and objective case markers per second. Postoperatively, IQ scores improve, except for the Perceptual Reasoning Index. Conclusions: AI analysis is able to identify differences in speech before and after epilepsy surgery upon an epilepsy patient with tuberous sclerosis complex. Full article
(This article belongs to the Special Issue Surgical Management of Medically Intractable Epilepsy)
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