Cases Of Drug-resistant Epilepsy Research Articles

SCN1A rs6732655A/T polymorphism: Diagnostic and therapeutic insights for drug-resistant epilepsy.

A significant subset of individuals with epilepsy fails to respond to currently available antiepileptic drugs, resulting in heightened mortality rates, psychosocial challenges, and a diminished quality of life. Genetic factors, particularly within the SCN1A gene, and the pro-inflammatory cytokine response is important in intricating the drug resistance in idiopathic epilepsy cases. In this extended study, we determined the correlation of rs6732655A/T single nucleotide polymorphism to understand the causative association of SCN1A gene with epilepsy drug resistance and inflammatory response. To find the correlation of SCN1A gene rs6732655A/T polymorphism with the drug-resistant epilepsy and inflammatory response. The study enrolled 100 age and sex-matched patients of both drug-resistant and drug-responsive epilepsy cases. We analysed the rs6732655A/T polymorphism to study its association and causative role in drug-resistant epilepsy cases using restriction fragment length polymorphism technique. The diagnostic performance of interleukin (IL)-1β, IL-6, and high mobility group box 1 (HMGB1) protein levels was evaluated in conjunction with genotypic outcome receiver operating characteristic analysis. AT and AA genotypes of rs6732655 SCN1A gene polymorphism were associated with higher risk of drug resistance epilepsy. Serum biomarkers IL-6, IL1β and HMGB1 demonstrated diagnostic potential, with cutoff values of 4.63 pg/mL, 59.52 pg/mL and 7.99 ng/mL, respectively, offering valuable tools for epilepsy management. Moreover, specific genotypes (AA and AT) were found to be linked to the elevated levels of IL-1β and IL-6 and potentially reflecting increased oxidative stress and neuro-inflammation in drug-resistant cases supporting the previous reported outcome of high inflammatory markers response in drug resistance epilepsy. SCN1A genotypes AA and AT are linked to higher drug-resistant epilepsy risk. These findings underscore the potential influence of inflammation and genetics on epilepsy treatment resistance.

Sex-Specific Complement and Cytokine Imbalances in Drug-Resistant Epilepsy: Biomarkers of Immune Vulnerability.

Drug-resistant epilepsy (DRE) poses significant challenges in treatment and management. While seizure-related alterations in peripheral immune players are increasingly recognized, the involvement of the complement system, central to immune function, remains insufficiently explored in DRE. This study aimed to investigate the levels of complement system components and their association with cytokine profiles in patients with DRE. We analyzed serum samples from DRE patients (n = 46) and age- and sex-matched healthy controls (n = 45). Complement components and cytokines were quantified using Multi- and Single-plex ELISA. Statistical analyses examined relationships between complement molecules, cytokines, and clinical outcomes including epilepsy duration, Full-Scale Intelligence Quotient (FSIQ) scores, and age. We found common alterations in all DRE cases, including significant complement deficiencies (C1q, Factor H, C4, C4b, C3, and C3b/iC3b) and detectable bFGF levels. DRE females showed significantly lower levels of TNFα and IL-8 compared to healthy females. We observed a trend towards elevated CCL2 and CCL5 levels in DRE males compared to healthy males. These findings suggest potential sex dimorphism in immune profiles. Our analysis also indicated associations between specific complement and inflammatory markers (C2, IL-8, and IL-9) and Full-Scale Intelligence Quotient (FSIQ) scores in DRE patients. Our study reveals sex-specific peripheral complement deficiencies and cytokine dysregulation in DRE patients, indicating an underlying immune system vulnerability. These findings provide new insights into DRE mechanisms, potentially guiding future research on complement and cytokine signaling toward personalized treatments for DRE patients.

Altered Cytokine Profile in Clinically Suspected Seronegative Autoimmune Associated Epilepsy.

