Ictal EEG wave forms from epidural electrodes predictive of seizure control after temporal lobectomy |
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| Authors: | Edward Faught Ruben I. Kuzniecky David C. Hurst |
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| Affiliation: | 1. University of Alabama at Birmingham Epilepsy Center, Birmingham, AL 35294, U.S.A.;2. Department of Biostatistics and Biomathematics, University of Alabama School of Medicine, Birmingham, AL 35294, U.S.A.;1. Univ Grenoble Alpes, GIN, F-38000 Grenoble, France;2. INSERM, U836, F-38000 Grenoble, France;3. CHU de Grenoble, Hôpital Michallon F-38000 Grenoble, France;4. UMS IRMaGe, F-38000 Grenoble, France;1. Department of Anatomical Sciences, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran;2. Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran;3. Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Research center of Nervous system stem cells, Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran;5. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran;6. Institute of Neuroanatomy, RWTH Aachen University, Aachen, Germany;7. Giulan Neuroscience Research Center, Department of Anatomical Sciences, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran;1. Epilepsy Unit, Hospital de Bellvitge, Spain;2. Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, 08097, Spain;3. Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, 08097, Spain;4. Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain;5. Vall d’ Hebron Institut de Recerca, Spain;6. Department of Pathology, Hospital de Bellvitge, Spain;1. Medical Image and Signal Processing Group, Department of Electronics and Information Systems, Ghent University – imec, De Pintelaan 185, 9000 Ghent, Belgium;2. Epilog, Vlasgaardstraat 52, 9000 Ghent, Belgium;3. Department of Neurology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;4. Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark;5. Department of Clinical Neurophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;6. Department of Neurology, Danish Epilepsy Centre, Kolonivej 1, 4293 Dianalund, Denmark;7. Department of Diagnostic Radiology, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark;8. Department of Paediatrics, Child Neurology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;9. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;10. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;11. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Visby Allé 5, 4293 Dianalund, Denmark;12. Department of Clinical Neurophysiology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark |
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| Abstract: | Ictal wave form characteristics — frequency, spatial distribution, and duration — were analyzed for 140 complex partial seizures recorded from epidural strip electrodes implanted in 28 patients. None had abnormalities on imaging studies. All had bilateral electrode placements, unilateral seizure onsets, temporal lobectomies, and were followed for a mean of 33 months postoperatively. Sixteen patients (57%) became free of complex partial seizures: 12 had reductions in seizure frequency of a least 50% but were not seizure-free.The only predictor of the seizure-free state was the presence of low voltage fast activity (LVF), in the alpha or beta ranges, localized to one gyrus. This phenomenon occurred in 14/16 seizure-free patients, 2/12 of others (P < 0.001). As seizures progressed, LVF typically increased in amplitude, propagated, and slowed into the theta range.Wave forms were classified into 8 categories based upon their frequency and morphology. Stepwise discriminant analysis of these wave forms, with consideration of whether they were localized or regional, revealed that both frequency and localization were critical for the post-surgical prognosis. The mere presence of a localized seizure onset was unreliable unless the wave form was taken into account.Well-localized rhythmic activity over 8 Hz at seizure onset from epidural subtemporal electrodes predicts surgical success. Slower rhythms imply greater separation in space and time from seizure onset. |
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