Article
Clinical Neurology
Valeri Borger, Motaz Hamed, Julia Taube, Gulsah Aydin, Inja Ilic, Matthias Schneider, Patrick Schuss, Erdem Guresir, Albert Becker, Christoph Helmstaedter, Christian E. Elger, Hartmut Vatter
Summary: Temporal lobe epilepsy (TLE) is a common form of epilepsy, and about 30% of patients have drug-resistant seizures. This study evaluated the seizure outcomes of patients with drug-refractory TLE who underwent resective temporal lobe surgery (rTLS), finding that the lack of MRI lesions and placement of depth electrodes before surgery were associated with unfavorable postsurgical seizure outcomes.
JOURNAL OF NEUROSURGERY
(2021)
Review
Clinical Neurology
Carmen Barba, Sabrina Giometto, Ersilia Lucenteforte, Simona Pellacani, Giulia Matta, Alessandra Bettiol, Sara Minghetti, Lavinia Falorni, Federico Melani, Gianpiero Di Giacomo, Flavio Giordano, Salvatore De Masi, Renzo Guerrini
Summary: The efficacy of temporal lobe epilepsy (TLE) surgery varies between children and adults, with higher seizure freedom rates observed in children. Histopathology and surgical approach have an impact on seizure outcome, with age being an important variable.
Review
Clinical Neurology
Niravkumar Barot, Kavita Batra, Jerry Zhang, Mary Lou Klem, James Castellano, Jorge Gonzalez-Martinez, Anto Bagic
Summary: MRgLITT is an effective and safe intervention for drug-resistant epilepsy with different disease etiologies. The seizure freedom outcome is overall comparable between extratemporal and temporal lobe epilepsy; and highest with patients having hypothalamic hamartomas.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2022)
Article
Clinical Neurology
Valeri Borger, Motaz Hamed, Majd Bahna, Attila Racz, Inja Ilic, Anna-Laura Potthoff, Tobias Baumgartner, Theodor Rueber, Albert Becker, Alexander Radbruch, Florian Mormann, Rainer Surges, Hartmut Vatter, Matthias Schneider
Summary: This study aimed to evaluate the impact of piriform cortex (PiC) resection on long-term seizure outcome in patients with mesial temporal lobe epilepsy (mTLE) treated with selective amygdalo-hippocampectomy (tsSAHE). The results showed that the extent of PiC resection strongly correlated with long-term seizure outcome, suggesting PiC to be a key target volume in tsSAHE for achieving long-term seizure freedom.
ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY
(2022)
Article
Clinical Neurology
Carmen Barba, Massimo Cossu, Renzo Guerrini, Giancarlo Di Gennaro, Flavio Villani, Luca De Palma, Laura Grisotto, Alessandro Consales, Domenica Battaglia, Nelia Zamponi, Piergiorgio d'Orio, Martina Revay, Michele Rizzi, Sara Casciato, Vincenzo Esposito, Pier Paolo Quarato, Roberta Di Giacomo, Giuseppe Didato, Chiara Pastori, Giusy Carfi Pavia, Simona Pellacani, Giulia Matta, Mattia Pacetti, Gianpiero Tamburrini, Elisabetta Cesaroni, Gabriella Colicchio, Giampaolo Vatti, Sofia Asioli, Massimo Caulo, Carlo Efisio Marras, Laura Tassi
Summary: The study assessed seizure and cognitive outcomes in children and adults undergoing temporal lobe epilepsy surgery, finding significant differences in clinical characteristics, predictors, and long-term effects between the two age groups. Children were more likely to achieve sustained seizure freedom and discontinue antiepileptic drugs after surgery.
Article
Neurosciences
Paul S. Buckmaster, Bianca Reyes, Tahsin Kahn, Megan Wyeth
Summary: This study evaluated seizure initiation zones in rats with temporal lobe epilepsy and found that the ventral hippocampal formation is the primary bilateral epileptogenic zone, while the dorsal hippocampus is a secondary epileptogenic zone. These findings are consistent with human patients and validate the use of LFP (local field potential) method for identifying seizure onset zones.