Autoimmune-associated epilepsy (AAE), a condition which responds favorably to immune therapies but not traditional anti-seizure interventions, is emerging as a significant contributor to cases of drug-resistant epilepsy. Current standards for the diagnosis of AAE rely on screening for known neuronal autoantibodies in patient serum or cerebrospinal fluid. However, this diagnostic method fails to capture a subset of drug-resistant epilepsy patients with suspected AAE who respond to immunotherapy yet remain seronegative (snAAE) for known autoantibodies. To identify potential biomarkers for snAAE, we evaluated the most comprehensive panel of assayed cytokines and autoantibodies to date, comparing patients with snAAE, anti-seizure medication (ASM) responsive epilepsy, and patients with other neuroinflammatory diseases. We found a unique signature of 14 cytokines significantly elevated in snAAE patients including: GM-CSF, MCP-2/CCL8, MIP-1a/CCL3, IL-1RA, IL-6, IL-8, IL-9, IL-10, IL-15, IL-20, VEGF-A, TNF-b, LIF, and TSLP. Based on prior literature, we highlight IL-6, IL-8, IL-10, IL-13, VEGF-A, and TNF-b as potentially actionable cytokine biomarkers for snAAE, which could be of diagnostic utility in clinical evaluations of snAAE patients. Autoantibody-ome screening failed to identify autoantibodies targeting neuronal channel proteins in snAAE patients. Interestingly, ASM-responsive epilepsy patients displayed elevations in the proportion of autoantibodies targeting brain plasma membrane proteins, possibly pointing to the presence of immune hyperactivity/dysfunction despite well-controlled seizure activity and suggesting ASM-responsive patients may experience disease progression independent of seizure activity (PISA). Overall, our findings suggest that simply expanding existing autoantibody screens may not sufficiently enhance diagnostic power for snAAE. Instead, we propose that cytokine analysis may serve as a promising diagnostic avenue for identifying immune dysregulation in AAE patients and enabling opportunities for trials of immunotherapies.

Optimizing ketogenic diet therapy for childhood epilepsy: Identifying key factors for seizure control and psychomotor enhancement.

To identify key factors influencing the therapeutic efficacy of the ketogenic diet (KD) for children with drug-resistant epilepsy and elucidate their interconnected relationships to optimize clinical practice. Participants were selected from children receiving KD treatment at West Second University Hospital of Sichuan University from September 2015 to October 2023. Clinical factors pre-KD and post-KD (at the third month) were analyzed systematically using an analytical framework. Descriptive analyses, univariate analyses, and multivariate regression analyses were performed for the entire cohort and subgroups of genetic and non-genetic (i.e., structural and unknown) etiologies. Thereby, the most significant predictors were identified for each relevant dependent variable. Path analysis diagrams were used for visual representation. Of 156 patients, genetic etiology was prevalent (38.5%). In the genetic subgroup, channelopathies predicted lower baseline seizure frequency and increased chance of seizure freedom with KD. Frequent seizures and complex history of anti-seizure medications (ASMs) predicted severe baseline psychomotor abnormalities. Younger age at KD initiation benefited psychomotor improvement. In the non-genetic subgroup, lower baseline seizure frequency increased the likelihood of seizure freedom post-KD. Concurrent use of multiple ASMs helped achieve ≥50% seizure reduction. Boys were more likely to experience psychomotor improvement. A significant correlation was found between ≥50% seizure reduction and psychomotor improvement in both subgroups. Delayed KD initiation (longer epilepsy duration at KD start) was related to a greater number of ASMs used, infrequent seizures, and older age at epilepsy onset. In addition, patients with channelopathies had delayed initiation of KD. Children with genetic epilepsy display more pronounced characteristics of epileptic encephalopathy. Early KD intervention is crucial for channelopathies, notably SCN1A variants. For other drug-resistant epilepsy cases, KD alongside diverse ASMs may improve seizure control and developmental outcomes. However, the patient population benefiting most from early KD tends to start the treatment later, urging a re-evaluation of KD decision-making paradigms.

Incomplete resection of the intracranial electroencephalographic seizure onset zone is not associated with postsurgical outcomes.

Delineation of seizure onset regions using intracranial electroencephalography (icEEG) is vital in the surgical workup of drug-resistant epilepsy cases. However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] < .7). Investigating the spatial extent of onset regions, we found no substantial evidence of an association with postsurgical seizure control (all AUC < .7). Although seizure onset regions are typically resected completely or in large part, incomplete resection is not associated with worse postsurgical outcomes. We conclude that postsurgical seizure recurrence cannot be attributed to an incomplete resection of the icEEG SOZ alone. Other network mechanisms beyond icEEG seizure onset likely contribute.

