Refractory Epilepsy Patients Research Articles

Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: a systematic review and meta-analysis.

Robotic assistance has improved electrode implantation precision in stereoelectroencephalography (SEEG) for refractory epilepsy patients. We sought to assess the relative safety of the robotic-assisted (RA) procedure compared to the traditional hand-guided one. A systematic search on PubMed, Web of Science, Embase, and Cochrane was performed for studies directly comparing robot-assisted vs. manually guided SEEG to treat refractory epilepsy. The primary outcomes included target point error (TPE), entry point error (EPE), time of implantation of each electrode, operative time, postoperative intracranial hemorrhage, infection, and neurologic deficit. We included 427 patients from 11 studies, of whom 232 (54.3%) underwent robot-assisted surgery and 196 (45.7%) underwent manually guided surgery. The primary endpoint, TPE, was not statistically significant (MD 0.04 mm; 95% CI - 0.21, - 0.29; p = 0.76). Nonetheless, EPE was significantly lower in the intervention group (MD - 0.57 mm; 95% CI - 1.08; - 0.06; p = 0.03). Total operative time was significantly lower in the RA group (MD - 23.66 min; 95% CI - 32.01, - 15.31; p < 0.00001), as well as the individual time of implantation of each electrode (MD - 3.35 min; 95% CI - 3.68, - 3.03; p < 0.00001). Postoperative intracranial hemorrhage did not differ between groups: robotic (9/145; 6.2%) vs. manual (8/139; 5.7%) (RR 0.97; 95% CI 0.40-2.34; p = 0.94). There was no statistically relevant difference in infection (p = 0.4) and postoperative neurological deficit (p = 0.47) incidence between the two groups. In this analysis, there is a potential relevance in the RA procedure when comparing the traditional one, since operative time, time of implantation of each electrode, and EPE were significantly lower in the robotic group. More research is needed to corroborate the superiority of this novel technique.

Detection of brain somatic mutations in focal cortical dysplasia during epilepsy presurgical workup.

Brain-restricted somatic variants in genes of the mechanistic target of rapamycin signalling pathway cause focal epilepsies associated with focal cortical dysplasia type II. We hypothesized that somatic variants could be identified from trace tissue adherent to explanted stereoelectroencephalography electrodes used in the presurgical epilepsy workup to localize the epileptogenic zone. We investigated three paediatric patients with drug-resistant focal epilepsy subjected to neurosurgery. In the resected brain tissue, we identified low-level mosaic somatic mutations in AKT3 and DEPDC5 genes. We collected stereoelectroencephalography depth electrodes in the context of a second presurgical evaluation and identified 4/33 mutation-positive electrodes that were either located in the epileptogenic zone or at the border of the dysplasia. We provide the proof-of-concept that somatic mutations with low levels of mosaicism can be detected from individual stereoelectroencephalography electrodes and support a link between the mutation load and the epileptic activity. Our findings emphasize future opportunities for integrating genetic testing from stereoelectroencephalography electrodes into the presurgical evaluation of refractory epilepsy patients with focal cortical dysplasia type II to improve the patients' diagnostic journey and guide towards precision medicine.

A STUDY OF CLINICAL AND IMAGING FEATURES OF REFRACTORY EPILEPSY IN PATIENTS ATTENDING A TERTIARY CARE HOSPITAL

Background &amp; objectives Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. It is estimated that 70% of people living with epilepsy could live seizure free if properly diagnosed and treated. The exact magnitude of medically intractable epilepsy in India is unknown. The factors that determine the outcome of epilepsy are age of onset and the type of seizure. The aim of our study was to identify the causes of refractory epilepsy To identify the clinical and imaging features i Objectives: n refractoriness. To determine the importance of early and proper evaluation of seizures in refractory epilepsy. It was an observational study Methods: in patients of refractory epilepsy. After taking informed consent, detailed history was taken and examination was done. 105 Patie Results: nts with refractory epilepsy were included in the study. Majority were between 21-30 years age group. 44% of the patients had the onset of seizures below 10 years. Focal seizure type (68 patients) was the most frequent type. Status epilepticus was found in 41.9% of the patients. Engel's seizure score showed the association of high seizure score with RE. The most common cause for refractoriness was found to be congenital anomalie Interpretation &amp; Conclusions: s in children and calcication in adults.

