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Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products

Fri, 06 Dec 2024 22:13:34 -0000

Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products Category: Article Type: Nolan Kyle Winslow, Alexander Scott Himstead, Sumeet VaderaDepartment of Neurosurgery, University of California, Irvine, Orange, United StatesCorrespondence Address:Nolan Kyle Winslow, Department of Neurosurgery, University of California, Irvine, Orange, United States.DOI:10.25259/SNI_277_2024Copyright: © 2024 … Continue reading Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products →

<div><!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" "http://www.w3.org/TR/REC-html40/loose.dtd"> <html><head><meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body><div class="row"><div class="col-lg-9 col-sm-8 col-xs-12"><div class="media-body details-body"> <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13273"><h2 class="media-heading"><h2 class="media-heading">Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products</h2></h2></a> </div><div class="disp_categories"> <p><label>Category: </label><span></span></p> <p><label>Article Type: </label><span></span></p> </div><a href="mailto:nolankwinslow@gmail.com" target="_top">Nolan Kyle Winslow</a>, <a href="mailto:ahimstea@hs.uci.edu" target="_top">Alexander Scott Himstead</a>, <a href="mailto:svadera1@hs.uci.edu" target="_top">Sumeet Vadera</a><ol class="smalllist"><li>Department of Neurosurgery, University of California, Irvine, Orange, United States</li></ol><p><strong>Correspondence Address:</strong><br>Nolan Kyle Winslow, Department of Neurosurgery, University of California, Irvine, Orange, United States.<br></p><p><strong>DOI:</strong>10.25259/SNI_277_2024</p>Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.<div class="parablock"><p><strong>How to cite this article: </strong>Nolan Kyle Winslow, Alexander Scott Himstead, Sumeet Vadera. Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products. 06-Dec-2024;15:454</p></div><div class="parablock"><p><strong>How to cite this URL: </strong>Nolan Kyle Winslow, Alexander Scott Himstead, Sumeet Vadera. Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products. 06-Dec-2024;15:454. Available from: <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13273">https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13273</a></p></div> </div> <div class="col-lg-3 col-sm-4 col-xs-12"><div class="article-detail-sidebar"><div class="icon sidebar-icon clearfix add-readinglist-icon"><button id="bookmark-article" class="add-reading-list-article">Add to Reading List</button><button id="bookmark-remove-article" class="remove-reading-list-article">Remove from Reading List</button></div><div class="icon sidebar-icon clearfix"><a class="btn btn-link" target="_blank" type="button" id="OpenPdf" href="https://surgicalneurologyint.com/wp-content/uploads/2024/12/13273/SNI-15-454.pdf"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/pdf-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a target="_blank" href="javascript:void(0);" onclick="return PrintArticle();"><img decoding="async" src="https://i0.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/file-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a class="btn btn-link" type="button" id="EmaiLPDF"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/mail-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a></div><div class="date"> <p>Date of Submission<br><span class="darkgray">10-Apr-2024</span></p> <p>Date of Acceptance<br><span class="darkgray">15-Nov-2024</span></p> <p>Date of Web Publication<br><span class="darkgray">06-Dec-2024</span></p> </div> </div></div> </div> <div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a href="javascript:void(0);" name="Abstract">Abstract</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><strong>Background: </strong>Stereoelectroencephalography (SEEG) is a common diagnostic surgical procedure for patients with medically refractory epilepsy. We aimed to describe our initial experience with the recently released NeuroOne Evo SEEG electrode product (Zimmer Biomet, Warsaw, IN) and review technical specifications for other currently approved depth SEEG electrodes.</p><p><strong>Methods: </strong>We performed a record review on the first five patients implanted with NeuroOne Evo SEEG electrode product using the robotic stereotactic assistance robot platform and described our surgical technique in detail. We recorded technical specifications of all currently Food and Drug Administration-approved SEEG electrodes for comparison.</p><p><strong>Results: </strong>Our initial 5 surgical patients were reviewed. The average total time of operation was 92 min, with an average of 16.8 electrodes. The estimated time per electrode insertion was </p><p><strong>Conclusion: </strong>NeuroOne SEEG electrodes can be implanted with efficiency and provide a valuable additional tool for the epilepsy surgeon. A tapered drill bit prevents the bolt from being placed beyond the inner cortex and may reduce the risk of brain contusion or inadvertent advancement of anchor bolts, and the electrode internal stylet also affords the potential to reduce the number of trajectory passes.</p><p><strong>MeSH Terms: </strong>Epilepsy, EEG, Drug-resistant Epilepsy, Intracranial EEG</p><p><strong>Keywords: </strong>AdTech, DiXi, NeuroOne, Positron emission tomography (PMT), Stereoelectroencephalography</p><p></p></div> </div></body></html> </div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"><p></p><p><inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="SNI-15-454-inline001.tif"/></p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="INTRODUCTION">INTRODUCTION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Stereoelectroencephalography (SEEG) is a widely utilized technique in invasive monitoring for medically refractory epilepsy when less invasive techniques are unable to distinguish potential epileptogenic areas effectively. In this procedure, multiple electrodes are surgically implanted into the brain using one of several targeting methods. Stereotactic head frames and surgical robots are common tools used for insertion. Robotic insertion has been shown to lower average operative time and perhaps improve accuracy.[<xref ref-type="bibr" rid="ref3"> <a href='#ref3'>3</a> </xref>,<xref ref-type="bibr" rid="ref5"> <a href='#ref5'>5</a> </xref>,<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>,<xref ref-type="bibr" rid="ref9"> <a href='#ref9'>9</a> </xref>,<xref ref-type="bibr" rid="ref11"> <a href='#ref11'>11</a> </xref>] The procedure is generally considered to have a low complication rate, with hemorrhage being the most common adverse event at 1–3%.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>,<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>,<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>,<xref ref-type="bibr" rid="ref10"> <a href='#ref10'>10</a> </xref>] Electrode design and placement techniques have been relatively unchanged to date, and most electrode manufacturers recommend similar steps for the placement of each electrode. These include accessing the cranial vault, placement of a fixed skull bolt, opening of the dura, creation of a tract for the electrode to traverse, and placement of the electrode, which is subsequently fixed to the skull bolt.</p><p>Currently, Food and Drug Administration-approved SEEG electrode products include those from AdTech (Oak Creek, WI), PMT (Chanhassen, MN), DiXI (Chaudefontaine, France), and NeuroOne (Zimmer Biomet, Warsaw, IN, USA) companies. NeuroOne is the most recently approved of these, and little has been published about this electrode system to date.[<xref ref-type="bibr" rid="ref4"> <a href='#ref4'>4</a> </xref>]</p><p>SEEG is becoming a more and more prevalent method of intracranial monitoring when advanced diagnostics are required to localize a patient’s epilepsy. Due to the minimally invasive nature of SEEG, our center frequently employs this technique in refractory epilepsy that scalp electroencephalography (EEG) is unable to categorize confidently. The NeuroOne electrode design provides for reduced steps during implantation and makes the process of implantation more efficient. The authors report our initial experience and the technical specifications of the NeuroOne electrodes, with the goal of making the reader aware of new devices in epilepsy surgery, which could enhance safety and reduce steps involved in the implantation process.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="MATERIALS AND METHODS">MATERIALS AND METHODS</a></h3><div class="clearfix"></div><div class="hline"></div><p>We performed a case series review of our first five consecutive patients with Zimmer NeuroOne EVO SEEG electrodes inserted at the University of California, Irvine Douglas, over approximately 6 months in 2023. The clinical, radiographic, and surgical history of each epilepsy patient was reviewed retrospectively through medical record review [<xref ref-type="table" rid="T1"> <a href='#T1'>Table 1</a> </xref>]. No identifiable information was maintained for our report. The total operative time recorded was based on nursing operative documentation. The senior surgeon (Author SV) performed all procedures. Technical specifications of currently approved electrode products are listed in <xref ref-type="table" rid="T2"> <a href='#T2'>Table 2</a> </xref>. Images of NeuroOne electrode insertion equipment are displayed in <xref ref-type="fig" rid="F1"> <a href='#F1'>Figure 1</a> </xref>. To be selected for SEEG implantation, each patient care plan was agreed upon at a multidisciplinary care conference. SEEG was performed to clarify the localization of epilepsy when focal epilepsy was suspected but not diagnosed with noninvasive methods, when bilateral epileptiform activity was suspected, and in other instances.</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F1'></a> <br /><img src='https://i1.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13273/SNI-15-454-g001.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 1:</h3><p>Various equipment components used with NeuroOne stereoelectroencephalography electrodes.</p></div> </div> </div> </div><div class="clearfix"> </div><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='T1'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13273/SNI-15-454-t001.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Table 1:</h3><p>Patient demographics from initial cases with NeuroOne electrode product.</p></div> </div> </div> </div><div class="clearfix"> </div><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='T2'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13273/SNI-15-454-t002.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Table 2:</h3><p>Comparison data from each currently FDA-approved SEEG depth electrode product.