Hemispherectomy at The Hospital for Sick Children: expanded indications and lessons learned over 35 years

OBJECTIVE Functional hemispherectomy is an effective surgical intervention for select patients with drug-resistant epilepsy. The last several decades have seen dramatic evolutions in preoperative evaluation, surgical techniques, and postoperative care. Here, the authors present a retrospective review of the medical records of 146 children who underwent hemispherectomy between 1987 and 2022 at The Hospital for Sick Children, providing a unique overview of the evolution of the procedure and patient outcomes over 35 years. METHODS The medical records of all children who underwent hemispherectomy at The Hospital for Sick Children between 1987 and 2022 were reviewed. Demographic information, preoperative clinical features, short-term and long-term seizure outcomes, and details regarding postoperative complications were recorded. RESULTS The seizure outcomes of 146 children were analyzed. There were 68 females and 78 males with a mean age of 5.08 years, 123 of whom demonstrated seizure freedom (Engel class IA) in the short-term postoperative follow-up period and 89 in the long term. The effectiveness of hemispherectomy in achieving long-term seizure control has improved over time (β = 0.06, p &lt; 0.001). Factors associated with overall seizure freedom included younger age at the time of hemispherectomy and stroke as the etiology of seizures, as well as complete disconnection during the first surgery. Additionally, the etiologies of epilepsy for which hemispherectomy is performed have expanded over time, while complication rates have remained unchanged. CONCLUSIONS Hemispherectomy is an increasingly effective treatment for certain cases of drug-resistant epilepsy. The etiologies of epilepsy for which hemispherectomy is performed are broadening, with no change in its safety profile. Seizure outcomes are better when the etiology of epilepsy is an ischemic injury, and the most common complication after the procedure is hydrocephalus. These findings reinforce the ongoing use of hemispherectomy as a safe and effective treatment option for certain individuals with drug-resistant epilepsy, support its application to a broader range of etiologies, and highlight areas of future investigation.

Seizure freedom without seizure medication following stereoelectroencephalography implantation: a case report of drug-resistant post-traumatic epilepsy.

Achieving seizure freedom following failure of several antiseizure medications (ASMs) is rare, with the likelihood of achieving further control decreasing with each successive ASM trial. When cases of drug-resistant epilepsy arise, a diagnostic procedure known as stereoelectroencephalography (sEEG) can be used to identify epileptogenic zones (EZ) within the brain. After localization of these zones, they can be targeted for future surgical intervention. Here, we describe a case of complete seizure freedom off medication after sEEG without resection or other therapeutic intervention. In 2017, a 36-year-old right-handed male presented with drug-resistant epilepsy stemming from prior traumatic brain injury. Due to ongoing seizures, in 2020 a robotic-assisted sEEG electrode placement procedure was employed to localize the seizure onset zone. During sEEG monitoring, a single event was captured where the patient had dysarthric speech, left arm dystonic flexion, and difficulty responding to questioning. Notably, this event had no sEEG correlate, suggesting seizure occurrence in a region not monitored by implanted electrodes, which prompted the placement of scalp electrodes following this event. However, no further clinical events consistent with seizure were provoked through the remainder of recording. Following the 13-day admission, the patient chose to self-discontinue all seizure medications and has remained seizure free as of October 2023, more than 3.5 years later. While sEEG is considered a relatively safe procedure for seizure localization in drug resistant epilepsy, the possibility of microlesions created by sEEG depth electrodes remains largely unexplored. Further evaluation should be performed into potential tissue injury produced by depth electrode insertion.

Etiological analysis of 167 cases of drug-resistant epilepsy in children

BackgroundTo analyze the etiological distribution characteristics of drug-resistant epilepsy (DRE) in children, with the aim of providing valuable perspectives to enhance clinical practice.MethodsIn this retrospective study, clinical data were collected on 167 children with DRE who were hospitalized between January 2020 and December 2022, including gender, age of onset, seizure types, video electroencephalogram(VEEG) recordings, neuroimaging, and genetic testing results. Based on the etiology of epilepsy, the enrolled children were categorized into different groups. The rank-sum test was conducted to compare the age of onset for different etiologies.ResultsOf the 167 cases, 89 (53.3%) had a clear etiology. Among them, structural factors account for 23.4%, genetic factors for 19.2%, multiple factors for 7.2%, and immunological factors for 3.6%. The age of onset was significantly earlier in children with genetic causes than those with structural (P < 0.001) or immunological (P = 0.001) causes.ConclusionsMore than half of children with DRE have a distinct underlying cause, predominantly attributed to structural factors, followed by genetic factors. Genetic etiology primarily manifests at an early age, especially among children aged less than one year. This underscores the need for proactive enhancements in genetic testing to unveil the underlying causes and subsequently guide treatment protocols.