Evaluation of Cognitive Impairment in Refractory Temporal Lobe Epilepsy Patients Concerning Structural Brain Lesions

Introduction: Temporal lobe epilepsy (TLE) is the most prevalent form of drug-resistant epilepsy with concurrent cognitive impairment. Prevention, earlier diagnosis, and personalized management of cognitive deficits in TLE require more understanding of underlying structural and functional brain Ialterations. No study has evaluated the performance of TLE patients in different cognitive domains based on their structural brain lesions. Methods: In this study, 69 refractory TLE patients underwent magnetic resonance imaging (MRI) epilepsy protocol and several neuropsychological tests, consisting of the Wechsler adult intelligence scale-revised, Rey-Osterrieth complex figure test, verbal fluency test, digit span test, spatial span test, Wechsler memory scale-III, design fluency test, Rey visual design learning test, auditory-verbal learning test, and trail making test. MRI findings were classified into the following groups: Focal cortical dysplasia, gliosis, atrophy, mesial temporal sclerosis (MTS), tumor, vascular malformation, and other lesions or normal. Results of neuropsychological tests were compared between MRI groups using a generalized linear model with gamma distribution and log link. Results: Patients with MTS showed better performance in general intellectual functioning, working memory, attentional span, and auditory-verbal learning compared to patients with non-MTS MRI lesions. Atrophy and focal cortical dysplasia had the largest differences from MTS. Conclusion: Cognitive performance of refractory TLE patients varies concerning structural brain alterations. Further neuroimaging studies of TLE lead to prevention and more accurate management of cognitive decline in clinical settings.

The Efficacy and Cognitive Impact of Perampanel Monotherapy in Patients with Self-Limited Epilepsy with Centrotemporal Spikes: A Retrospective Analysis.

The third generation of antiepileptic medication (ASM) perampanel (PER), is mostly used as an add-on treatment for refractory epilepsy patients, and rarely used as a monotherapy. This study aims to observe the efficacy and assess the cognitive effects of PER monotherapy in patients with self-limited epilepsy with centrotemporal spikes (SeLECTS). Through screening, 86 patients who were first diagnosed with SeLECTS and treated with PER monotherapy were included in this study. All patients were followed up at least 12 months, and Evaluated the efficacy and safety of PER by observing the seizures of patients. At the same time, we used the P300 event-related potential (ERP) component and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) to evaluate the cognitive changes in children before and after treatment with PER. Ten percent of the children experienced adverse effects, such as dizziness, gait instability, and irritability. The drug retention rate at the last follow-up was 98.83%. Further more, the P300 ERP component and WISC-IV tests were performed no significant difference before and 12 months after PER monotherapy in SeLECTS children. The third-generation of ASM PER monotherapy had a clear effect in children with SeLECTS. A small dose of PER can control seizures well and has no obvious effect on cognitive development.

Efficacy and Quality of Life Outcome of Combined Epilepsy Surgery with RNS Placement (P5-1.002)

<h3>Objective:</h3> Retrospectively review clinical outcomes in patients treated with resection or Laser interstitial Thermal Therapy (LiTT) immediately (≤ 90 days) after implantation of RNS. <h3>Background:</h3> Surgical resection and LiTT are standard treatments for refractory epilepsy, but these options can be limited by eloquent cortex and seizure multifocality. Previous studies have suggested RNS may be used in conjunction with resective surgery (RNS+R) or LiTT (RNS+LiTT) as a new combination of treatments. Besides seizure control, quality of life and psychiatric symptoms including depression and anxiety are considered as important outcome evaluation after epilepsy surgery. <h3>Design/Methods:</h3> 34 patients that had RNS+R or RNS+LiTT at our center were reviewed and 10 were excluded. The decision of dual procedures was made prior to surgery. Patients received RNS+R had both resective surgery and RNS placement in the same procedure. Patients received RNS+LiTT had several weeks gap between the RNS placement and LiTT due to neurosurgical logistics. Clinical follow-ups were performed at 12, 18, 24, 36 and 48 months for evaluation of seizure frequency. Patient health questionnaire-9 (PHQ-9) is used as a depression assessment. Quality of life in epilepsy questionnaire (QOLIE-31) was used as scoring for evaluation of general quality of life. <h3>Results:</h3> Among the 24 patients that had RNS+R or RNS+LiTT, 22 patients (91.6%) showed improved seizure frequency at the last follow up. Fourteen patients had PHQ-9 evaluation and the average score was 5.85±6.29 (mean±SD), among which nine were between 0–4 (minimal depression), one was between 5–9(mild depression), three were between 10–14(moderate depression), one was 15–19(moderately severe depression) and none was 20–27(severe depression). QOLIE-31 done in eight patients showed average score of 65.61 ± 18.09 (mean±SD) in last follow-up visit. <h3>Conclusions:</h3> Our study showed significant seizure control rate of RNS+R or RNS+LiTT therapy in refractory epilepsy patients. It also suggestive for promising psychiatric outcomes and quality of life scoring after surgery. <b>Disclosure:</b> Dr. Pan has nothing to disclose. Dr. Mirza has nothing to disclose. Dr. Agostini has nothing to disclose. Dr. Alick-Lindstrom has nothing to disclose. Dr. Das has received personal compensation for serving as an employee of Concentra. Dr. Das has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for janicek. The institution of an immediate family member of Dr. Das has received research support from NIH. The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS. Dr. Doyle has nothing to disclose. Dr. Dieppa has nothing to disclose. Dr. Hays has nothing to disclose. Dr. Harvey has received personal compensation for serving as an employee of RSC Diagnostics. The institution of Dr. Harvey has received research support from GW Pharmaceuticals. The institution of Dr. Harvey has received research support from Cerevel Pharmaceuticals. The institution of Dr. Harvey has received research support from UCB Pharmaceuticals. The institution of Bradley Lega has received research support from NIH. irina podkorytova has nothing to disclose. Dr. Zepeda Garcia has nothing to disclose. Dr. Perven has nothing to disclose.

