Dataset Information

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography.

ABSTRACT:

Objective

Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected bilateral MTL epilepsy in order to assess the time required to determine the seizure lateralization and whether this information could influence treatment decisions.

Methods

Ambulatory ECoG was reviewed in patients with suspected bilateral MTL epilepsy who were among a larger cohort with intractable epilepsy participating in a randomized controlled trial of responsive neurostimulation. Subjects were implanted with bilateral MTL leads and a cranially implanted neurostimulator programmed to detect abnormal interictal and ictal ECoG activity. ECoG data stored by the neurostimulator were reviewed to determine the lateralization of electrographic seizures and the interval of time until independent bilateral MTL electrographic seizures were recorded.

Results

Eighty-two subjects were implanted with bilateral MTL leads and followed for 4.7 years on average (median 4.9 years). Independent bilateral MTL electrographic seizures were recorded in 84%. The average time to record bilateral electrographic seizures in the ambulatory setting was 41.6 days (median 13 days, range 0-376 days). Sixteen percent had only unilateral electrographic seizures after an average of 4.6 years of recording.

Significance

About one third of the subjects implanted with bilateral MTL electrodes required >1 month of chronic ambulatory ECoG before the first contralateral MTL electrographic seizure was recorded. Some patients with suspected bilateral MTL seizures had only unilateral electrographic seizures. Chronic ambulatory ECoG in patients with suspected bilateral MTL seizures provides data in a naturalistic setting, may complement data from inpatient video-EEG monitoring, and can contribute to treatment decisions.

SUBMITTER: King-Stephens D

PROVIDER: S-EPMC4676303 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography.

King-Stephens David D Mirro Emily E Weber Peter B PB Laxer Kenneth D KD Van Ness Paul C PC Salanova Vicenta V Spencer David C DC Heck Christianne N CN Goldman Alica A Jobst Barbara B Shields Donald C DC Bergey Gregory K GK Eisenschenk Stephan S Worrell Gregory A GA Rossi Marvin A MA Gross Robert E RE Cole Andrew J AJ Sperling Michael R MR Nair Dileep R DR Gwinn Ryder P RP Park Yong D YD Rutecki Paul A PA Fountain Nathan B NB Wharen Robert E RE Hirsch Lawrence J LJ Miller Ian O IO Barkley Gregory L GL Edwards Jonathan C JC Geller Eric B EB Berg Michel J MJ Sadler Toni L TL Sun Felice T FT Morrell Martha J MJ

Epilepsia 20150519 6

<h4>Objective</h4>Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected ...[more]

PMID: 25988840

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Project description:Background and purposeAlthough most studies on epilepsy have focused on the epileptogenic zone, epilepsy is a system-level disease characterized by aberrant neuronal synchronization among groups of neurons. Increasingly, studies have indicated that mesial temporal lobe epilepsy may be a network-level disease; however, few investigations have examined resting-state functional connectivity of the entire brain, particularly in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. This study primarily investigated whole-brain resting-state functional connectivity abnormality in patients with mesial temporal lobe epilepsy and right hippocampal sclerosis during the interictal period.Materials and methodsWe investigated resting-state functional connectivity of 21 patients with mesial temporal lobe epilepsy with right hippocampal sclerosis and 21 neurologically healthy controls. A multivariate pattern analysis was used to identify the functional connections that most clearly differentiated patients with mesial temporal lobe epilepsy with right hippocampal sclerosis from controls.ResultsDiscriminative analysis of functional connections indicated that the patients with mesial temporal lobe epilepsy with right hippocampal sclerosis exhibited decreased resting-state functional connectivity within the right hemisphere and increased resting-state functional connectivity within the left hemisphere. Resting-state network analysis suggested that the internetwork connections typically obey the hemispheric lateralization trend and most of the functional connections that disturb the lateralization trend are the intranetwork ones.ConclusionsThe current findings suggest that weakening of the resting-state functional connectivity associated with the right hemisphere appears to strengthen resting-state functional connectivity on the contralateral side, which may be related to the seizure-induced damage and underlying compensatory mechanisms. Resting-state network-based analysis indicated that the compensatory mechanism among different resting-state networks may disturb the hemispheric lateralization.