Inflammation and oxidative stress in epileptic children: from molecular mechanisms to clinical application of ketogenic diet.

Childhood epilepsy affects up to 1 % of children. It has been shown that 30 % of patients are resistant to drug treatments, making further investigation of other potential treatment strategies necessary. One such approach is the ketogenic diet (KD) showing promising results and potential benefits beyond the use of current antiepileptic drugs. This study aims to investigate the effects of KD on inflammation and oxidative stress, as one of the main suggested mechanisms of neuroprotection, in children with epilepsy. This narrative review was conducted using the Medline and Google Scholar databases, and by searching epilepsy, drug-resistant epilepsy, child, children, ketogenic, ketogenic diet, diet, ketogenic, keto, ketone bodies (BHB), PUFA, gut microbiota, inflammation, inflammation mediators, neurogenic inflammation, neuroinflammation, inflammatory marker, adenosine modulation, mitochondrial function, MTOR pathway, Nrf2 pathway, mitochondrial dysfunction, PPARɣ, oxidative stress, ROS/RNS, and stress oxidative as keywords. Compelling evidence underscores inflammation and oxidative stress as pivotal factors in epilepsy, even in cases with genetic origins. The ketogenic diet effectively addresses these factors by reducing ROS and RNS, enhancing antioxidant defenses, improving mitochondrial function, and regulating inflammatory genes. Additionally, KD curbs pro-inflammatory cytokine and chemokine production by dampening NF-κB activation, inhibiting the NLRP3 inflammasome, increasing brain adenosine levels, mTOR pathway inhibition, upregulating PPARɣ expression, and promoting a healthy gut microbiota while emphasizing the consumption of healthy fats. KD could be considered a promising therapeutic intervention in patients with epilepsy particularly in drug-resistant epilepsy cases, due to its targeted approach addressing oxidative stress and inflammatory mechanisms.

IEEG-recon: A fast and scalable pipeline for accurate reconstruction of intracranial electrodes and implantable devices.

Clinicians use intracranial electroencephalography (iEEG) in conjunction with noninvasive brain imaging to identify epileptic networks and target therapy for drug-resistant epilepsy cases. Our goal was to promote ongoing and future collaboration by automating the process of "electrode reconstruction," which involves the labeling, registration, and assignment of iEEG electrode coordinates on neuroimaging. We developed a standalone, modular pipeline that performs electrode reconstruction. We demonstrate our tool's compatibility with clinical and research workflows and its scalability on cloud platforms. We created iEEG-recon, a scalable electrode reconstruction pipeline for semiautomatic iEEG annotation, rapid image registration, and electrode assignment on brain magnetic resonance imaging (MRI). Its modular architecture includes a clinical module for electrode labeling and localization, and a research module for automated data processing and electrode contact assignment. To ensure accessibility for users with limited programming and imaging expertise, we packaged iEEG-recon in a containerized format that allows integration into clinical workflows. We propose a cloud-based implementation of iEEG-recon and test our pipeline on data from 132 patients at two epilepsy centers using retrospective and prospective cohorts. We used iEEG-recon to accurately reconstruct electrodes in both electrocorticography and stereoelectroencephalography cases with a 30-min running time per case (including semiautomatic electrode labeling and reconstruction). iEEG-recon generates quality assurance reports and visualizations to support epilepsy surgery discussions. Reconstruction outputs from the clinical module were radiologically validated through pre- and postimplant T1-MRI visual inspections. We also found that our use of ANTsPyNet deep learning-based brain segmentation for electrode classification was consistent with the widely used FreeSurfer segmentations. iEEG-recon is a robust pipeline for automating reconstruction of iEEG electrodes and implantable devices on brain MRI, promoting fast data analysis and integration into clinical workflows. iEEG-recon's accuracy, speed, and compatibility with cloud platforms make it a useful resource for epilepsy centers worldwide.