JOURNAL OF NEUROSCIENCE
(2022)
Article
Clinical Neurology
Sita Jayalakshmi, Sindhu Vasireddy, Jala Sireesha, Sudhindra Vooturi, Anuja Patil, Sai Sirisha, Rammohan Vadapalli, Y. B. V. K. Chandrasekhar, Manas Panigrahi
Summary: This study compared the long-term outcomes of surgery vs best medical management in patients with drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis. The results showed that surgery was associated with higher rates of seizure freedom, resolution of epilepsy, and improvement in perceived life changes.
Article
Clinical Neurology
Alessandra Maccabeo, Maryse A. Van't Klooster, Eline Schaft, Matteo Demuru, Willemiek Zweiphenning, Peter Gosselaar, Tineke Gebbink, Wim M. Otte, Maeike Zijlmans
Summary: In this study, the distribution of spikes and HFOs recorded during intraoperative electrocorticography (ioECoG) was investigated to predict the postsurgical outcomes of patients with lateral neocortical temporal lobe epilepsy (TLE) whose mesiotemporal structures are left in situ. The results showed that low rates of mesiotemporal post-ioECoG ripples and older age at epilepsy onset were predictors of good seizure outcomes. HFOs in ioECoG may be helpful in informing the success chance of hippocampus-sparing resection in patients with lateral neocortical TLE.
FRONTIERS IN NEUROLOGY
(2022)
Review
Clinical Neurology
Ali A. Asadi-Pooya, Amir Tajbakhsh, Amir Savardashtaki
Summary: This review systematically examined the potential applications of microRNAs as biomarkers in drug-resistant temporal lobe epilepsy. While three studies provided some evidence, challenges remain before microRNAs can be translated into clinical practice for the diagnosis of drug-resistant TLE.
NEUROLOGICAL SCIENCES
(2021)
Article
Clinical Neurology
Austin Gamblin, Vance L. Fredrickson, Todd C. Hollon, Karen L. Salzman, William T. Couldwell
Summary: Herniation of the parahippocampal gyrus is rare without known risk factors and is usually caused by intracranial pressure differentials. This case report discusses a patient with a long history of seizures who was found to have chronic mesial temporal lobe herniation on MRI, despite lacking risk factors for cerebral herniation. Accurate radiographic identification of the condition likely prevented unnecessary surgery or biopsy, allowing the patient to receive appropriate conservative care.
ACTA NEUROCHIRURGICA
(2021)
Article
Pharmacology & Pharmacy
Kai Zhong, Chengyu Qian, Rui Lyu, Xinyi Wang, Zhe Hu, Jie Yu, Jing Ma, Yilu Ye
Summary: Crocin has shown anti-epileptic effects in models of temporal lobe epilepsy, reducing seizure stages and duration, as well as suppressing generalized and spontaneous recurrent seizures. These effects may be mediated by its neuroprotective properties and modulation of inflammatory and neurotrophic factors.
FRONTIERS IN PHARMACOLOGY
(2022)
Article
Behavioral Sciences
Ali A. Asadi-Pooya, Mohsen Farazdaghi
Summary: By applying Two-Step cluster analysis on a cohort of patients with temporal lobe epilepsy, it was found that there are two distinct clusters of patients with different seizure outcomes based on their clinical characteristics. These findings can be used to develop a practical outcome prediction tool for patients with temporal lobe epilepsy.
EPILEPSY & BEHAVIOR
(2022)
Article
Medicine, General & Internal
Sung-Min You, Baek-Hwan Cho, Hyo-Eun Bae, Young-Kyun Kim, Jae-Rim Kim, Soo-Ryun Park, Young-Min Shon, Dae-Won Seo, In-Young Kim
Summary: The impact of epilepsy on cardiovascular function and autonomic regulation, particularly heart-rate variability (HRV), is complex and may contribute to sudden unexpected death in epilepsy (SUDEP). A retrospective study analyzed data from 75 patients with temporal lobe epilepsy to investigate the influence of various factors on HRV indices during different seizure intervals. Significant differences in HRV indices were observed based on hemispheric laterality, language dominancy, hippocampal atrophy, amygdala enlargement, sustained theta activity, and seizure frequency. This study suggests a potential relationship between HRV and the risk of SUDEP.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Clinical Neurology
Nadim Jaafar, Amar Bhatt, Alexandra Eid, Mohamad Z. Koubeissi
Summary: Some surgical failures after temporal lobe epilepsy surgery may be caused by the presence of extratemporal epileptogenic zones, particularly in the medial parietal lobe. Seizures originating from this area may not cause obvious symptoms before spreading to the temporal lobe.