External Validation of Novel Method of Seizure Onset Zone Localization Based on Neural Resonance (P2-1.006)

<h3>Objective:</h3> We aimed to validate a recently published technique that used neural resonance to localize seizure onset zones (SOZ) with a retrospective dataset collected at an external institution. Further, we critically examined the need for a larger, tailored prospective validation study. <h3>Background:</h3> Accurate localization of the SOZ could improve surgical outcomes in medically refractory epilepsy patients. A recent study successfully used a novel metric of neural resonance to retrospectively identify SOZ regions and predict surgical success. The technique leverages distinct electrophysiological features of evoked responses during single pulse electrode stimulation (SPES) and incorporates them into a dynamical model. We aimed to validate these findings with a retrospective cohort of six patients to assess whether neural resonance predicted surgical outcomes. <h3>Design/Methods:</h3> We collected intracranial electroencephalographic (iEEG) data from six patients that underwent intracranial monitoring, single-pulse electrical stimulation protocol, and resection surgery between June 2020 and May 2021. Four out of six patients were stimulated in both SOZ regions and non-SOZ regions and thus were tested using the logistic regression model trained on the original dataset at the primary study institution. <h3>Results:</h3> Three of the four patients had successful surgical outcomes. Of the four patients tested with the logistic regression model, only one out of four was predicted correctly; the model predicted success for one true success and the failure patient. <h3>Conclusions:</h3> We hypothesize that the non-reproducibility of the original findings are resultant of differences in a research-driven SPES protocol and a clinically driven stimulation protocol. The external validation dataset stimulated a fewer number of sites, used a different clinical EEG and stimulation system, and varied stimulation parameters in a different subspace. However, this work highlights the need for a large, prospective validation dataset that is multi-center and encompasses a wide range of parameters; the gathering of this dataset is currently underway. <b>Disclosure:</b> Mr. Barnagian has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Kang has nothing to disclose. Mark Hays has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Sarma has stock in Neurologic Solutions, Inc.. Dr. Barot has nothing to disclose.

837 Responsive Neurostimulation of the Thalamus for the Treatment of Refractory Epilepsy

INTRODUCTION: One-third of patients with epilepsy experience seizures despite antiepileptic medications. Some of these refractory patients may not be candidates for surgical resection. The Responsive Neurostimulation System (RNS) is a closed-loop device that uses programmable detection and stimulation. METHODS: We performed a prospective single-center study of consecutive refractory epilepsy patients who underwent RNS system implantation in the anterior (ANT) and centromedian (CM) thalamic nuclei from September 2015 to December 2020. Patients were followed postoperatively to evaluate seizure freedom and complications. RESULTS: Twenty-three patients underwent placement of 36 RNS thalamic leads (CM = 27 leads, ANT = 9 leads). Mean age at implant was 18.8 ± 11.2 years. Two patients (8.7%) developed infections: 1 improved with antibiotic treatments alone, and 1 required removal with eventual replacement of the system. Mean follow-up was 22.3 months. Based on overall reduction of seizure frequency, 2 patients (8.7%) had no- to &lt;25% improvement, 6 patients (26.1%) had 25-49% improvement, 14 patients (60.9%) had 50-99% improvement, and 1 patient (4.3%) became seizure-free. All patients reported significant improvement in seizure duration and severity, and 17 patients (74%) reported improved post-ictal state. There was a trend for subjects with foci located in the temporal lobe to achieve better outcomes after thalamic RNS compared to those with extratemporal foci. Seizure etiology was syndromic in 12 cases (52.2%). CONCLUSIONS: Thalamic RNS achieved ≥50% seizure control in ∼65% of patients. Infections were the most common complication. This therapeutic modality may be particularly useful for patients affected by aggressive epilepsy syndromes since a young age, those whose seizure foci are located in the mesial temporal lobe, and those who have failed prior surgical interventions.