Simultaneous sampling of both cingulate gyri using a single interhemispheric depth electrode: A technical note.

Simultaneous sampling of the cingulate gyri through a single depth electrode inserted underneath the falx cerebri is clinically useful in certain cases of drug-resistant epilepsy. However, the frequency at which each region of the cingulate gyri - namely, anterior, middle, and posterior - can be simultaneously sampled with a single electrode remains uncertain. We assessed the anatomical relationship between the falx cerebri and the cingulate gyrus in 50 adults and children. Subsequently, we determined whether an arbitrary line, denoted as A (representing a 5 mm gap between the falx cerebri and corpus callosum necessary for depth electrode insertion), fell within the anterior, middle, or posterior cingulate gyrus. The shape of the falx cerebri and its intersection point with the corpus callosum varied substantially across individuals, with a significant difference between children and adults (P = 0.02). The A line was located in the middle cingulate gyrus in 18 children (72%), while 3 (12%) and 4 (16%) had it located in the posterior and anterior cingulate gyrus, respectively. Among adults, 15 individuals (60%) had the A line in the middle cingulate gyrus, 10 (40%) in the posterior cingulate gyrus, and none in the anterior cingulate gyrus. This study demonstrates the feasibility of simultaneous sampling of both the anterior and middle cingulate gyri in adults and children. Moreover, it represents the first investigation to document the wide interindividual variability in the morphology of the falx cerebri and its association with the cingulate gyrus.

Clinical features of 21 cases of drug-resistant epilepsy and the therapeutic effect of stereotactic electroencephalography guided epileptic foci resection.

To investigate the clinical characteristics of 21 patients with drug-resistant epilepsy (DRE) and evaluate the therapeutic outcome of guided resection of epileptic foci by stereotactic electroencephalography (SEEG). The clinical data of 21 patients with DRE treated in the Brain Hospital of Guangxi Zhuang Autonomous Region from April 2022 to April 2024 were retrospectively analyzed. All patients underwent multimodal imaging assessment before surgery, and the SEEG electrode implantation scheme was designed based on clinical data. The etiology was determined via SEEG. Intraoperative resection of epileptogenic foci was guided by SEEG, followed by a postoperative follow-up to evaluate the therapeutic effect. Patients' prognosis was assessed according to the Engle Seizure Control Scale, with Engel grade I indicating a good prognosis and grades II to IV indicating a poor prognosis. Logistic regression analysis was used to further explore the influencing factors of surgical prognosis. A total of 240 SEEG electrodes were implanted in 21 patients, ranging from 8 to 17 per patient, with an average of (11.43±2.77) electrodes. There were a total of 1472 contact points, ranging from 31 to 118 per patient, with an average of (70.10±21.32). The postoperative follow-up time varied from 2 to 15 months. One patient experienced memory decline. Of the 21 patients, 11 (52.38%) had a good prognosis and 10 (47.62%) had a poor prognosis. Multivariate logistic regression analysis showed that long course of disease was an independent risk factor for poor postoperative prognosis. In the treatment of drug-resistant epilepsy, multimodal imaging based SEEG can effectively detect epileptogenic foci, guiding the surgical excision safely and efficiently. This method holds promise for enhancing surgical outcomes in the treatment of DRE.

A case of drug-resistant epilepsy and autism with de novo SLC6A8 gene variant

A case of drug-resistant epilepsy and autism with de novo SLC6A8 gene variant

NMDA, AMPA and GABA Receptor Antibodies: Relation to Clinical and Electrophysiological Findings in Drug-Resistant Epilepsy