</p></div> </div> </div> </div><div class="clearfix"> </div><p>Surgical and medical device photographs were collected without any identifying features or patient identifiers, and, as is standard practice at our institution, each patient has consented before surgery to the possibility of publishing any photographs or videos obtained in connection with their clinical and surgical information in a de-identified fashion. This study was performed in line with the principles of the Declaration of Helsinki. Local Institutional Review Board Approval was granted before study initiation. This case series has been reported in line with the PROCESS guideline.</p><h3 class = "title3">Surgical procedure</h3><p><list list-type="order"> <list-item><p>Procedures were performed under general endotracheal anesthesia. After preprocedural time-out and clipping of hair, the head was fixed into place with a Leksell stereotactic frame (Elekta Solutions, Sweden) or Mayfield skull clamp system (Integra Neurosciences, Plainsboro, NJ) and then attached to the robotic stereotactic assistance (ROSA) robot (Zimmer Biomet, Warsaw, IN, USA). Facial registration was performed using the built-in robotic software and laser capabilities, utilizing both preoperative computed tomography (CT) and double-contrast magnetic resonance imaging. This registration process takes between 20 and 40 min. Once the robot is calibrated, the patient is prepped and draped. Electrode trajectories were preplanned and loaded onto the robot.</p></list-item> <list-item><p>Variable-length NeuroOne electrodes were inserted with ROSA assistance through previously planned trajectories as described in the following text. Systolic arterial pressure was maintained below 130 mmHg for the duration of electrode insertion time. Antiplatelets and anticoagulants were held for multiple days before each procedure.</p></list-item> <list-item><p>Drilling into the skull was accomplished with a 2.1 mm tapered drill bit aimed through a robotic attachment piece along the trajectory for each electrode. The width of the bone at each entry point was measured on preoperative images, and the robotic attachment for drill guidance was used as a safety stop and positioned 3–5 mm beyond the anticipated bone width. With each increase in the depth of drilling, the surgeon would move the robot drill guide several millimeters along the trajectory and then advance the drill. In doing so, the surgeon was able to maintain manual feedback upon drilling through the inner table of the calvarium and perform one final 1–2 mm advancement of the drill guide (and subsequently, drill bit) with the intent to perforate through the dura mater with the drill tip. These drilling steps are illustrated in our associated surgical video [<xref ref-type="supplementary-material" rid="Supp1"> <a href='#Supp1'> Video 1 </a> </xref>]. Unlike the design of other drill bits, the NeuroOne drill provides a tapered tip which prevents the bolt from being placed too deep within the skull and also reduces the risk of causing intracranial injury.</p> <h3>Video 1</h3> <div style="padding:56.25% 0 0 0;position:relative;"><iframe src="https://player.vimeo.com/video/1036885289?badge=0&autopause=0&player_id=0&app_id=58479" frameborder="0" allow="autoplay; fullscreen; picture-in-picture; clipboard-write" style="position:absolute;top:0;left:0;width:100%;height:100%;" title="Initial experience with NeuroOne SEEG"></iframe></div><script src="https://player.vimeo.com/api/player.js"></script></br> </list-item> <list-item><p>An alternative to using the drill tip to perforate the dura is to use a separate probe with a tapered sharp endpoint combined with a cautery device to open the dura. With this method, the surgeon can also palpate the dura and use monopolar electrocautery periodically to transmit electricity through the palpation probe and create a small opening within the dura.</p></list-item> <list-item><p>Varying length bolts (20–35 mm) were placed into the predrilled hole based on the measured soft-tissue thickness at each location. Once into the bone, approximately 5 turns were performed to anchor each bolt.</p></list-item> <list-item><p>After dural perforation, each electrode was inserted. No preinserting stylet pass was used, as the NeuroOne Evo SEEG electrode has an incorporated internal stylet, which provides adequate rigidity for placement. Electrodes were planned and placed with an orthogonal trajectory whenever possible.</p></list-item> <list-item><p>Each electrode was anchored to a metal bolt fixated in the skull by tightening the electrode cap until finger tight.</p></list-item> <list-item><p>Each electrode had between 10 and 16 contacts. After insertion, electrodes were labeled, and sterile bandages were dressed along each exit site. Postoperative X-rays were obtained before leaving the operating room (OR) [<xref ref-type="fig" rid="F2"> <a href='#F2'> Figure 2 </a> </xref>]. After each surgery, a fine-cut, noncontrast head CT was obtained to record electrode position and rule out obvious hemorrhage. Inpatient monitoring was performed in a specialized unit for EEG patients.</p></list-item> </list></p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F2'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13273/SNI-15-454-g002.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 2:</h3><p>Postoperative X-rays on each patient after stereoelectroencephalography placement.</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="RESULTS">RESULTS</a></h3><div class="clearfix"></div><div class="hline"></div><p>Our initial five cases with NeuroOne EVO electrodes proceeded without any apparent technical issues. It is reasonable to expect an average time of <2 min per electrode insertion with this system. We did not have any intracranial hemorrhage on immediate postoperative CT scans. Monitoring yielded diagnostic information in all patients, and there were no apparent hardware complications. Surgical removal of the electrode and anchor bolt systems after monitoring proceeded without any complications, and incisions (closed with staples) were well healed at 2-week follow-up appointments for each patient.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="DISCUSSION">DISCUSSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>There are several small alterations to surgical techniques utilized in our series that make electrode insertion more efficient. The use of a robot to aid in the efficiency and accuracy of electrode insertion has been documented previously.[<xref ref-type="bibr" rid="ref3"> <a href='#ref3'>3</a> </xref>,<xref ref-type="bibr" rid="ref5"> <a href='#ref5'>5</a> </xref>,<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>,<xref ref-type="bibr" rid="ref11"> <a href='#ref11'>11</a> </xref>] Our technique to use the drill-guide attachment on the robot arm as a drill safety stop reduces time with each burr hole and reduces the inadvertent advancement of the drill. The tapered design of the NeuroOne drill bit is uniquely designed to prevent the anchor bolt and the drill from extending into the cranial vault or excessively deep placement of the anchor bolt. This appears to be a useful safety feature during drill use for both experienced surgeons and those in training. In our institutional-specific practice, we utilize the ROSA robot drill attachment as a safety stop for the drill. With the separate attachable safety stop, the surgeon must use a flathead screwdriver to adjust the safety stop on the drill bit; each time, more length of the drill bit needs to be exposed. Using the robot drill-guide attachment, the surgeon can easily move the drill guide several millimeters further along the robotic trajectory each time the drill needs to be advanced, and with less chance of the safety-stop unintentionally moving. A final nuance with the potential to reduce operative time is the absence of a preelectrode pass through the brain with a stylet to create a tract for the electrode to traverse. The NeuroOne electrodes have a built-in stylet that provides significant rigidity to obviate the need for the creation of a tract. Once the dura has been perforated adequately, the risk of errant placement of electrodes is significantly reduced.</p><p>Other benefits of a built-in stylet model are the lack of need for a separate stylet, which adds cost to the procedure, and the avoidance of potential deformation or bending of a stylet with repeated use. A disposable stylet can be opened for each case should the surgeon desire to create an additional trajectory pass before inserting the SEEG electrode. As we accumulate experience with NeuroOne electrode insertion, we anticipate that high accuracy of placement will eliminate the need for utilizing this (or multiple) additional stylets and perhaps reduce cost.</p><p>Another potential benefit of not using a separate stylet is a reduced rate of intracranial hemorrhage due to a reduced number of trajectory passes. Multiple authors cite a relationship between the number of electrode passes in deep brain stimulation and hemorrhage risk, and one could assume a similar correlation in SEEG.[<xref ref-type="bibr" rid="ref12"> <a href='#ref12'>12</a> </xref>] The overall hemorrhage rate in SEEG has been quoted at 1–3% and is likely escalated with an increasing number of electrodes and frontal lobe location.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>,<xref ref-type="bibr" rid="ref10"> <a href='#ref10'>10</a> </xref>] This reduced number of trajectory passes with an internal stylet may, of course, be offset as the total number of electrodes for each procedure increases. The most common type of hemorrhage after SEEG is intraparenchymal, which would not be easily detected intraoperatively.[<xref ref-type="bibr" rid="ref10"> <a href='#ref10'>10</a> </xref>] For the surgeon, electrode diameter is important when planning the site of brain entry and reducing the chance of surface vessel contact. NeuroOne has a relatively thin electrode profile, which may reduce the chance of a vascular collision in either circumstance. McGovern <i>et al</i>. demonstrated that hemorrhage risk in SEEG is related to the total number of electrodes, underlying the importance of establishing a focused monitoring hypothesis when possible.[<xref ref-type="bibr" rid="ref8"> <a href='#ref8'>8</a> </xref>] They demonstrated a 2.2% symptomatic hemorrhage risk after SEEG but a 19.1% radiographic hemorrhage risk for all types of intracranial bleeding.[<xref ref-type="bibr" rid="ref8"> <a href='#ref8'>8</a> </xref>] Worthy of mention is a very recent publication from Lee <i>et al</i>., which showed a larger radial error in trajectory targeting when using an internal-stylet technique as opposed to an external, manually measured stylet pass before inserting the final SEEG electrode with robotic assistance.[<xref ref-type="bibr" rid="ref7"> <a href='#ref7'>7</a> </xref>] In addition to the internal-stylet method, greater trajectory entry angle and greater target depth were also correlated with greater targeting error.[<xref ref-type="bibr" rid="ref7"> <a href='#ref7'>7</a> </xref>] It will be of great interest to see if we find similar results and acceptable accuracy in our future experience with NeuroOne electrodes and their internal stylet feature.