Pathomorphological Diagnostic Criteria for Focal Cortical Dysplasias and Other Common Epileptogenic Lesions-Review of the Literature.

Focal cortical dysplasia (FCD) represents a heterogeneous group of morphological changes in the brain tissue that can predispose the development of pharmacoresistant epilepsy (recurring, unprovoked seizures which cannot be managed with medications). This group of neurological disorders affects not only the cerebral cortex but also the subjacent white matter. This work reviews the literature describing the morphological substrate of pharmacoresistant epilepsy. All illustrations presented in this study are obtained from brain biopsies from refractory epilepsy patients investigated by the authors. Regarding classification, there are three main FCD types, all of which involve cortical dyslamination. The 2022 revision of the International League Against Epilepsy (ILAE) FCD classification includes new histologically defined pathological entities: mild malformation of cortical development (mMCD), mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy (MOGHE), and "no FCD on histopathology". Although the pathomorphological characteristics of the various forms of focal cortical dysplasias are well known, their aetiologic and pathogenetic features remain elusive. The identification of genetic variants in FCD opens an avenue for novel treatment strategies, which are of particular utility in cases where total resection of the epileptogenic area is impossible.

Detection of pathological high-frequency oscillations in refractory epilepsy patients undergoing simultaneous stereo-electroencephalography and magnetoencephalography

BackgroundStereo-electroencephalography (SEEG) and magnetoencephalography (MEG) have generally been used independently as part of the pre-surgical evaluation of drug-resistant epilepsy (DRE) patients. However, the possibility of simultaneously employing these recording techniques to determine whether MEG has the potential of offering the same information as SEEG less invasively, or whether it could offer a greater spatial indication of the epileptogenic zone (EZ) to aid surgical planning, has not been previously evaluated. MethodsData from 24 paediatric and adult DRE patients, undergoing simultaneous SEEG and MEG as part of their pre-surgical evaluation, was analysed employing manual and automated high-frequency oscillations (HFOs) detection, and spectral and source localisation analyses. ResultsTwelve patients (50%) were included in the analysis (4 males; mean age=25.08 years) and showed interictal SEEG and MEG HFOs. HFOs detection was concordant between the two recording modalities, but SEEG displayed higher ability of differentiating between deep and superficial epileptogenic sources. Automated HFO detector in MEG recordings was validated against the manual MEG detection method. Spectral analysis revealed that SEEG and MEG detect distinct epileptic events. The EZ was well correlated with the simultaneously recorded data in 50% patients, while 25% patients displayed poor correlation or discordance. ConclusionMEG recordings can detect HFOs, and simultaneous use of SEEG and MEG HFO identification facilitates EZ localisation during the presurgical planning stage for DRE patients. Further studies are necessary to validate these findings and support the translation of automated HFO detectors into routine clinical practice.

Clinical Benefit of Vagus Nerve Stimulation for Epilepsy: Assessment of Randomized Controlled Trials and Prospective Non-Randomized Studies.

We examined the efficacy of vagal nerve stimulation (VNS) for patients suffering from medically intractable epilepsy. Four randomized controlled trials (RCTs - 3 adult RCTs and 1 pediatric RCT) were identified in our comprehensive literature search. Across the 4 studies, high frequency VNS stimulation (frequency >20Hz) consistently achieved a greater seizure frequency reduction (23.4-33.1%) relative to low frequency VNS stimulation (1Hz, .6-15.2%). We identified 2 RCTs examining whether the parameters of stimulation influenced seizure control. These studies reported that VNS achieved seizure control comparable to those reported by the first 4 RCTs (22-43% seizure frequency reduction), irrespective of the parameters utilized for VNS stimulation. In terms of VNS associated morbidity, these morbidities were consistently higher in adults who underwent high frequency VNS stimulation (eg dysphonia 37-66%, dyspnea 6-25.3%). However, no such differences were observed in the pediatric population. Moreover, <2% of patients withdrew from the RCTs/prospective studies due to intolerable symptoms. To provide an assessment of how the risks and benefits of VNS impact the patient experience, 1 study assessed the well-being of enrolled patients (as a secondary end point) and found VNS was associated with an overall improvement in well-being. Consistent with this observation, we identified a prospective, non-randomized study that demonstrated improved quality of life for epilepsy patients managed with VNS and best medical practice relative to best medical practice alone. In aggregate, these RCT studies support the efficacy and benefit of VNS as a neuro-modulatory platform in the management of a subset of medically refractory epilepsy patients.

