ObjectiveTo analyze the effect of magnetic resonance-guided laser interstitial thermal therapy (Magnetic resonance-guided laser interstitial thermal therapy , MRgLITT) for drug resistant epilepsy (DRE). MethodsThe present study analyzed the clinical information of DRE patients treated by MRgLITT in Beijing Tiantan Hospital from August 2020 to February 2021, including the type of disease, postoperative complications, and prognosis (Engel classification) in the one year after surgery. ResultsA total of 55 patients were enrolled. There were 27 males and 28 females, with an average of (21.7±14.1) years, all of whom successfully completed the operation and were followed up for the 1 year after surgery. The diagnosis included intracranial tumors, hypothalamic hamartoma (HH), focal cortical dysplasia (FCD), cavernous malformations (CM), mesial temporal lobe epilepsy (mTLE), and idiopathic generalized epilepsy (underwent corpus callosotomy). The patients with seizure freedom accounted for 59.6% (31/52), and the average remission rate of palliative surgery was 68.6%. The short-term postoperative complications included bleeding in neurological deficit in 6 cases (10.9%), 4 cases (7.3%), and noninfectious fever in 2 cases (3.6%). No serious, long-term complications occurred. The average postoperative hospital stay was (4.7±1.6) days. ConclusionsMRgLITT is gradually mature and has a wide range of indications. This technology provides a safe and effective therapy for DRE patients.
ObjectiveTo investigate the value of interictal scalp high-frequency oscillations (HFOs) in localizing the epileptogenic zone (EZ) in children with infantile epileptic spasms syndrome (IESS). Methods A retrospective analysis was conducted on surgical IESS patients treated at the Epilepsy Center of Shenzhen Children’s Hospital from August 2018 to November 2021. Preoperative EEG and clinical data were collected. Based on Engel classification at 2-year follow-up, patients were divided into a seizure-free group (Engel Ia) and a non–seizure-free group (non–Engel Ia). An automated detection system was used to identify ripple events (80–250 Hz), and the H-index (ripples per channel per minute) was calculated in the resection zone (RZ) and non-resection zone (non-RZ). Result 35 children were included (19 seizure-free, 16 non–seizure-free). The H-index in the RZ was significantly higher than in the non-RZ in the seizure-free group [(58.16±43.95) vs. (24.07±22.85), P<0.05]. Using the RZ of the seizure-free group as the gold standard, the area under the ROC curve (AUC) of the H-index for predicting the EZ was 0.83 [95%CI (0.70, 0.96) , P<0.001], with an optimal diagnostic threshold of 21.50 (sensitivity 73.68%, specificity 84.21%). Conclusion The results confirm that the interictal scalp HFO index may serve as a potential biomarker for localizing the EZ in IESS children with structural etiologies.
ObjectiveTo evaluate the application of stereotactic electrode implantation on precise epileptogenic zone localization. MethodRetrospectively studied 140 patients with drug-resist epilepsy from March 2012 to June 2015, who undergone a procedure of intracranial stereotactic electrode for localized epileptogenic zone. ResultsIn 140 patients who underwent the ROSA navigated implantation of intracranial electrode, 109 are unilateral implantation, 31 are bilateral; 3 patients experienced an intracranial hematoma caused by the implantation. Preserved time of electrodes, on average, 8.4days (range 2~35 days); Obseved clinical seizures, on average, 10.8 times per pt (range 0~98 times); There were no cerebrospinal fluid leak, intracranial hematoma, electrodes fracture or patient death, except 2 pt's scalp infection (1.43%, scalp infection rate); 131 pts' seizure onset area was precisely localized; 71 pts underwent SEEG-guide resections and were followed up for more than 6 months. In the group of 71 resection pts, 56 pts were reached Engel I class, 2 were Engel Ⅱ, 3 was Engel Ⅲ and 10 were Engel IV class. ConclusionTo intractable epilepsy, when non-invasive assessments can't find the epileptogenic foci, intracranial electrode implantation combined with long-term VEEG is an effective method to localize the epileptogenic foci, especially the ROSA navigated stereotactic electrode implantation, which is a micro-invasive, short-time, less-complication, safe-guaranteed, and precise technique.