</p><p>The thin profile of NeuroOne electrodes provides an additional technical specification that might reduce hemorrhage risk. With a diameter of 0.8 mm, NeuroOne has a slim profile [<xref ref-type="table" rid="T2"> <a href='#T2'>Table 2</a> </xref>]. A range between 5 and 16 contacts, each 2 mm in length, allows for sufficient recording coverage. Contact spacing ranges from 1.5 to 3.2 mm for larger electrodes to offer more customized surface contact per brain region. In comparison, DIXI Medical, USA (DIXI) SEEG electrodes (Chaudefontaine, France) have a similar diameter (0.8 mm) and a semi-rigid structure intended to allow the surgeon to choose between utilizing a preelectrode stylet and using the electrode alone to create the trajectory. The stylet is listed as a single-use item. DIXI electrodes exhibit a fixed distance of 1.5 mm between all contacts, and a nonsterile attachment cable is typically used [<xref ref-type="table" rid="T2"> <a href='#T2'>Table 2</a> </xref>]. PMT Medical Corporation, Chanhassen, MN (PMT) offers the surgeon an option of selecting an electrode with or without internal stylet on order, which is unique among the existing companies. In theory, PMT electrodes (without a stylet) may be the least rigid of existing products, which may predispose to trajectory deflection; the exact incidence of this is unknown. AdTech (Oak Creek, WI) SEEG electrodes have a wide range of contact sizes and diameters, some of which are available through special order. Some of the special-order electrodes have a diameter over twice as large as their competitors, leaving a bigger trajectory footprint and a need for careful preoperative planning to avoid vascular structures if these models are used. The ideal number of contacts will be different depending on the area of tissue monitored and the suspected epileptogenic and irritative zones. Connection cables for AdTech are typically advertised as a sterile, single-use product.</p><p>With a learning curve for insertion considered, it would be reasonable to infer small cost savings from the shortened duration of anesthesia if the surgeon fully realizes the potential surgical time benefits of the NeuroOne tapered drill and internal stylet.</p><p>Although this series is one of the earliest reports of NeuroOne SEEG electrodes, it includes a very limited number of patients. Due to an overall low complication rate with SEEG, a larger number of electrode insertions would be necessary to compare operative times, technical issues, or hardware complications between these and other electrode models. The same statement could be made about the diagnostic capabilities of this electrode versus other available designs. This text is intended to be a review of some technical specifications of this new SEEG product and not a lengthy review of the indications for SEEG. There are many similarities between currently approved electrode models. The lack of a separate stylet for NeuroOne electrode insertion may prompt the concern of electrode deviation; the risk of this event is unknown and would be elicited with a large volume of consecutive cases. Finally, as the variable of cost is influenced by many factors – insurance, availability, and hospital contractual agreements, it may be difficult to generalize trends.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="CONCLUSION">CONCLUSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Our initial experience with NeuroOnc SEEG products gives us positive expectations for continued use in epilepsy surgery. Their low profile, variability in contact spacing, and semi-rigid internal stylet design suggest that they can be both versatile and efficient for the surgeon in terms of OR time and cost. There are multiple similarities in design between the existing electrode companies, which will make studying some differences challenging, whether this may be hardware complications, successful use in monitoring data, or risk of complications in a procedure with already low complication rates.</p><p></p><p></p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Author contributions">Author contributions</a></h3><div class="clearfix"></div><div class="hline"></div><p>NW: Conceptualization, data curation, formal analysis, writing of original draft, review, and editing; AH: Conceptualization, review, and editing; SV: Conceptualization, formal analysis, review and editing, supervision.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Ethical approval">Ethical approval</a></h3><div class="clearfix"></div><div class="hline"></div><p>The research/study was approved by the Institutional Review Board at the University of California Irvine, number 3656, dated 10/01/2023.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Declaration of patient consent">Declaration of patient consent</a></h3><div class="clearfix"></div><div class="hline"></div><p>The authors certify that they have obtained all appropriate patient consent.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Financial support and sponsorship">Financial support and sponsorship</a></h3><div class="clearfix"></div><div class="hline"></div><p>Nil.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Conflicts of interest">Conflicts of interest</a></h3><div class="clearfix"></div><div class="hline"></div><p>There are no conflicts of interest.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Use of artificial intelligence (AI)-assisted technology for manuscript preparation">Use of artificial intelligence (AI)-assisted technology for manuscript preparation</a></h3><div class="clearfix"></div><div class="hline"></div><p>The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Video available on: ">Video available on: </a></h3><div class="clearfix"></div><div class="hline"></div><p><ext-link ext-link-type="uri" xlink:href="https://doi.org/10.25259/SNI_277_2024">https://doi.org/10.25259/SNI_277_2024</ext-link></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Disclaimer">Disclaimer</a></h3><div class="clearfix"></div><div class="hline"></div><p>The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.</p></div> </div></div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"><h3 class="blogheading pull-left Main-Title col-lg-9 col-sm-8 col-xs-12"><a href="javascript:void(0);" name="Acknowledgments">Acknowledgments</a></h3><div class="clearfix"></div><div class="hline"></div><p>We would like to recognize all surgical device company representatives who have worked at UCI in their efforts to provide accurate information and assist with patient care.</p></div> </div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a name="References" href="javascript:void(0);">References</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><a href='javascript:void(0);' name='ref1' style='text-decoration: none;'>1.</a> Cardinale F, Cossu M, Castana L, Casaceli G, Schiariti MP, Miserocchi A. Stereoelectroencephalography: Surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery. 2013. 72: 353-66</p><p><a href='javascript:void(0);' name='ref2' style='text-decoration: none;'>2.</a> De Almeida AN, Olivier A, Quesney F, Dubeau F, Savard G, Andermann F. Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography-or magnetic resonance imaging-guided electrode implantation. J Neurosurg. 2006. 104: 483-7</p><p><a href='javascript:void(0);' name='ref3' style='text-decoration: none;'>3.</a> Faraji AH, Remick M, Abel TJ. Contributions of robotics to the safety and efficacy of invasive monitoring with stereoelectroencephalography. Front Neurol. 2020. 16: 570010</p><p><a href='javascript:void(0);' name='ref4' style='text-decoration: none;'>4.</a> , editors. FDA approval of neuroone electrodes. K211367.pdf. 2021. p. </p><p><a href='javascript:void(0);' name='ref5' style='text-decoration: none;'>5.</a> Gomes FC, Larcipretti AL, Nger G, Dagostin CS, UdomaUdofa OC, Pontes JP. Robot-assisted vs. manually guided stereoelectroencephalography for refractory epilepsy: A systematic review and meta-analysis. Neurosurg Rev. 2023. 46: 102</p><p><a href='javascript:void(0);' name='ref6' style='text-decoration: none;'>6.</a> González-Martínez J, Bulacio J, Thompson S, Gale J, Smithason S, Najm I. Technique, results, and complications related to robot-assisted stereoelectroencephalography. Neurosurgery. 2016. 78: 169-80</p><p><a href='javascript:void(0);' name='ref7' style='text-decoration: none;'>7.</a> Lee SJ, Lee PS, Faraji AH, Richardson RM, Kokkinos V. Implantation accuracy and operative variables in robot-assisted stereoelectroencephalography. J Neurosurg. 2023. 139: 1598-603</p><p><a href='javascript:void(0);' name='ref8' style='text-decoration: none;'>8.</a> McGovern R, Ruggieri P, Bulacio J, Najm I, Bingaman W, Gonzalez-Martinez J. Risk analysis of hemorrhage in stereo-electrocephalography procedures. Epilepsia. 2019. 60: 571-80</p><p><a href='javascript:void(0);' name='ref9' style='text-decoration: none;'>9.</a> Mullin J, Smithason S, Gonzalez-Martinez J. Stereo-electro-encephalo-graphy (SEEG) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: A technical note. J Vis Exp. 2016. 112: e53206</p><p><a href='javascript:void(0);' name='ref10' style='text-decoration: none;'>10.</a> Mullin JP, Shriver M, Alomar S, Najm I, Bulacio J, Chauvel P. Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia. 2016. 57: 386-401</p><p><a href='javascript:void(0);' name='ref11' style='text-decoration: none;'>11.</a> Zhang D, Cui X, Zheng J, Zhang S, Wang M, Lu W. Neurosurgical robot-assistant stereoelectroencephalography system: Operability and accuracy. Brain Behav. 2021. 11: e2347</p><p><a href='javascript:void(0);' name='ref12' style='text-decoration: none;'>12.</a> Zrinzo L, Foltynie T, Limousin P, Hariz MI. Reducing hemorrhagic complications in functional neurosurgery: A large case series and systematic literature review. J Neurosurg. 2012. 116: 84-94</p></div> </div></div>
Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data

Fri, 06 Dec 2024 21:49:01 -0000

Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data Category: Article Type: Javed Iqbal1, Muhammad Ashir Shafique2, Burhanuddin Sohail Rangwala3, Hafsah Alim Ur Rahman4, Muhammad Abdullah Naveed4, Afia Fatima3, Ahila Ali4, Tirath Patel5, Moosa Abdur Raqib6, Muhammad Saqlain Mustafa3, Abdul Haseeb3, Sandesh Raja4, Adarsh Raja7, Stephanie Hage8, Mohammad Ashraf9Department … Continue reading Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data →

