OBJECT: During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete "clusterectomy" (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes. METHODS: The authors retrospectively reviewed the charts and imaging studies of 65 patients undergoing MEG followed by resective epilepsy surgery from 2009 until 2012 at the Cleveland Clinic. Preoperative MEG studies were fused with postoperative MRI studies to evaluate whether clusters were within the resected area. These data were then correlated with postoperative seizure freedom. RESULTS: Sixty-five patients were included in this study. The average duration of follow-up was 13.9 months, the mean age at surgery was 23.1 years, and the mean duration of epilepsy was 13.7 years. In 30 patients, the main cluster was located completely within the resection cavity, in 28 it was completely outside the resection cavity, and in 7 it was partially within the resection cavity. Seventy-four percent of patients were seizure free at 12 months after surgery, and this rate decreased to 60% at 24 months. Improved likelihood of seizure freedom was seen with complete clusterectomy in patients with localization outside the temporal lobe (extra-temporal lobe epilepsy) (p = 0.04). CONCLUSIONS: In patients with preoperative MEG studies that show clusters in surgically accessible areas outside the temporal lobe, we suggest aggressive resection to improve the chances for seizure freedom. When the cluster is found within the temporal lobe, further diagnostic testing may be required to better localize the epileptogenic zone.
OBJECT: During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete "clusterectomy" (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes. METHODS: The authors retrospectively reviewed the charts and imaging studies of 65 patients undergoing MEG followed by resective epilepsy surgery from 2009 until 2012 at the Cleveland Clinic. Preoperative MEG studies were fused with postoperative MRI studies to evaluate whether clusters were within the resected area. These data were then correlated with postoperative seizure freedom. RESULTS: Sixty-five patients were included in this study. The average duration of follow-up was 13.9 months, the mean age at surgery was 23.1 years, and the mean duration of epilepsy was 13.7 years. In 30 patients, the main cluster was located completely within the resection cavity, in 28 it was completely outside the resection cavity, and in 7 it was partially within the resection cavity. Seventy-four percent of patients were seizure free at 12 months after surgery, and this rate decreased to 60% at 24 months. Improved likelihood of seizure freedom was seen with complete clusterectomy in patients with localization outside the temporal lobe (extra-temporal lobe epilepsy) (p = 0.04). CONCLUSIONS: In patients with preoperative MEG studies that show clusters in surgically accessible areas outside the temporal lobe, we suggest aggressive resection to improve the chances for seizure freedom. When the cluster is found within the temporal lobe, further diagnostic testing may be required to better localize the epileptogenic zone.
Authors: Rafeed Alkawadri; Richard C Burgess; Yosuke Kakisaka; John C Mosher; Andreas V Alexopoulos Journal: JAMA Neurol Date: 2018-10-01 Impact factor: 18.302
Authors: Hiroatsu Murakami; Zhong I Wang; Ahmad Marashly; Balu Krishnan; Richard A Prayson; Yosuke Kakisaka; John C Mosher; Juan Bulacio; Jorge A Gonzalez-Martinez; William E Bingaman; Imad M Najm; Richard C Burgess; Andreas V Alexopoulos Journal: Brain Date: 2016-11-01 Impact factor: 13.501
Authors: Naoaki Tanaka; Christos Papadelis; Eleonora Tamilia; Michel AlHilani; Joseph R Madsen; Phillip L Pearl; Steven M Stufflebeam Journal: Pediatr Neurol Date: 2018-03-15 Impact factor: 3.372
Authors: Andrew Zillgitt; Mohamad Ayman Haykal; Konstantin Elisevich; Sanjay Patra; Frederick Sherburn; Susan M Bowyer; David E Burdette Journal: Epilepsy Behav Rep Date: 2022-03-24
Authors: Margit Schönherr; Hermann Stefan; Hajo M Hamer; Karl Rössler; Michael Buchfelder; Stefan Rampp Journal: Neuroimage Clin Date: 2016-12-05 Impact factor: 4.881
Authors: Burkhard S Kasper; Karl Rössler; Hajo M Hamer; Arnd Dörfler; Ingmar Blümcke; Roland Coras; Julie Roesch; Angelika Mennecke; Jörg Wellmer; Björn Sommer; Bogdan Lorber; Johannes D Lang; Wolfgang Graf; Hermann Stefan; Stefan Schwab; Michael Buchfelder; Stefan Rampp Journal: Neuroimage Clin Date: 2018-05-01 Impact factor: 4.881