Abstract Background Epilepsy is a neurological disorder characterized by sudden recurrent episodes of convulsions, sensory disturbance, or loss of consciousness, resulting from abnormal electrical brain activity. It can have both genetic and acquired causes, with interaction of these factors in many cases. Auto-antibodies against synaptic receptors have been detected in a number of neurological conditions such as anti-NMDA receptor encephalitis and limbic encephalitis. Recently, three types of synaptic receptors have been the subject of research as regarding their role in the normal physiology of the nervous system, and their involvement in various neurological conditions. These receptors include AMPA receptors, NMDA receptors and GABAB receptors. Antibodies directed against these receptors may be the underlying cause of many cases of drug resistant epilepsy. Objectives To determine the prescence of autoantibodies against AMPA, NMDA and GABAB receptors in drug-resistant epilepsy and their correlation with clinical and electrophysiological findings. Methods The study was conducted on 17 epilepsy patients (12 males and 5 females) who were sampled for both CSF and blood. All CSF and serum samples were examined by the Indirect Immunofluorescence cell based technique for the detection of AntiAMPAR, Anti-NMDAR and Anti-GABAB antibodies. Results Only one case tested positive for Anti-NMDAR antibodies in CSF, while all other serum and CSF samples were negative for other antibodies. These results are still in process since our data will be used in a further study related to auto-immune drug-resistant epilepsy patients involving other auto-antibodies such as Ant-LGI1, Anti-CASPR2 and Anti-DPPX antibodies. Conclusion Testing Anti-NMDAR antibodies can be promising in detecteing drug resistant epilepsy patients even after receiving immunomodulatory treatment protocols.

Clinical importance of peri-ictal water drinking

BackgroundPeri-ictal water drinking is drinking water within a short period or during a seizure. This behavior can be experienced in childhood and adulthood and commonly affects adults suffering from temporal lobe epilepsy. Peri-ictal water drinking has clinical importance for lateralizing signs in the non-dominant hemisphere. It has been found in up to 7–15% of patients with focal epilepsy.Case presentationThis case study involved a 44-year-old right-handed female referred tour center as a case of drug-resistant epilepsy for presurgical evaluation. After evaluation in the Epilepsy Monitoring Unit, the patient was considered a candidate for right temporal lobectomy. The patient exhibited good outcome post-temporal lobectomy.ConclusionsThis case highlights the previously observed association between peri-ictal water drinking and the non-dominant hemisphere in patients with epilepsy. Clinicians must not overlook this automatic behavior that both patients and physicians usually underestimate because drinking water is a normal phenomenon.

SHORT-TERM SURGICAL OUTCOMES IN PATIENTS WITH DRUG-RESISTANT EPILEPSY DUE TO LESIONAL TEMPORA

Objectives: To describe the outcome of 35 cases of drug-resistant epilepsy due to the lesional temporal lobe surgery at Vietduc University Hospital from May 2018 to September 2022. Methods: A prospective description combined with retrospective, longitudinal follow-up of all patients diagnosed with drug resistance due to lesional temporal lobe epilepsy undergoing surgery at Vietduc University Hospital was conducted. Results: 35 cases of intractable lesional temporal lobe epilepsy surgery, male/female 1.5/1, partial seizures with loss of consciousness accounted for 99%, and 2/3 of cases occurred without aura. Seizure-free (post-operation 1 month) (Engel I) accounted for 74.3%, and the remaining (25.7%) had improved seizures (Engel 2, 3). Complications after surgery accounted for 17.1%, and there were no cases of death. Conclusion: Surgical treatment for drug resistance due to lesional temporal lobe epilepsy is safe and very effective, with a low complication rate.

210 Intra-Operative Electrocorticography (ECoG) for Lesional Epilepsy: A Randomized Controlled Trial (IO-ECoG Trial)

INTRODUCTION: Usage of Electrocorticography (ECoG) is not clearly established. Robust evidence doesnot exist to support its regular usage in Long term Epilepsy associated tumors (LEATs) which constitutes approximately 25-35% cases of drug resistant epilepsy. METHODS: Prospective randomized controlled trial, including all patients operated for drug resistant epilepsy with non-eloquent area LEATs. Patients were randomized into 2 groups namely Group I (without usage of ECoG) and Group II (with ECoG usage). Group II patients further underwent tailored resections if necessary, as per ECoG practice protocols. Surgical outcomes were evaluated for seizure outcome (Engel scale) and adverse event profile. RESULTS: Total of 38 patients operated for LEATs having drug resistant epilepsy were included in the study with mean age of 21.1 years (range 2-46 years). 18 patients belonged to Group I and 20 patients belonged to Group II with mean follow-up period of 11.02 months (range 3-22 months). 30% patients (n = 6) in Group II underwent extended resection based on rhythmic persistent post resection spikes. 90% of Group II patients had Engel score Ia during follow up compared to 77.7% of Group I with Engel score Ia (p = 0.302). In Group II, 85.7% patients with extended tailored resection had Engel score Ia compared to 83.8% cases without extended resection (p = 0.904). CONCLUSIONS: Though ECoGs role may have been established in focal cortical dysplasia, its utility in LEATs is limited. Our randomized study confirmed that there is no added benefit conferred by the use of ECoG in LEATS. Additional tailored resections aided by ECoG also did not yield seizure outcome benefits in LEATS.