<div><!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" "http://www.w3.org/TR/REC-html40/loose.dtd"> <html><head><meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body><div class="row"><div class="col-lg-9 col-sm-8 col-xs-12"><div class="media-body details-body"> <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13271"><h2 class="media-heading"><h2 class="media-heading">Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data</h2></h2></a> </div><div class="disp_categories"> <p><label>Category: </label><span></span></p> <p><label>Article Type: </label><span></span></p> </div><a href="mailto:ijaved578578@gmail.com" target="_top">Javed Iqbal</a><sup>1</sup>, <a href="mailto:ashirshafique109@gmail.com" target="_top">Muhammad Ashir Shafique</a><sup>2</sup>, <a href="mailto:brangwala70@gmail.com" target="_top">Burhanuddin Sohail Rangwala</a><sup>3</sup>, <a href="mailto:hafsahalim03@gmail.com" target="_top">Hafsah Alim Ur Rahman</a><sup>4</sup>, <a href="mailto:abdullahnaveed120703@gmail.com" target="_top">Muhammad Abdullah Naveed</a><sup>4</sup>, <a href="mailto:afiaesia@gmail.com" target="_top">Afia Fatima</a><sup>3</sup>, <a href="mailto:ahilaali68@gmail.com" target="_top">Ahila Ali</a><sup>4</sup>, <a href="mailto:tirathp611@gmail.com" target="_top">Tirath Patel</a><sup>5</sup>, <a href="mailto:moosa.bio.96@gmail.com" target="_top">Moosa Abdur Raqib</a><sup>6</sup>, <a href="mailto:msaqlain.mustafa@gmail.com" target="_top">Muhammad Saqlain Mustafa</a><sup>3</sup>, <a href="mailto:abdulhaseebg96@gmail.com" target="_top">Abdul Haseeb</a><sup>3</sup>, <a href="mailto:sandeshraja70@gmail.com" target="_top">Sandesh Raja</a><sup>4</sup>, <a href="mailto:adarshbudhwani01@gmail.com" target="_top">Adarsh Raja</a><sup>7</sup>, <a href="mailto:stephaniehage.md@gmail.com" target="_top">Stephanie Hage</a><sup>8</sup>, <a href="mailto:mohammad.ashraf@glasgow.ac.uk" target="_top">Mohammad Ashraf</a><sup>9</sup><ol class="smalllist"><li>Department of Neurosurgery, King Edward Medical University Pakistan, Lahore, Pakistan</li><li>Department of Neurosurgery, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan</li><li>Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan</li><li>Department of Medicine, Dow University of Health Sciences, Karachi, Sindh, Pakistan</li><li>Department of Neurosurgery, American University of Antigua, Coolidge, Saint George Parish, Antigua and Barbuda</li><li>Department of Medicine, Liaquat College of Medicine and Dentistry, Karachi, Pakistan</li><li>Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan</li><li>Department of Neurosurgery, University of Chicago, Chicago, United States</li><li>Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom</li></ol><p><strong>Correspondence Address:</strong><br>Mohammad Ashraf, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom.<br></p><p><strong>DOI:</strong>10.25259/SNI_592_2024</p>Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.<div class="parablock"><p><strong>How to cite this article: </strong>Javed Iqbal1, Muhammad Ashir Shafique2, Burhanuddin Sohail Rangwala3, Hafsah Alim Ur Rahman4, Muhammad Abdullah Naveed4, Afia Fatima3, Ahila Ali4, Tirath Patel5, Moosa Abdur Raqib6, Muhammad Saqlain Mustafa3, Abdul Haseeb3, Sandesh Raja4, Adarsh Raja7, Stephanie Hage8, Mohammad Ashraf9. Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data. 06-Dec-2024;15:450</p></div><div class="parablock"><p><strong>How to cite this URL: </strong>Javed Iqbal1, Muhammad Ashir Shafique2, Burhanuddin Sohail Rangwala3, Hafsah Alim Ur Rahman4, Muhammad Abdullah Naveed4, Afia Fatima3, Ahila Ali4, Tirath Patel5, Moosa Abdur Raqib6, Muhammad Saqlain Mustafa3, Abdul Haseeb3, Sandesh Raja4, Adarsh Raja7, Stephanie Hage8, Mohammad Ashraf9. Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data. 06-Dec-2024;15:450. Available from: <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13271">https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13271</a></p></div> </div> <div class="col-lg-3 col-sm-4 col-xs-12"><div class="article-detail-sidebar"><div class="icon sidebar-icon clearfix add-readinglist-icon"><button id="bookmark-article" class="add-reading-list-article">Add to Reading List</button><button id="bookmark-remove-article" class="remove-reading-list-article">Remove from Reading List</button></div><div class="icon sidebar-icon clearfix"><a class="btn btn-link" target="_blank" type="button" id="OpenPdf" href="https://surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-s001.pdf"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/pdf-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a target="_blank" href="javascript:void(0);" onclick="return PrintArticle();"><img decoding="async" src="https://i0.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/file-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a class="btn btn-link" type="button" id="EmaiLPDF"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/mail-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a></div><div class="date"> <p>Date of Submission<br><span class="darkgray">16-Jul-2024</span></p> <p>Date of Acceptance<br><span class="darkgray">14-Oct-2024</span></p> <p>Date of Web Publication<br><span class="darkgray">06-Dec-2024</span></p> </div> </div></div> </div> <div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a href="javascript:void(0);" name="Abstract">Abstract</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><strong>Background: </strong>Epilepsy poses significant challenges globally, with varied clinical, social, and economic impacts. Despite advances in treatment, epilepsy-related mortality remains a concern. This study aimed to analyze the demographic and regional distributions of epilepsy-related mortality in the United States (U.S.) from 1999 to 2020, identifying high-risk populations for targeted interventions.</p><p><strong>Methods: </strong>Data on death certificates were obtained from the 1999 to 2020 Centers for Disease Control and Prevention Wide-Ranging Online Study Epidemiologic Research (CDC-WONDER) database. We gathered data on demographics, place of death, and urban/rural classification. Mortality rates per 100,000 people were computed and classified according to state, year, sex, race/ethnicity, and urban/rural status. Trends were examined using Joinpoint regression.</p><p><strong>Results: </strong>A total of 12,573 deaths (age </p><p><strong>Conclusion: </strong>Epilepsy-related mortality exhibits demographic and regional disparities in the U.S. Understanding these patterns can guide targeted interventions to mitigate mortality risk.</p><p><strong>Keywords: </strong>Demographics, Epilepsy, Mortality, Regional distribution, United States</p><p></p></div> </div></body></html> </div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"><p></p><p><inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="SNI-15-450-inline001.tif"/></p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="INTRODUCTION">INTRODUCTION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Significant neurological conditions like epilepsy can be prevented, and their symptoms can be controlled. It also has extensive clinical, psychological, and economic ramifications that vary globally and are linked to varying incidence, prevalence, and mortality rates.[<xref ref-type="bibr" rid="ref4"> <a href='#ref4'>4</a> </xref>,<xref ref-type="bibr" rid="ref15"> <a href='#ref15'>15</a> </xref>,<xref ref-type="bibr" rid="ref21"> <a href='#ref21'>21</a> </xref>] Recurrent seizures and the ensuing neurological, cognitive, psychological, and social effects are its defining features. It is a chronic brain disorder that can have a major impact on an individual’s life. The following conditions result in an epilepsy diagnosis: (1) two or more unprovoked (or reflex) seizures that happen more than 24 h apart; (2) one unprovoked (or reflex) seizure with a probability of future seizures equal to the combined risk of recurrence after two unprovoked seizures over the next 10 years, which is at least 60%; or (3) the identification of an epilepsy syndrome.[<xref ref-type="bibr" rid="ref8"> <a href='#ref8'>8</a> </xref>]</p><p>Between 1% and 2% of people worldwide have epilepsy, a neurological condition that affects about 3.4 million people in the United States (U.S.).[<xref ref-type="bibr" rid="ref29"> <a href='#ref29'>29</a> </xref>] Approximately one-third of people still have refractory seizures even after using antiseizure drugs[<xref ref-type="bibr" rid="ref13"> <a href='#ref13'>13</a> </xref>], which raises the risk of disease and death, lowers the quality of life, and increases the need for medical care.[<xref ref-type="bibr" rid="ref18"> <a href='#ref18'>18</a> </xref>,<xref ref-type="bibr" rid="ref28"> <a href='#ref28'>28</a> </xref>] According to research on the American populace, ischemic heart disease, organic mental diseases, central nervous system degenerative disorders, hypertension, and malignant neoplasms are the leading causes of mortality linked to epilepsy.[<xref ref-type="bibr" rid="ref5"> <a href='#ref5'>5</a> </xref>,<xref ref-type="bibr" rid="ref20"> <a href='#ref20'>20</a> </xref>]</p><p>Five novel anti-seizure drugs (brivaracetam, cannabidiol, cenobamate, everolimus, and fenfluramine) have been used as recent therapies for epilepsy.[<xref ref-type="bibr" rid="ref7"> <a href='#ref7'>7</a> </xref>,<xref ref-type="bibr" rid="ref19"> <a href='#ref19'>19</a> </xref>,<xref ref-type="bibr" rid="ref26"> <a href='#ref26'>26</a> </xref>] By employing one or more low- or high-intensity ultrasound beams, focused ultrasound can be utilized to modify brain activity or destroy neural tissue.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>,<xref ref-type="bibr" rid="ref11"> <a href='#ref11'>11</a> </xref>,<xref ref-type="bibr" rid="ref14"> <a href='#ref14'>14</a> </xref>] Phytocannabinoids, which have anticonvulsants properties, are receiving more attention within the area of treatment resistant epilepsy.[<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>,<xref ref-type="bibr" rid="ref17"> <a href='#ref17'>17</a> </xref>,<xref ref-type="bibr" rid="ref25"> <a href='#ref25'>25</a> </xref>,<xref ref-type="bibr" rid="ref30"> <a href='#ref30'>30</a> </xref>]</p><p>Although there has been significant advancement in the treatment of epilepsy, the death rate related to this illness has not yet been fully studied. This is due to the fact that no previous study has focused on or published death rates among epileptic patients. The objective of the current study was to examine the geographic and demographic patterns of mortality associated with epilepsy in the U.S. between 1999 and 2020. To enable prompt actions to lower death rates, this investigation sought to identify the groups most at risk of epilepsy-related mortality. The study extracts data from death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Study Epidemiologic Research (CDC WONDER) using the International Classification of Diseases, Tenth Revision (ICD-10) codes.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="METHODOLOGY">METHODOLOGY</a></h3><div class="clearfix"></div><div class="hline"></div><h3 class = "title3">Study setting and population</h3><p>Data from death certificates for the years 1999–2020 were obtained from the CDC WONDER database using the ICD-10 codes. Particular codes used were G40.0, G40.1, G40.2, G40.3, G40.4, G40.5, G40.6, G40.7, G40.8, and G40.9. The multiple cause-of-death public-use record death certificates were used to identify deaths connected to epilepsy, that is, deaths in which epilepsy was mentioned as an underlying or contributing cause of death on the death certificate. This included data extracted from death certificates in the District of Columbia and all 50 states. All patients with epilepsy as the cause of death, regardless of age at death, were included in this study. This study has been exempted from local institutional review board clearance since it used a de-identified public use data set from the government and followed Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines.</p><h3 class = "title3">Data extraction</h3><p>Demographics, place of death, year of death, urban/rural classification, regional split, and state-specific data were gathered. The demographic section contained information on race/ethnicity, age, and sex. The places of death included homes, hospices, nursing homes/long-term care facilities, and medical facilities (death on arrival, outpatient, inpatient, emergency room, or status unknown). Based on information from death certificates and earlier WONDER database study, race/ethnicity was divided into nonHispanic (NH) or African American; NH White, NH Asian, or Pacific Islander; Hispanic or Latino; and NH American Indian or Alaskan Native categories. The National Center for Health Statistics Urban-Rural Classification Scheme categorizes the population into urban and rural areas based on the 2013 U.S. census. Urban areas were further subdivided into medium/ small metropolitan regions, which have populations between 50,000 and 999,999, and big metropolitan areas, which have populations over one million. In the current investigation, the same classification scheme was applied. Geographical regions were categorized using the U.S. Census Bureau’s guidelines into the Midwest, Northeast, South, and West areas.</p><h3 class = "title3">Statistical analysis</h3><p>We looked into epilepsy-related mortality trends by carefully analyzing data from 1999 to 2020. With a focus on regional patterns, mortality rates per 100,000 people were computed for both age-adjusted and unadjusted data. These rates came with 95% confidence intervals (CIs) and were broken down by year, sex, race/ethnicity, state, and urban/rural status. The total number of deaths from epilepsy divided by the matching U.S. population for each year yielded the crude mortality rates. Up to 2000, the U.S. epilepsy-related deaths were standardized to determine age-adjusted mortality rates (AAMR). We used the Joinpoint Regression Program (Version 5.0.2, National Cancer Institute) to analyze the annual percent change (APC) and its related 95% CI in age-adjusted mortality rates (AAMR) to identify any significant changes over time.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="RESULTS">RESULTS</a></h3><div class="clearfix"></div><div class="hline"></div><p>Between 1999 and 2020, there were 12,573 deaths in the population under 35 years old that were associated with epilepsy [<xref ref-type="fig" rid="F1"> <a href='#F1'>Figure 1</a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental Table 1</a> </xref>]. In total, 22947 deaths were recorded in the age range of 35–64 [<xref ref-type="fig" rid="F1"> <a href='#F1'>Figure 1</a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental Table 2</a> </xref>], whereas 21,782 deaths were reported in the age group of 65 and above [<xref ref-type="fig" rid="F1"> <a href='#F1'>Figure 1</a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental Table 3</a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F1'></a> <br /><img src='https://i1.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g001.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 1:</h3><p>Overall.</p></div> </div> </div> </div><div class="clearfix"> </div><p>For 12550 cases, information on the place of death for infants to younger adults (those under 35) was available. Of them, 47.9% happened at home, 2% happened in nursing homes or long-term care facilities, 1.4% happened in hospices, and 41.1% happened in medical facilities [<xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental Table 4</a> </xref>].</p><p>A total of 269283 fatalities among middle-aged people (aged 35–64) were recorded. Of them, 34.7% happened at home, 9.2% in long-term care or nursing homes, 2.4% in hospices, and 50.3% occurred in medical facilities [<xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental >Table 5</a> </xref>]. Data on the location of death for 57,254 deaths among older persons 65 years of age and older were recorded. About 34.2% of these deaths took place in hospitals (medical facilities), 16.9% in long-term care or nursing homes, 2.9% in hospices, and 39.88% at home [<xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'>Supplemental Table 6</a> </xref>].</p><h3 class = "title3">Annual trends in AAMR associated with epilepsy in infants to young adults</h3><p>In 1999, the AAMR for fatalities in the population of <35 years caused by epilepsy was 1.9 (95% CI: 1.6–2.2); by 2020, it had increased to 6.3 (95% CI: 5.7–6.9). The AAMR increased overall between 1999 and 2011, with a noteworthy APC of 3.7016 (95% CI: 1.0337–5.3265). From 2011 to 2020, there was another notable increase, with an APC of 9.1412 (95% CI: 7.6822–11.7359) [<xref ref-type="fig" rid="F1"> <a href='#F1'> Figure 1 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 7 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 8 </a> </xref>].</p><h3 class = "title3">Epilepsy-related yearly patterns in AAMR in middle-aged adults</h3><p>In 1999, the AAMR for epilepsy-related deaths in people aged 35–64 was 6.3 (95% CI: 5.8–6.8); by 2020, it had risen to 15.8 (95% CI: 15.1–16.5). AAMR increased significantly between 1999 and 2011 (APC of 0.3596, 95% CI: −0.4050–0.9969) and then increased significantly again between 2011 and 2020 (APC of 9.5371, 95% CI: 8.6977–10.8628) [<xref ref-type="fig" rid="F1"> <a href='#F1'> Figure 1 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 9 </a> </xref>-<xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 11 </a> </xref>].</p><h3 class = "title3">Epilepsy-related yearly patterns in AAMR in older adults</h3><p>In addition, in 1999, the AAMR for fatalities in the population of 64 and above years of age caused by epilepsy was 17.3 (95% CI: 15.9–18.6); by 2020, it had increased to 53 (95% CI: 51.1–55). With an APC of −1.5866 (−3.3958–−0.0128), the AAMR showed a large overall decline from 1999 to 2009. From 2009 to 2020, however, there was a significant increase, with an APC of 12.3579 (11.4440–13.5803) [<xref ref-type="fig" rid="F1"> <a href='#F1'> Figure 1 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 13 </a> </xref>].</p><h3 class = "title3">Epilepsy gender-based annual trends in AAMR among infants and young adults</h3><p>The study found that across all age categories, male AAMRs were consistently higher than female AAMRs, with men’s having overall AAMRs of 4.6 (95% CI: 4.4–4.7) and women’s having overall AAMRs of 3.2 (95% CI: 3.1–3.3). Male AAMR in 1999 was 3.1, with a 95% CI of 2.7–3.5. The APC increased to 3.7 (95% CI: 3.2–4.1) in 2011, indicating an increase in the rate. A following increase in AAMR to 9.1 (95% CI: 8.4–9.7) with an APC of 10.0922 and a 95% CI spanning from 8.4824 to 13.8721 occurred in 2020. In 1999, women’s AAMR was 1.9, with a 95% CI spanning from 1.6 to 2.2. APC of 2.5547 (95% CI: 1.5827–3.3951) indicates that the AAMR went risen between 1999 and 2011. With an APC of 10.1021 (95% CI: 9.0051–11.8872), there was a further, more notable increase through 2020. By the end of the study period, the female AAMR was 6.3 (95% CI: 5.7–6.9) [<xref ref-type="fig" rid="F2"> <a href='#F2'> Figure 2 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 7 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 8 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F2'></a> <br /><img src='https://i0.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g002.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 2:</h3><p>Gender.</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3">Epilepsy gender-based annual trends in AAMR among middle-aged adults</h3><p>Males’ AAMRs were higher than females’ across the board for all ages in the analysis conducted for people aged 35–64. Men’s overall AAMRs were 10.2 (95% CI: 10–10.3), while women’s were 6.7 (95% CI: 6.6–6.8). Male AAMR in 1999 was 8, with a 95% CI of 7.2–8.8. The AAMR value changed to 8.4 (95% CI: 7.7–9.2) in 2011, with the APC showing a slight decreasing trend of −0.1168 (95% CI: −0.8942–0.5252). There was a significant increase to 18.1 (95% CI: 17.1–19.2) in 2020 in AAMR with an APC of 9.2574 (95% CI: 8.5433–10.2134). Comparable to this, the 1999 AAMR for women between the ages of 35 and 64 was 4.6 (95% CI: 4.1–5.2). APC of 1.0686 (95% CI: −0.9412–2.5645) indicates that the AAMR went up between 1999 and 2011. Up to 2020, there was a more notable increase, with an APC of 10.0227 (95% CI: 8.4063–12.4949). By the end of the study period, the AAMR for females was 13.5 (95% CI: 12.6–14.4) [<xref ref-type="fig" rid="F2"> <a href='#F2'> Figure 2 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 9 </a> </xref>-<xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 11 </a> </xref>].</p><h3 class = "title3">Epilepsy-related yearly patterns in AAMR graded by gender in older adults</h3><p>The overall AAMRs of men and women were found to be consistently higher in the study on mortality trends for ages spanning from 65 and above. Men’s AAMRs were 25.6 (95% CI: 25.1–26.1), and women’s AAMRs were 22 (95% CI: 21.7–22.4). In 1999, male AAMR was 18.7, with a 95% CI of 16.3–21. The AAMR value changed to 15.3 (95% CI: 13.4–17.2) in 2009. The APC values also showed a slightly decreasing trend of −1.9575 (95% CI: −4.2313–−0.0398). There was a significant increase to 56 (95% CI: 53–59.1) in 2020 with an APC of 11.9738 (95% CI: 10.8531–13.5006). Similar to this, the AAMR for women aged 65 and above in 1999 was 16.3 (95% CI: 14.6– 18) with an APC of −1.3562 (95% CI: −3.1845–0.1553). The years 1999–2009 saw a decrease in the AAMR. Up to 2020, there was a more notable increase, with an APC of 12.5546 (95% CI: 11.6798–13.7399). By the end of the study period, the AAMR for females was 50.1 (95% CI: 47.6–52.7) [<xref ref-type="fig" rid="F2"> <a href='#F2'> Figure 2 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 13 </a> </xref>].