Current Position of Callosotomy

Callosotomy is widely used today as a treatment option for medically refractory epilepsy in patients with generalized or unknown-onset seizures. Other surgical indications include bilaterally distributed, most often synchronous, epileptiform discharges on EEG and some epilepsy syndromes, including Lennox-Gastaut syndrome and infantile spasms/West syndrome. Patients with drop attacks, mainly caused by epileptic spasms or atonic seizures, are most likely to benefit from this procedure. A more favorable seizure outcome was observed after a one-stage total callosal section in pediatric patients. For older children and adults, anterior callosotomy should initially be applied, and staged complete sections should be considered if the seizure outcome is insufficient. In terms of complications, most surgically associated brain and vascular injuries are avoidable in this era of microsurgery, and some less invasive newer methods, including endoscopic and stereotactic methods, are being explored. Disconnection syndrome is an unavoidable condition. However, it is usually transient in most cases and does not outweigh the improvement in symptoms of epilepsy in most patients, particularly in children who have compensatory functions or plasticity of the developing brain.

Detection of pathological High-Frequency Oscillations in refractory epilepsy patients undergoing simultaneous stereo-electroencephalography and magnetoencephalography

Detection of pathological High-Frequency Oscillations in refractory epilepsy patients undergoing simultaneous stereo-electroencephalography and magnetoencephalography

The Relationship Between Epilepsy, Obstructive Sleep Apnea, and Treatment Outcome.

Both epilepsy and obstructive sleep apnea are common conditions and hence frequently coexist in a given patient. A complex bidirectional relationship exists between the 2 conditions where the presence of one affects the other. Treatment of obstructive sleep apnea with continuous positive airway pressure may improve seizure control in medically refractory epilepsy patients, leading to improved quality of life. Understanding of this complex relationship between epilepsy, sleep, and sleep disorders such as obstructive sleep apnea continues to evolve.

Evaluation of the Relationship Between Celiac Disease and Refractory Epilepsy in Patients Referring to Imam Khomeini Hospital, Urmia.

Celiac disease can be associated with other diseases, including neurological disorders. In this study, the relationship between celiac disease and refractory epilepsy was evaluated in patients who were referred to Imam Khomeini Hospital in Urmia. In this cross-sectional study, patients with refractory epilepsy who were referred to the neurology clinic of Imam Khomeini Hospital in Urmia, during the second half of 2019 and cases with controlled epilepsy were studied as a control group. The statistical population of the present study included 50 patients with refractory seizures and 50 patients with controlled seizures. The mean age of patients was 32.96±11.35 years. Five milliliters of blood samples were taken from the patients, and a serum anti-tTG test was performed using the ELISA kit. Then, in patients with positive anti-tTG, a duodenal biopsy sample was prepared using an endoscopy. This study showed that the mean serum level of anti-tTG in patients with refractory epilepsy was higher than in patients with controlled epilepsy. Anti-tTG test results were positive in five out of 50 patients with refractory epilepsy, and it was positive in two out of 50 patients with controlled epilepsy. There was no significant difference between the two groups in terms of serum levels of anti-tTG (P=0.14). Also, there was no significant relationship between serum levels of anti-tTG, age, and genus (P>0.05). Biopsy results in three patients in the refractory epilepsy group and one patient in the controlled epilepsy group were in favor of a definitive diagnosis of celiac disease. Patients with confirmed celiac disease using endoscopy had higher anti-tTG levels (P=0.006). There was no significant difference between celiac disease in cases with refractory epilepsy and controlled epilepsy.