FRONTIERS IN NEUROLOGY
(2022)
Article
Health Care Sciences & Services
Sung Chul Lim, Juhee Oh, Bo Young Hong, Seong Hoon Lim
Summary: Temporal lobe epilepsy (TLE) is a network disorder of the brain, characterized by hippocampal dysfunction. This study found significant changes in the volumes of the amygdala, hippocampus, and thalamus in patients with left TLE and hippocampal sclerosis (HS), while no abnormal diffusion properties associated with volume reduction were found in specific brain regions of patients with right TLE and HS.
Article
Clinical Neurology
Levente Hadady, Peter Klivenyi, Emilio Perucca, Stefan Rampp, Daniel Fabo, Csaba Bereczki, Guido Rubboli, Ali A. Asadi-Pooya, Michael R. Sperling, Sandor Beniczky
Summary: The study validated that the use of the algorithm recommending ASMs based on individual characteristics is associated with better outcomes compared to using less desirable ASMs, including higher retention rates, higher seizure freedom rates, and fewer discontinuations due to adverse effects. The freely available decision support system proved to be beneficial for healthcare professionals in prescribing medication for individuals with epilepsy.
EUROPEAN JOURNAL OF NEUROLOGY
(2022)
Article
Clinical Neurology
Olivia Begasse De Dhaem, Sandra India Aldana, Andres Miguel Kanner, Michael Sperling, Jacqueline French, Siddhartha S. Nadkarni, Omotola A. Hope, Terry O'Brien, Chris Morrison, Melodie Winawer, Mia T. Minen
Summary: This study compared symptoms of depression, anxiety, and suicidality among patients with newly diagnosed focal epilepsy with and without migraine. The results showed that patients with comorbid migraine had higher incidence of depressive and anxiety symptoms.
JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES
(2022)
Review
Clinical Neurology
Sylvain Rheims, Mickael R. Sperling, Philippe Ryvlin
Summary: Patients with drug-resistant epilepsy have an increased mortality rate, with the majority of deaths being epilepsy related and 40% due to sudden unexpected death in epilepsy (SUDEP). Epilepsy surgery has been found to reduce the risk of death and SUDEP, although the quality of available evidence is variable.
Article
Clinical Neurology
Heather Angus-Leppan, Michael R. Sperling, Vicente Villanueva
Summary: Up to 10% of people over the age of 80 experience seizures, and many do not require anti-seizure medication. The diagnosis is often made based on the patient's medical history. Targeted investigations are important for classification and risk prediction. Patients with a low risk of seizure recurrence do not usually need medication, while high-risk patients with multiple seizures and other symptoms are offered medication. Future technologies may offer better seizure monitoring and prediction, but they are not yet reliable or convenient. Therapeutic drug monitoring can be useful in confirming medication toxicity or identifying causes of breakthrough seizures. Current evidence does not support routine monitoring of medication levels. The decision to discontinue medication should be made after a discussion with the patient, considering their individual risks and preferences. Medication is usually discontinued gradually after at least two years of remission, and patients need specialist follow-up during this time.
JOURNAL OF NEUROLOGY
(2023)
Article
Clinical Neurology
Piero Perucca, Kate Stanley, Natasha Harris, Anne M. McIntosh, Ali A. Asadi-Pooya, Mohamad A. Mikati, Danielle M. Andrade, Patricia Dugan, Chantal Depondt, Hyunmi Choi, Erin L. Heinzen, Gianpiero L. Cavalleri, Russell J. Buono, Orrin Devinsky, Michael R. Sperling, Samuel F. Berkovic, Norman Delanty, David B. Goldstein, Terence J. O'Brien
Summary: This study investigated whether rare genetic variations influence seizure outcomes of MTLE surgery. The results showed that MTLE cases carried a higher burden of ultrarare missense variants in constrained genes and genes encoding voltage-gated cation channels. However, these genetic variations did not have a major role in the failure of MTLE surgery.