</p><h3 class = "title3">Epilepsy and race-based annual trends in AAMR among newborn and young adults</h3><p>In this population, the NH or African American population had the highest AAMRs, followed by the NH American Indian or Alaska Native, NH White, and Hispanic or Latino groups. The following were the overall AAMR values: NH or African American, 5.8 (95% CI: 5.6–6); NH American Indian or Alaska Native, 4.2 (95% CI: 3.4–4.9); NH White, 3.8 (95% CI: 3.7–3.9); and Hispanic or Latino, 3.2 (95% CI: 3.1–3.4). In conclusion, there was an increase in AAMR among NH White people between 1999 and 2011. The APC was 2.0765 (95% CI: −2.2581–4.2343). A significant increase in the mortality trend was observed with an APC of 10.6017 (95% CI: 8.2341–16.3243) through 2020. The AAMR for the NH or African American population increased similarly from 1999 to 2011, with an APC of 2.0765 (95% CI: −2.2581–4.2343), which showed a significant increase until 2020 with an APC of 10.6017 (95% CI: 8.2341–16.3243). From 1999 to 2011, the AAMR for the Hispanic or Latino population increased, and the APC was 1.5668 (95% CI: −2.5224–4.1074). Subsequently, there was an increase in mortality until 2020, with an APC of 10.6381 (95% CI: 8.3859–16.3447) [<xref ref-type="fig" rid="F3"> <a href='#F3'> Figure 3.1 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 7 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 14 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F3'></a> <br /><img src='https://i0.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g003.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 3.1:</h3><p>Race newborn to younger adults (1–34 years).</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3">Epilepsy-related yearly patterns in AAMR graded by race/ethnicity in middle-aged adults</h3><p>The highest AAMR was observed in the NH or African American population, followed by the NH American Indian or Alaska Native, NH White, Hispanic or Latino, and NH Asian or Pacific Islander groups. The corresponding AAMR values for each group were as follows: NH White: 8 (95% CI: 7.9–8.2), NH American Indian or Alaska Native: 13.4 (95% CI: 11.8–14.9), NH Asian or Pacific Islander: 2.5 (95% CI: 2.3–2.8), Hispanic or Latino: 3.2 (95% CI: 3.1–3.4), and NH or African American: 14.5 (95% CI: 14.1–14.9). Between 1999 and 2011, the AAMR for NH White individuals increased, with an APC of 1.2072 (95% CI: 0.0996– 2.1401). Furthermore, a rising mortality trend was observed, with an APC of 9.8766 (95% CI: 8.9024–11.1332) until 2020. In contrast, the AAMR for the Hispanic and Latino populations decreased from 1999 to 2011, with an APC of −0.6206 (95% CI: −13.9388– 2.9201), and then increased significantly until 2020, with an APC of 8.8012 (95% CI: 5.3485–22.3329). The AAMR for NH and African American individuals also decreased from 1999 to 2010, with an APC of −2.5489 (95% CI: −5.0380–−0.6865). After that, mortality rates increased until 2020, with an APC of 9.2360 (95% CI: 7.4995–11.8797) [<xref ref-type="fig" rid="F4"> <a href='#F4'> Figure 3.2 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 10 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 15 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F4'></a> <br /><img src='https://i0.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g004.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 3.2:</h3><p>Race middle aged (35–64 years).</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3">Epilepsy-related yearly patterns in AAMR graded by race/ethnicity in older adults</h3><p>The highest AAMR was observed in the NH and African American groups, followed by the Hispanic, Latino, and NH White groups. The respective AAMR values were as follows: NH or African American: 42.5 (95% CI: 41.1–44.0), NH White: 21.8 (95% CI: 21.5–22.1), and Hispanic or Latino: 26.7 (95% CI: 25.3–28.0). It was concluded that there was a decrease in AAMR for NH or African American individuals between 1999 and 2009, with an APC of −4.0413 (95% CI: −9.3105–−0.3574). In addition, a rising mortality trend was observed, with an APC of 11.9042 (95% CI: 9.6239–15.6015) through 2020. The AAMR for NH White individuals showed an increasing trend from 1999 to 2009, with an APC of −1.1620 (95% CI: −2.7863–0.1569). This trend continued to increase from 2009 to 2020, with an APC of 12.3621 (95% CI: 11.5653–13.5243). The AAMR for the Hispanic and Latino populations also decreased from 1999 to 2008, with an APC of −2.5244 (95% CI: −19.1973– 3.9210), which then showed a significant increase until 2020, with an APC of 12.6252 (95% CI: 10.4388–17.4924) [<xref ref-type="fig" rid="F5"> <a href='#F5'> Figure 3.3 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 16 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F5'></a> <br /><img src='https://i0.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g005.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 3.3:</h3><p>Race older adults (65+).</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3">Epilepsy-related yearly patterns in AAMRs graded by geographic region</h3><h3 class = "title3" style="color:green;">States - Newborn to younger adults</h3><p>There were notable differences in the AAMR among the states, ranging from 2 (95% CI: 1.6–2.3) in Massachusetts to 7.8 (95% CI: 7.2–8.3) in Michigan. AAMRs were more than 3 times higher in the top 90<sup>th</sup> percentile (South Dakota, Massachusetts) than in the bottom 10<sup>th</sup> percentile (New Hampshire, Massachusetts, Maryland, Delaware, Connecticut, and New York breeds) [<xref ref-type="fig" rid="F6"> <a href='#F6'> Figure 4.1 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Table 17 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F6'></a> <br /><img src='https://i0.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g006.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 4.1:</h3><p>States - Newborn to younger adults.</p></div> </div> </div> </div><div class="clearfix"> </div><p>The AAMR, which varied from 2 (95% CI: 1.6–2.3) in Massachusetts to 7.8 (95% CI: 7.2–8.3) in Michigan, was significantly different in each state. The AAMRs of the breeds in the lowest 10<sup>th</sup> percentile (New Hampshire, Massachusetts, Maryland, Delaware, Connecticut, and New York) were <3 times greater than those of the top 90<sup>th</sup> percentile (South Dakota and Massachusetts) [<xref ref-type="fig" rid="F6"> <a href='#F6'> Figure 4.1 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Table 17 </a> </xref>].</p><h3 class = "title3" style="color:green;">States – Middle-aged adults</h3><p>The AAMR, which spanned from 3.4 (95% CI: 2.8–4.1) in Connecticut to 16.5 (95% CI: 13.4–19.6) in South Dakota, differed significantly across all states, with the highest values observed in South Dakota, Vermont, Michigan, and Wyoming, which were in the top 90<sup>th</sup> percentile, and the lowest values in Connecticut and Massachusetts, which were in the bottom 10<sup>th</sup> percentile [<xref ref-type="fig" rid="F7"> <a href='#F7'> Figure 4.2 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Table 18 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F7'></a> <br /><img src='https://i1.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g007.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 4.2:</h3><p>States - Middle-aged adults</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3" style="color:green;">States - Older adults</h3><p>For individuals aged 65 and over, the AAMR varied from 11.4 (with a 95% CI of 8.5–15.0) in Hawaii to 38.3 (with a 95% CI of 34.8–41.7) in Colorado. The AAMR in states such as Texas, Oregon, Colorado, and California, which were in the top 90<sup>th</sup> percentile, was more than 3 times higher than that in states such as Massachusetts, Hawaii, Florida, and Delaware, which were in the bottom 10<sup>th</sup> percentile [<xref ref-type="fig" rid="F8"> <a href='#F8'> Figure 4.3 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Table 19 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F8'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g008.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 4.3:</h3><p>States - Older Adults.</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3" style="color:green;">Census region: Newborn to younger adults</h3><p>The Western region had the greatest death rate throughout the study period, at 4.8 (95% CI: 4.6–4.9), followed by the Midwestern region at 4.5 (95% CI: 4.4–4.7), the Southern region at 3.6 (95% CI: 3.5–3.7), and the Northeastern region at 2.5 (95% CI: 2.3–2.6). In summary, the Western region’s AAMR increased between 1999 and 2012, with an APC of 2.4853 (95% CI: −0.3934–4.1655). AAMRs increased significantly between 2012 and 2020 (APC of 9.7581, 95% CI: 7.2047–16.3046). Between 1999 and 2012, the Midwestern region’s AAMR climbed consistently, with an APC of 2.5850 (95% CI: −6.4413–4.6854), which then showed a further increase with an APC of 8.9186 (95% CI: 5.6160–22.2300) from 2012 to 2020. The AAMR in the Southern region initially declined from 1999 to 2009, with an APC of 0.5261 (95% CI: −4.0527–3.2322), but then showed an increase with an APC of 10.1040 (95% CI: 8.4217–13.4707) from 2009 to 2020. Finally, the AAMR in the Northeastern region showed a significant increase with an APC of 2.9995 (95% CI: −16.4385–9.1995) during the 1999–2007 period. This was followed by a further significant increase until 2020, with an APC of 10.8459 (95% CI: 8.5056–23.0045) [<xref ref-type="fig" rid="F9"> <a href='#F9'> Figure 5 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Table 7 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 20 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F9'></a> <br /><img src='https://i1.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g009.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 5:</h3><p>Census.</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3" style="color:green;">Census region: Middle-aged adults</h3><p>Among individuals aged 35–64 years, the highest mortality rate was observed in the Western region at 10.7/1000 population (95% CI: 10.5–11), followed by the Midwestern region at 9.7/1000 population (95% CI: 9.4–10), the Southern region at 7.9/1000 population (95% CI: 7.7–8), and the Northeastern region at 5.1/1000 population (95% CI: 4.9–5.3). In summary, the age-adjusted mortality rate (AAMR) in the western region showed an increasing trend from 1999 to 2013, with an APC of 1.8168 (95% CI: 0.5533–2.8253). This trend continued between 2013 and 2020, with an APC of 9.2882 (95% CI: 7.3245–12.6445). The AAMR in the Midwestern region increased from 1999 to 2012, with an APC of 1.6631 (95% CI: −0.7636–3.0376), which then showed a significant increase with an APC of 7.8958 (95% CI: 5.7550–13.0807). The Southern region’s AAMR decreased between 1999 and 2010 (APC = −2.0062, 95% CI: −4.0373–−0.3665) and then increased between 2010 and 2020 (APC = 11.2939, 95% CI: 9.7546–13.4050). Finally, the Northeastern region’s AAMR from 1999 to 2009 showed a decline with an APC of −1.8372 (95% CI: −7.9218– 1.5804) and then an increase until 2020 with an APC of 10.0640 (95% CI: 7.8012–14.6558) [<xref ref-type="fig" rid="F9"> <a href='#F9'> Figure 5 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 10 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 21 </a> </xref>].