Intracranial direct electrical mapping reveals the functional architecture of the human basal ganglia

The basal ganglia play a key role in integrating a variety of human behaviors through the cortico–basal ganglia–thalamo–cortical loops. Accordingly, basal ganglia disturbances are implicated in a broad range of debilitating neuropsychiatric disorders. Despite accumulating knowledge of the basal ganglia functional organization, the neural substrates and circuitry subserving functions have not been directly mapped in humans. By direct electrical stimulation of distinct basal ganglia regions in 35 refractory epilepsy patients undergoing stereoelectroencephalography recordings, we here offer currently the most complete overview of basal ganglia functional characterization, extending not only to the expected sensorimotor responses, but also to vestibular sensations, autonomic responses, cognitive and multimodal effects. Specifically, some locations identified responses weren’t predicted by the model derived from large-scale meta-analyses. Our work may mark an important step toward understanding the functional architecture of the human basal ganglia and provide mechanistic explanations of non-motor symptoms in brain circuit disorders.

Clinical efficacy and safety of cannabidiol for pediatric refractory epilepsy indications: A systematic review and meta-analysis

Antiseizure medications (ASMs) are the mainstay for the treatment of seizure disorders. However, about one-third of people with epilepsy remain refractory to current ASMs. Cannabidiol (CBD) has recently been approved as ASM for three refractory epilepsy syndrome indications in children and adults. In this study, we evaluated the overall clinical potential of an oral CBD to treat refractory epilepsy in patients with Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC) through a systematic review and meta-analysis. A comprehensive search of databases was conducted, including randomized controlled trials (RCTs) assessing the effect of CBD in epilepsy patients. The review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review focused on RCTs involving patients receiving highly purified oral CBD (Epidiolex, 10 to 50 mg/kg/day) for up to 16 weeks. A subgroup analysis by syndrome and CBD with or without concomitant clobazam was conducted. The key outcomes were reduction in seizure frequency, differences in 50% responder rates, adverse events, and interactions with clobazam as co-therapy. Odds ratio (OR) with 95% confidence interval (CI) were estimated. Of 1183 articles screened, we included 6 RCTs meeting our eligibility criteria. All studies were considered to have a low risk of bias. In the pooled analysis, CBD treatment was found to be more efficacious compared to placebo (OR = 2.45, 95% CI =1.81–3.32, p < 0.01). Subgroup analysis by syndrome demonstrated the odds of ≥50% reduction in seizures with CBD treatment in patients with DS (OR = 2.26, 95% CI:1.38–3.70), LGS (OR = 2.98, 95% CI:1.83–4.85) and TSC (OR = 1.99, 95% CI = 1.06–3.76). Compared with placebo, CBD was associated with increased adverse events (OR = 1.81, 95% CI = 1.33–2.46) such as diarrhea, somnolence, and sedation, and any serious adverse events (OR = 2.86, 95% CI = 1.63–5.05). Other factors, including dosage and clobazam co-therapy, were significantly associated with a greater effect on seizure control and side effects of CBD. In conclusion, the study shows that CBD is highly efficacious both as standalone and adjunct therapy with clobazam for controlling seizures in DS, LGS, and TSC conditions while limiting side effects. Further pharmacodynamic investigation of CBD actions, drug interaction assessments, and therapeutic management guidelines are warranted.

O039 / #583 PATIENT-SPECIFIC STRUCTURAL CONNECTIVITY PREDICTS OUTCOMES OF RESPONSIVE NEUROSTIMULATION FOR TEMPORAL LOBE EPILEPSY: TRACK 2: NEUROMODULATION FOR EPILEPSY

Responsive neurostimulation (RNS) is an effective therapy option for refractory temporal lobe epilepsy patients. However, seizure reduction is variable across patients and the optimal stimulation location or parameters are currently undefined. We hypothesize that this variability may be related to the networks modulated with RNS. Our objective was to determine if stimulation location or stimulation-dependent networks are predictive of seizure reduction.

Research progress in the treatment of refractory temporal lobe epilepsy based on stereotactic-electroencephalogram

Temporal lobe epilepsy, with a variety of etiological, symptomatic, electrophysiological characteristics, has the highest incidence among all focal epilepsy, and a high rate of progression to refractory epilepsy. Surgery is an effective treatment, but traditional methods are usually difficult to accurately locate the epileptogenic zone, which may be resolved by stereotactic-electroencephalogram(SEEG) technique. Radiofrequency thermocoagulation and MRI-guided laser interstitial thermal therapy based on SEEG provide a new accurate and minimally invasive choice for refractory epilepsy patients with high surgical risk and difficulty.

WE-138. Ultra-long-term EEG recording in refractory epilepsy patients treated with vagus nerve stimulation

WE-138. Ultra-long-term EEG recording in refractory epilepsy patients treated with vagus nerve stimulation