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Evaluation and Treatment of Drug-Resistant Epilepsy
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Evaluation and Treatment of Drug-Resistant Epilepsy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (1 June 2021) | Viewed by 5429

Special Issue Editor

Dr. Pierre Bourdillon

E-Mail Website
Guest Editor
1. Department of Neurosurgery, Fondation Adolphe de Rothschild Hospital, 29 rue Manin, 75019 Paris, France
2. Paris Brain Institute, Sorbonne Université, Pitié-Salpêtrière Hospital 47 boulevard de l'hôpital, 75013 Paris, France
Interests: epilepsy surgery; epileptic network; intracranial EEG; neuro-modulation; stereotactic lesioning

Special Issue Information

Dear Colleagues,

Drug resistant epilepsy management remains challenging despite numerous innovations.Focal epilepsies are eligible to a surgical treatment consisting in a resection, a lesion or a disconnection of the ictal onset zone. Identification of the ictal onset zone and the functional connectome, through non-invasive (MRI, EEG, MEG, PET-scan) and invasive (intracranial-EEG) investigations, remains crucial to propose a surgical treatment with a favorable epilepto-functional balance. Novel approaches of interpretation of these investigations (new signal analysis approaches, artificial intelligence, new electode) and multimodal integration of this data lead to recent improvements in this field. Alongside this improvement, new surgical techniques, such as stereotactic lesioning (laser interstitial thermal therapy, thermo-coagulation, radiosurgery, disconnection (robotized disconnection) or awake condition surgery, have recently been described aiming to reduce the risk of the procedures.  The first goal of this special issue is to provide both synthesis and original researches of this field.

More recently, strategies aiming to treat patients having drug resistant epilepsy ineligible to curative surgery (large epileptic network, ictal onset zone located in non-compensable zone of the functional connectome) have been evaluated. Schematically, two trends are currently developed. One the one hand, targeting the epileptic network instead of focusing on the ictal onset zone (lesion of network node, neuro-modulation through deep brain stimulation). On the other hand, trying to make the seizure less disabling instead of trying to cure the seizure (close loop system aiming to prevent the loss of consciousness during the seizure). The second goal of this special issue is to provide insight on these innovative strategies.

We invite researchers from different fields, including clinical neurology, neurophysiology, neurosciences, neurosurgery and engineering, to submit their original work or reviews to this Special Issue.

Dr. Pierre Bourdillon
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Epileptic networks
  • Pre-surgical evaluation
  • Intra-cranial-EEG
  • Network nodes
  • Neuro-modulation
  • Stereotactic lesioning
  • Epilepsy surgery
  • Drug-resistant epilepsy
  • Closed-loop
  • Electrophysiology

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Published Papers (2 papers)