ANNALS OF NEUROLOGY
(2023)
Article
Multidisciplinary Sciences
Shennan A. Weiss, Itzhak Fried, Chengyuan Wu, Ashwini Sharan, Daniel Rubinstein, Jerome Engel Jr, Michael R. Sperling, Richard J. Staba
Summary: Fast ripples (FR) are a biomarker of epileptogenic brain. The FR resection ratio (RR) did not correlate with seizure-outcome, but the FR rate-distance radius resected difference and the FR MI mean characteristic path length RR did correlate with seizure-outcome. The diagnostic accuracy of the resection of FR events for predicting seizure freedom can be improved by using graph theoretical measures of FR networks.
SCIENTIFIC REPORTS
(2023)
Editorial Material
Clinical Neurology
Jo M. Wilmshurst, Michael R. Sperling
Editorial Material
Clinical Neurology
Pavel Klein, Gregory L. Krauss, Bernhard J. Steinhoff, Orrin Devinsky, Michael R. Sperling
Summary: Despite the approval of numerous antiseizure medications (ASMs), a significant number of epilepsy patients still experience seizures. Two new ASMs, cenobamate and fenfluramine, have shown improved efficacy in reducing seizures with sustained results. However, these medications are underutilized, likely due to limited knowledge, access restrictions, and insufficient post-launch information about their efficacy and safety. Addressing these issues can improve seizure control and ultimately reduce morbidity and mortality in epilepsy patients.
Editorial Material
Clinical Neurology
Michael R. Sperling
Article
Clinical Neurology
William E. Rosenfeld, Louis Ferrari, Wesley T. Kerr, Michael R. Sperling
Summary: This study retrospectively analyzed the mortality rate, sudden unexpected death in epilepsy (SUDEP) rate, and standardized mortality ratio (SMR) among adult patients treated with cenobamate. The results indicate that cenobamate may effectively reduce excess mortality associated with epilepsy.
Editorial Material
Clinical Neurology
Michael R. Sperling
Article
Clinical Neurology
Shennan Aibel Weiss, Dawn Eliashiv, John Stern, Daniel Rubinstein, Itzhak Fried, Chengyuan Wu, Ashwini Sharan, Jerome Engel, Richard Staba, Michael R. Sperling
Summary: The mechanism by which responsive neurostimulation (RNS) reduces seizure frequency is not well understood. This study examined whether stimulation of fast ripples (FRs) generating networks differs between RNS super responders and intermediate responders. The results showed that the efficiency of the FR temporal correlational network on stimulated contacts differed significantly between the two groups. These findings suggest that RNS that targets FR networks more effectively may reduce epileptogenicity better.
Article
Neurosciences
Nora A. Herweg, Lukas Kunz, Daniel Schonhaut, Armin Brandt, Paul A. Wanda, Ashwini D. Sharan, Michael R. Sperling, Andreas Schulze-Bonhage, Michael J. Kahana
Summary: Distinct lines of research in both humans and animals have found that the hippocampus plays a specific role in spatial and episodic memory function. Concept cells in the hippocampus and surrounding areas suggest that the medial temporal lobe maps physical and semantic spaces using a similar neural architecture. This study examines the emergence of such maps using recordings from the medial temporal lobe of patients navigating a virtual environment with meaningful landmarks, and finds that the field potentials in the medial temporal lobe contain information to decode the subjects' locations and temporal sequences.
JOURNAL OF NEUROSCIENCE
(2023)
Article
Clinical Neurology
Shennan A. Weiss, Itzhak Fried, Jerome Engel, Anatol Bragin, Shuang Wang, Michael R. Sperling, Robert K. S. Wong, Yuval Nir, Richard J. Staba
Summary: This study confirmed that pathological high frequency oscillations (pHFOs) occur during the UP-DOWN transition of slow wave activity and disrupt temporal correlations between brain regions. These findings suggest that pHFOs may interfere with information transmission and memory consolidation.
Article
Clinical Neurology
Levente Hadady, Michael R. Sperling, Juan Luis Alcala-Zermeno, Jacqueline A. French, Patricia Dugan, Lara Jehi, Daniel Fabo, Peter Klivenyi, Guido Rubboli, Sandor Beniczky
Summary: This study conducted external validation of previously published epilepsy surgery prediction tools using a large independent multicenter dataset and found that these tools can effectively stratify patients for surgery and freedom from disabling seizures.