Deep Brain Stimulation and Responsive Neurostimulation Implantation for Medically Refractory Epilepsy: A Case Report Study of a Single-Center's Experience

BACKGROUND AND IMPORTANCE: Nearly 25% of all epilepsy is drug-resistant epilepsy. Responsive neurostimulation (RNS) and deep brain stimulation (DBS) offer viable options when resection or ablation is not feasible. Neuromodulation leads to improved seizure control. However, in patients with highly complex epileptogenic networks, a multimodality approach using simultaneous RNS and DBS may provide a summative benefit. CLINICAL PRESENTATION: We present 2 cases of drug-resistant epilepsy who received simultaneous anterior nucleus of the thalamus DBS and RNS neuromodulation. To our knowledge, this is the first report of simultaneous DBS and RNS neurostimulation for the treatment of epilepsy. Given the complexity of their seizure networks, a combined neuromodulatory approach was deemed best to achieve seizure control. Both experienced multiple seizure semiology patterns consistent with multifocal onsets which were confirmed on phase I monitoring, nuclear medicine, and magnetoencephalography studies. Case 1 had a seizure reduction of 75% to 89% at 12 months which has remained stable at last follow-up (26 months) and case 2 achieved near seizure freedom and remained seizure-free at last follow-up (16 months). CONCLUSION: Neuromodulation has proven efficacious and safe in randomized controlled trials for the treatment of epilepsy. This is particularly important in multifocal epilepsy or if resective surgery is not an option. The optimal stimulation pathways and multimodal neuromodulation technique remains under investigation. We are the first to report that RNS and DBS implantation in the same patient is feasible, without major adverse effects and potentially effective.

ID:16045 Simultaneous Deep Brain Stimulation and Responsive Neurostimulation for Drug Refractory Epilepsy: A Case Report Study

Nearly 25% of all epilepsy is Drug Resistant Epilepsy (DRE) 1-3. Surgical evaluation should be considered early in the course of the disease to minimize morbidity and the risk of sudden unexpected death in epilepsy (SUDEP)4-5. Neuromodulation is a viable option when resection or ablation is not feasible. A growing body of evidence shows improved seizure control and long-term efficacy with both7. With highly complex epileptogenic networks, a multimodality approach may provide an additional benefit to maximize seizure control. We report two cases of DRE who underwent anterior nucleus of the thalamus (ANT) DBS implantation followed by RNS implantation. To our knowledge, this is the first report of simultaneous DBS and RNS neurostimulation for the treatment of epilepsy.

Non-invasive, neurotoxic surgery reduces seizures in a rat model of temporal lobe epilepsy

Surgery can be highly effective for treating certain cases of drug resistant epilepsy. The current study tested a novel, non-invasive, surgical strategy for treating seizures in a rat model of temporal lobe epilepsy. The surgical approach uses magnetic resonance-guided, low-intensity focused ultrasound (MRgFUS) in combination with intravenous microbubbles to open the blood-brain barrier (BBB) in a transient and focal manner. During the period of BBB opening, a systemically administered neurotoxin (Quinolinic Acid: QA) that is normally impermeable to the BBB gains access to a targeted area in the brain, destroying neurons where the BBB has been opened. This strategy is termed Precise Intracerebral Non-invasive Guided Surgery (PING). Spontaneous recurrent seizures induced by pilocarpine were monitored behaviorally prior to and after PING or under control conditions. Seizure frequency in untreated animals or animals treated with MRgFUS without QA exhibited expected seizure rate fluctuations frequencies between the monitoring periods. In contrast, animals treated with PING targeting the intermediate-temporal aspect of the hippocampus exhibited substantial reductions in seizure frequency, with convulsive seizures being eliminated entirely in two animals. These findings suggest that PING could provide a useful alternative to invasive surgical interventions for treating drug resistant epilepsy, and perhaps for treating other neurological disorders in which aberrant neural circuitries play a role.