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Research

12 pages, 748 KiB  
Article
Epilepsy Due to Mild TBI in Children: An Experience at a Tertiary Referral Center
by Jun T. Park, Sarah J. DeLozier and Harry T. Chugani
J. Clin. Med. 2021, 10(23), 5695; https://doi.org/10.3390/jcm10235695 - 3 Dec 2021
Cited by 4 | Viewed by 2491
Abstract
Rationale: Posttraumatic epilepsy (PTE) is a common cause of morbidity in children after a traumatic brain injury (TBI), occurring in 10–20% of children following severe TBI. PTE is diagnosed after two or more unprovoked seizures occurring 1-week post TBI. More often, studies have [...] Read more.
Rationale: Posttraumatic epilepsy (PTE) is a common cause of morbidity in children after a traumatic brain injury (TBI), occurring in 10–20% of children following severe TBI. PTE is diagnosed after two or more unprovoked seizures occurring 1-week post TBI. More often, studies have focused on children with epilepsy due to severe TBI. We aim to understand the utility of head computed tomography (HCT), EEG, and the risk of developing drug-resistant epilepsy in children after mild TBI. Method: We retrospectively studied 321 children with TBI at a tertiary pediatric referral center during a 10-year period. Mild TBI was defined as loss of consciousness (LOC) or amnesia < 30 min, moderate TBI as LOC or amnesia between 30 min and 1 day, and severe TBI as LOC or amnesia > 1 day, subdural hemorrhage, or contusion. Multiple clinical variables were reviewed, including past and present antiepileptic drug(s), seizure control, and mode of injury. First and subsequent post-TBI EEGs/prolonged video-EEGs were obtained acutely, subacutely, and/or chronically (range, day 1–3 years, median 1 month). Descriptive analyses were conducted using medians and ranges for continuous data. Categorical data were reported using frequencies and percentages, while comparisons between groups were made using Fisher’s exact test for small sample sizes. Results: Forty-seven children were diagnosed with posttraumatic epilepsy: eight children (17%) due to mild TBI, 39 children (83%) due to severe TBI. For the eight children with mild TBI whom all had an accidental trauma (non-inflicted), the median follow-up time was 25 months (range 1.5 months–84 months). The median age was 10 years (range 4–18 years), and the median age at the time of injury was seven years (range: 23 months–13 years). No relevant previous medical history was present for six patients (80%), and two patients’ (20%) relevant previous medical histories were unknown. Seven patients (88%) had no history of seizures, and patient #6 (12%) had unknown seizure history. Six patients (75%) had normal routine EEG(s). Patient #6 (13%) had an abnormal VEEG 3 months after the initial normal routine EEG, while patient #1 (13%) had an initial prolonged EEG 8 months after TBI. Compared to the 39 patients with severe TBI, 31 (79%) of whom had abnormal EEGs (routine and/or prolonged with video), mild TBI patients were more likely to have normal EEGs, p = 0.005. Head CT scans were obtained acutely for seven patients (90%), all of which were normal. One patient only had brain magnetic resonance imaging (MRI) 8 months after the injury. Compared to the 39 patients with severe TBI, all of whom had abnormal HCTs, mild TBI patients were less likely to have abnormal HCTs, p < 0.0001. In patients with mild TBI, no patient had both abnormal EEG/VEEG and HCT, and no one was on more than one Antiepileptic drug (AED), p < 0.005. Six patients (75%) had MRIs, of which five (63%) were normal. Two patients (#1, 7) did not have MRIs, while one patient’s (#4) MRI was unavailable. Five patients (63%) had a seizure <24 h post TBI, while the rest had seizures after the first week of injury. Conclusion: Children with epilepsy due to mild TBI, loss of consciousness, or amnesia < 30 min are more likely to have normal HCT and EEG and to be on 0–1 AED. Limitations of our study include the small sample size and retrospective design. The current findings add to the paucity of data in children who suffer from epilepsy due to mild TBI. Full article
(This article belongs to the Special Issue Evaluation and Treatment of Drug-Resistant Epilepsy)
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10 pages, 1572 KiB  
Article
Intraoperative Ultrasound Shear-Wave Elastography in Focal Cortical Dysplasia Surgery
by Bertrand Mathon, Stéphane Clemenceau and Alexandre Carpentier
J. Clin. Med. 2021, 10(5), 1049; https://doi.org/10.3390/jcm10051049 - 3 Mar 2021
Cited by 10 | Viewed by 2372
Abstract
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound [...] Read more.
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound SWE techniques for the intraoperative detection of FCDs. We retrospectively analyzed data from 18 adult patients with drug-resistant epilepsy associated with FCD who had undergone SWE-guided surgery. Conventional B-mode images detected FCD in 2 patients (11.1%), while SWE detected FCD in 14 patients (77.8%). The stiffness ratios between MRI-positive and -negative cases were significantly different (3.6 ± 0.4 vs. 2.2 ± 0.6, respectively; p < 0.001). FCDs were significantly more frequently detected by interoperative SWE in women (OR 4.7, 95% CI (1.7–12.7); p = 0.004) and in patients in whom FCD was visible on magnetic resonance imaging (MRI; OR 2.3, 95% CI (1.3–4.3); p = 0.04). At 1 year after surgery and at last follow-up (mean = 21 months), seizure outcome was good (International League Against Epilepsy (ILAE) Class 1 or 2) in 72.2% and 55.6% of patients, respectively. Despite some limitations, our study highlighted the potential of SWE as an intraoperative tool to detect FCD. Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete FCD resection. Interobserver reliability of SWE measurements should also be assessed by further studies. Full article
(This article belongs to the Special Issue Evaluation and Treatment of Drug-Resistant Epilepsy)
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