Project description:The epilepsies represent one of the most common neurological disorders. Mesial temporal lobe epilepsies (MTLE) are the most frequent form of partial epilepsies and display frequent resistance to anti-epileptic drugs thus representing a major health care problem. In TLE, the origin of seizure activity typically involves the hippocampal formation, which displays major neuropathological features, described with the term hippocampal sclerosis (HS). HS is the most frequent pathological substrate of refractory mesial temporal lobe epilepsy. Complex partial seizures (CPS) are the predominant seizure type associated with medial temporal lobe epilepsy. MTLE is commonly due to mesial temporal sclerosis (MTS). The biology underlying the epilepstic seizures and the transcriptome associated to the seizure in intractable medial temporal lobe epilepsy is ill understood. The aim of the study was to identify potential biomarkers that could identify epileptic seizure. Thus we performed transcriptome profiling of ten medial temporal lobe epilepsy cases which are resistant to the drug and underwent temporal lobectomy. The cases constitutes of patients with intractable complex partial seizure, treated medically and have undergone detailed presurgical evaluation and subjected to surgery for standard temporal lobectomy and amygdalo-hippocampectomy. The spiking areas identified after the electrocorticography will form the test tissues, which compared with the nonspiking areas removed during the surgery, from the same patient. This could probably form one of the appropriate controls, as test and control are from same patient, which eliminates the genome variations that could incur due to the comparison with the tissues from the another patient. Also this could get rid of expression changes due to the treatments undergone by the patient. We performed two color microarray wherein we labled seizure focus (spiking area) with Cy5 and non-seizure region tissues (non-spiking) with Cy3. As a strategy to test the possibility of potential diagnostic biomarkers we are intended to test the differentially regulated molecules in an independent set of epilepsy samples. Two color experiment

Project description:OBJECTIVES:Brain functional topology was investigated in patients with mesial temporal lobe epilepsy (mTLE) by means of graph theory measures in two differentially defined graphs. Measures of segregation, integration, and centrality were compared between subjects with mTLE and healthy controls (HC). METHODS:Eleven subjects with mTLE (age 36.5±10.9years) and 15 age-matched HC (age 36.8±14.0years) participated in this study. Both anatomically and functionally defined adjacency matrices were used to investigate the measures. Binary undirected graphs were constructed to study network segregation by calculating global clustering and modularity, and network integration by calculating local and global efficiency. Node degree and participation coefficient were also computed in order to investigate network hubs and their classification into provincial or connector hubs. Measures were investigated in a range of low to medium graph density. RESULTS:The group of patients presented lower global segregation than HC while showing higher global but lower local integration. They also failed to engage regions that comprise the default-mode network (DMN) as hubs such as bilateral medial frontal regions, PCC/precuneus complex, and right inferior parietal lobule, which were present in controls. Furthermore, the cerebellum in subjects with mTLE seemed to be playing a major role in the integration of their functional networks, which was evident through the engagement of cerebellar regions as connector hubs. CONCLUSIONS:Functional networks in subjects with mTLE presented both global and local abnormalities compared to healthy subjects. Specifically, there was significant separation between groups, with lower global segregation and slightly higher global integration observed in patients. This could be indicative of a network that is working as a whole instead of in segregated or specialized communities, which could translate into a less robust network and more prone to disruption in the group with epilepsy. Furthermore, functional irregularities were also observed in the group of patients in terms of the engagement of cerebellar regions as hubs while failing to engage DMN-related areas as major hubs in the network. The use of two differentially defined graphs synergistically contributed to findings.

Dataset Information

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography.

Objective

Methods

Results

Significance

Publications

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography.

Similar Datasets

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