</p><h3 class = "title3" style="color:green;">Census region: Older adults</h3><p>The West region had the greatest mortality rate (32.1, 95% CI: 31.3–32.9) among people aged 65 and above, followed by the Midwestern region (23.3, 95% CI: 22.6–23.9), Southern region (22.8, 95% CI: 22.3–23.3), and Northeastern region (16.5, 95% CI: 15.9–17.1). In summary, the western region’s AAMR increased from 1999 to 2011, with an annual percentage change (APC) of 1.7984 (95% CI: −1.3098– 3.8437). This increase persisted between 2011 and 2020, with an APC of 11.6213 (95% CI: 9.6880–15.0780). From 1999 to 2011, the AAMR for the Midwestern area fell with an APC of 0.7257 (95% CI: −1.3645–2.3142) but then increased significantly with an APC of 10.5283 (95% CI: 8.8379–13.2260) between 2011 and 2020. With an APC of −5.1822 (95% CI: −8.2784–−2.6988), the AAMR for the Southern area fell between 1999 and 2008; however, from 2008 and 2020, it grew with an APC of 14.2170 (95% CI: 13.1276– 15.8664). With an initial increase from 1999 to 2002 (APC: 7.4610, 95% CI: −3.0250–25.8201) and a subsequent fall from 2002 to 2008 (APC: −6.4622, 95% CI: −17.0579–18.8307), the AAMR for the Northeastern area showed a changing trend. An increase was seen between 2008 and 2018, with an APC of 11.4012 (95% CI: 5.2262–13.9582), and between 2018 and 2020, there was an additional increase of 32.3161 (95% CI: 20.0965–40.2359) [<xref ref-type="fig" rid="F9"> <a href='#F9'> Figure 5 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 22 </a> </xref>].</p><h3 class = "title3" style="color:green;">Urbanization - Newborn to younger adults</h3><p>During the study period, the AAMR for epilepsy was consistently higher in nonmetropolitan areas, with an overall AAMR of 4.3 (95% CI: 4.1–4.5), compared to metropolitan areas’ AAMRs of 3.8 (95% CI: 3.7–3.9). The nonmetropolitan APC of 2.6588 and 95% CI of −12.3286–6.2589 suggest that AAMR increased in nonmetropolitan areas between 1999 and 2011. AAMR continued to rise in subsequent years, peaking in 2020 with an APC of 9.3819 and a 95% CI of 5.6056–25.1289. In contrast, from 1999 to 2011, the AAMR in urban regions grew, with an APC of 2.6727 and a 95% CI of 0.4064–4.0848. However, the mortality trend in metropolitan regions increased significantly from 2011 to 2020, with an APC of 10.1376 (95% CI: 8.3016–13.9555) [<xref ref-type="fig" rid="F10"> <a href='#F10'> Figure 6 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 7 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 23 </a> </xref>].</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F10'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13271/SNI-15-450-g010.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 6:</h3><p>Urbanization.</p></div> </div> </div> </div><div class="clearfix"> </div><h3 class = "title3" style="color:green;">Urbanization - Middle-aged adults</h3><p>Nonmetropolitan regions had higher total AAMR values in individuals aged 35–64 years, with a value of 10.4 (95% CI: 10.1–10.7), compared to metropolitan areas’ AAMR of 8 (95% CI: 7.9–8.1). Between 1999 and 2011, nonmetropolitan regions had an APC of 0.6693 with a 95% CI ranging from −1.1303 to 2.1639, indicating a decrease in mortality. However, from 2011 to 2020, there was an increase in mortality, with an APC of 12.1867 (95% CI: 10.4042–14.6994). Metropolitan regions, on the other hand, showed a declining trend in mortality, with an APC of −0.2217 and a 95% CI ranging from −1.1523 to 0.6452 between 1999 and 2010. Nonetheless, mortality increased from 2010 to 2020, with an APC of 8.4288 (95% CI: 7.6945–9.5738) [<xref ref-type="fig" rid="F10"> <a href='#F10'> Figure 6 </a> </xref>; <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 24 </a> </xref>].</p><h3 class = "title3" style="color:green;">Urbanization - Older adults</h3><p>The results show that individuals aged 64 or above residing in nonmetropolitan regions had a higher AAMR (26.4, 95% CI: 25.6–27.1) compared to those living in metropolitan areas (23.0, 95% CI: 22.6–23.3). As for APC values, nonmetropolitan regions demonstrated a declining trend from 1999 to 2007, with an APC of −3.6294 (95% CI: −9.0118–−1.4803). However, this trend reversed from 2007 to 2013, with an APC of 5.1926 (95% CI: −0.0878–11.2080). This upward trend persisted until 2020, with an APC of 14.8163 (95% CI: 13.0433–19.3884). In contrast, metropolitan areas experienced a decline in mortality rates from 1999 to 2009, with an APC of −1.0029 (95% CI: −3.1525–0.8046). This trend reversed from 2009 to 2020, with an APC of 12.3679 (95% CI: 11.3895−13.7544) [<xref ref-type="fig" rid="F10"> <a href='#F10'> Figure 6 </a> </xref>, <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> Supplemental Tables 12 </a> </xref> and <xref ref-type="supplementary-material" rid="supp1"> <a href='#supp1'> 25 </a> </xref>].</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="DISCUSSION">DISCUSSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Recurrent seizures are the hallmark of epilepsy, a neurological condition that poses a serious threat to worldwide public health. There is still a significant study vacuum concerning epilepsy-related mortality trends, especially when it comes to different demographic groups and geographical areas, despite the condition’s prevalence and potential for serious consequences, including death. To close this gap, this study examined mortality patterns associated with epilepsy in the US utilizing extensive data from the Centers for Disease Control and Prevention (CDC) covering more than 20 years, from 1999 to 2020.</p><p>Notable patterns in the fatality rates from epilepsy across different demographic and geographic groups over the research period were found by analyzing CDC data. The results showed that AAMRs were rising steadily in all age categories, with especially notable accelerations seen between 2011 and 2020. Across all age categories, males notably consistently showed greater AAMRs than females,[<xref ref-type="bibr" rid="ref3"> <a href='#ref3'>3</a> </xref>,<xref ref-type="bibr" rid="ref10"> <a href='#ref10'>10</a> </xref>] indicating possible sex-related differences in epilepsy management and outcomes. Moreover, differences in AAMRs associated with epilepsy were seen between racial/ethnic groupings, geographical areas, and urban-rural divides, highlighting the complex interactions between the socioeconomic determinants of health and epilepsy outcomes.</p><p>The trend of increasing mortality due to epilepsy that has seen may have been caused by many variables. Over time, more precise identification and reporting of deaths associated with Epilepsy is probably going to be facilitated by advancements in awareness, diagnostic methods, and reporting systems.[<xref ref-type="bibr" rid="ref16"> <a href='#ref16'>16</a> </xref>] In addition, as the population ages, there may be a rise in the prevalence of epilepsy and related comorbidities, which would raise the death rate for the elderly.[<xref ref-type="bibr" rid="ref22"> <a href='#ref22'>22</a> </xref>-,<xref ref-type="bibr" rid="ref24"> <a href='#ref24'>24</a> </xref>] Inequalities in access to health care, especially in underprivileged or rural regions, may potentially be a factor in increased death rates as people with epilepsy may find it difficult to get timely and effective medical care. Socioeconomic variables that affect access to care and health-seeking behaviors, such as homelessness, poverty, lack of sleep,[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] and poor education,[<xref ref-type="bibr" rid="ref12"> <a href='#ref12'>12</a> </xref>] may further inequities in epilepsy outcomes. Furthermore, comorbidities such as mental health problems, endocrine/metabolic disorders, and cardiovascular disease are frequently linked to epilepsy and can raise the risk of death.[<xref ref-type="bibr" rid="ref9"> <a href='#ref9'>9</a> </xref>,<xref ref-type="bibr" rid="ref27"> <a href='#ref27'>27</a> </xref>]</p><p>Although these findings shed light on variations in epilepsy-related mortality, it is crucial to acknowledge the several limitations of the research. Since the CDC mortality data used in this research were aggregated, there is a possibility that some epilepsy-related fatalities were misreported, incorrectly categorized, or reported unfairly. Moreover, the research disregarded factors at the individual level, such as medication adherence and lifestyle decisions, that may have an impact on how epilepsy develops. Moreover, neither the efficacy of therapies in lowering mortality rates nor the underlying causes of fatalities due to epilepsy were investigated in this study. To overcome these constraints and get a deeper understanding of the intricate factors influencing mortality due to epilepsy, future research should carry out longitudinal studies and incorporate individual-level data.</p><p>Subsequent investigations have to concentrate on mitigating these constraints and investigating the elements impacting death patterns associated with epilepsy. To evaluate changes in death rates over time and pinpoint risk variables that may be changed, longitudinal research is required. Further research is necessary to determine how differences in health-care access affect the management of epilepsy and death rates, especially in marginalized communities. Therefore, it is important to look into the effectiveness of treatments intended to improve epilepsy care and reduce death rates. With a greater knowledge of the evolving picture of epilepsy-related mortality, policymakers, health-care professionals, and researchers may collaborate to devise targeted interventions to reduce the burden of epilepsy on affected individuals and communities.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="CONCLUSION">CONCLUSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>This study provides valuable insights into epilepsy-related mortality trends in the U.S., highlighting the significant increase in mortality rates across different demographic groups and geographic regions. Addressing the underlying factors contributing to these trends requires a multifaceted approach that includes improving access to health care, addressing socioeconomic disparities, and enhancing epilepsy management strategies. By addressing these challenges, we can work toward reducing the burden of epilepsy and improving outcomes for affected individuals, ultimately enhancing public health and well-being.</p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Ethical approval">Ethical approval</a></h3><div class="clearfix"></div><div class="hline"></div><p>Institutional Review Board approval is not required.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Declaration of patient consent">Declaration of patient consent</a></h3><div class="clearfix"></div><div class="hline"></div><p>Patient’s consent is not required as there are no patients in this study.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Financial support and sponsorship">Financial support and sponsorship</a></h3><div class="clearfix"></div><div class="hline"></div><p>Nil.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Conflicts of interest">Conflicts of interest</a></h3><div class="clearfix"></div><div class="hline"></div><p>There are no conflicts of interest.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Use of artificial intelligence (AI)-assisted technology for manuscript preparation">Use of artificial intelligence (AI)-assisted technology for manuscript preparation</a></h3><div class="clearfix"></div><div class="hline"></div><p>The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Supplementary data available on: ">Supplementary data available on: </a></h3><div class="clearfix"></div><div class="hline"></div><p><ext-link ext-link-type="uri" xlink:href="https://dx.doi.org/10.25259/SNI_592_2024">https://dx.doi.org/10.25259/SNI_592_2024</ext-link></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Disclaimer">Disclaimer</a></h3><div class="clearfix"></div><div class="hline"></div><p>The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.</p></div> </div></div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"></div> </div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a name="References" href="javascript:void(0);">References</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><a href='javascript:void(0);' name='ref1' style='text-decoration: none;'>1.</a> Abe K, Taira T. Focused ultrasound treatment, present and future. Neurol Med Chir (Tokyo). 2017. 57: 386-91</p><p><a href='javascript:void(0);' name='ref2' style='text-decoration: none;'>2.</a> Alanis-Guevara IA, Peña E, Corona T, López-Ayala T, LópezMeza E, López-Gómez M. 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Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature

Fri, 06 Dec 2024 21:39:28 -0000

Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature Category: Article Type: Syed Faisal Nadeem1, Anum Gujrati2, Fatima Mubarak3, Ahsan Ali Khan1, Syed Ather Enam1Department of Surgery, Section of Neurosurgery, Aga Khan University, Karachi, PakistanDepartment of Surgery, Aga Khan University, Karachi, PakistanDepartment of … Continue reading Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature →

<div><!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" "http://www.w3.org/TR/REC-html40/loose.dtd"> <html><head><meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body><div class="row"><div class="col-lg-9 col-sm-8 col-xs-12"><div class="media-body details-body"> <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13268"><h2 class="media-heading"><h2 class="media-heading">Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature</h2></h2></a> </div><div class="disp_categories"> <p><label>Category: </label><span></span></p> <p><label>Article Type: </label><span></span></p> </div><a href="mailto:syedfaisal.nadeem@aku.edu" target="_top">Syed Faisal Nadeem</a><sup>1</sup>, <a href="mailto:anum.shiraz@aku.edu" target="_top">Anum Gujrati</a><sup>2</sup>, <a href="mailto:fatima.mubarak@aku.edu" target="_top">Fatima Mubarak</a><sup>3</sup>, <a href="mailto:ahsanali.khan@aku.edu" target="_top">Ahsan Ali Khan</a><sup>1</sup>, <a href="mailto:ather.enam@aku.edu" target="_top">Syed Ather Enam</a><sup>1</sup><ol class="smalllist"><li>Department of Surgery, Section of Neurosurgery, Aga Khan University, Karachi, Pakistan</li><li>Department of Surgery, Aga Khan University, Karachi, Pakistan</li><li>Department of Radiology, Aga Khan University, Karachi, Pakistan</li></ol><p><strong>Correspondence Address:</strong><br>Ahsan Ali Khan, Department of Surgery, Section of Neurosurgery, Aga Khan University, Karachi, Pakistan.<br></p><p><strong>DOI:</strong>10.25259/SNI_192_2024</p>Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.<div class="parablock"><p><strong>How to cite this article: </strong>Syed Faisal Nadeem1, Anum Gujrati2, Fatima Mubarak3, Ahsan Ali Khan1, Syed Ather Enam1. Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature. 06-Dec-2024;15:453</p></div><div class="parablock"><p><strong>How to cite this URL: </strong>Syed Faisal Nadeem1, Anum Gujrati2, Fatima Mubarak3, Ahsan Ali Khan1, Syed Ather Enam1. Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature. 06-Dec-2024;15:453. Available from: <a href="https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13268">https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13268</a></p></div> </div> <div class="col-lg-3 col-sm-4 col-xs-12"><div class="article-detail-sidebar"><div class="icon sidebar-icon clearfix add-readinglist-icon"><button id="bookmark-article" class="add-reading-list-article">Add to Reading List</button><button id="bookmark-remove-article" class="remove-reading-list-article">Remove from Reading List</button></div><div class="icon sidebar-icon clearfix"><a class="btn btn-link" target="_blank" type="button" id="OpenPdf" href="https://surgicalneurologyint.com/wp-content/uploads/2024/12/13268/SNI-15-453.pdf"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/pdf-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a target="_blank" href="javascript:void(0);" onclick="return PrintArticle();"><img decoding="async" src="https://i0.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/file-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a><a class="btn btn-link" type="button" id="EmaiLPDF"><img decoding="async" src="https://i1.wp.com/surgicalneurologyint.com/wp-content/themes/surgicalint/images/mail-icon.png?w=604&ssl=1" class="no-popup" data-recalc-dims="1"></a></div><div class="date"> <p>Date of Submission<br><span class="darkgray">16-Mar-2024</span></p> <p>Date of Acceptance<br><span class="darkgray">13-Nov-2024</span></p> <p>Date of Web Publication<br><span class="darkgray">06-Dec-2024</span></p> </div> </div></div> </div> <div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a href="javascript:void(0);" name="Abstract">Abstract</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><strong>Background: </strong>Intracranial arteriovenous malformations (AVMs) are extremely rare in the pediatric population, with an estimated prevalence of 0.014–0.028%. About 75–80% of pediatric AVMs present with intracranial hemorrhage, a source of significant morbidity and mortality. Awake craniotomy (AC) has become the standard approach for resecting eloquent area intracranial lesions in the adult population. Its use, however remains limited in the pediatric population and has very rarely been reported for an AVM of the motor cortex in this age group.</p><p><strong>Case Description: </strong>We report the case of a 17-year-old, right-handed boy who presented to our setup with a 2-month history of left-sided hemiparesis and left facial hypoesthesia following an episode of acute loss of consciousness (ALOC) while playing football. A computed tomography scan done after ALOC revealed an AVM in the right frontoparietal cortex with associated acute hemorrhage. Digital subtraction angiography (DSA) was done which revealed a right-sided grade II AVM with arterial supply from the right middle cerebral artery and venous drainage into the superior sagittal and cavernous sinuses. The patient underwent elective neuronavigation-guided right frontoparietal AC and resection of AVM. Postoperative DSA revealed no residual disease. The patient’s neurologic deficits showed improvement in the first few days following surgery. He was discharged with advice to follow up in a neurosurgery clinic to monitor his postoperative recovery and ensure compliance with physiotherapy.</p><p><strong>Conclusion: </strong>This case represents only the second pediatric patient in the available medical literature to have ever undergone AC for intracranial AVM resection. Pediatric AVMs are a rare entity and pose the risk of significant morbidity and mortality. Awake surgery has the potential to reduce iatrogenic neurological deficits in the pediatric population significantly. More work must be done to increase pediatric patient compliance with awake surgery.</p><p><strong>Keywords: </strong>Arteriovenous malformation, Awake craniotomy, Pediatric arteriovenous malformation (AVM)</p><p></p></div> </div></body></html> </div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"><p></p><p><inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="SNI-15-453-inline001.tif"/></p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="INTRODUCTION">INTRODUCTION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Intracranial arteriovenous malformations (AVMs) are extremely rare in the pediatric population, with an estimated prevalence of 0.014–0.028%.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] They do, however, carry the potential to cause excessive morbidity and mortality.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] Approximately 75–80% of pediatric AVMs present with intracranial hemorrhage, a figure much higher than the 50–65% frequency of adult AVMs presenting with hemorrhage.[<xref ref-type="bibr" rid="ref5"> <a href='#ref5'>5</a> </xref>]</p><p>Awake craniotomy (AC) is a surgical technique wherein the patient being operated on remains awake during the procedure to allow his/her neurologic function to be monitored.[<xref ref-type="bibr" rid="ref9"> <a href='#ref9'>9</a> </xref>] It is utilized in cases where lesions lie in or near eloquent brain regions.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] In addition to reducing the risk of iatrogenic neurologic injury, AC helps avoid the physiologic disturbances and postoperative nausea and vomiting often associated with general anesthesia (GA).[<xref ref-type="bibr" rid="ref9"> <a href='#ref9'>9</a> </xref>] Despite being accepted as a standard of care in adult patients, AC is still seldom utilized in the pediatric population.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] In this article, we review the case of a pediatric patient with a right motor cortex AVM who underwent awake resection. According to the available medical literature, this is only the second pediatric patient in history to have undergone AC for intracranial AVM resection.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>]</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="CASE DESCRIPTION">CASE DESCRIPTION</a></h3><div class="clearfix"></div><div class="hline"></div><p>A 17-year-old right-handed boy with no prior known comorbidities presented to the emergency room with complaints of left-sided hemiparesis and left facial hypoesthesia following an episode of acute loss of consciousness (ALOC) while playing football. A computed tomography (CT) scan head without contrast and a CT angiogram were done, which revealed an AVM in the right frontoparietal cortex with associated acute hemorrhage. The patient was conservatively managed with blood pressure control and neuromonitoring. He was subsequently discharged with advice to initiate physiotherapy and follow-up in the neurosurgery clinic for digital subtraction angiography (DSA) and possible planned elective AVM resection after the acute hemorrhage resolved. A decision was made to delay the DSA until the time of surgery to allow preoperative embolization to be done alongside it.</p><p>A month after the ALOC, elective DSA was performed, which revealed a right-sided grade II AVM with arterial supply from the right middle cerebral artery (MCA) and venous drainage into the superior sagittal and cavernous sinuses [<xref ref-type="fig" rid="F1"> <a href='#F1'>Figure 1</a> </xref>]. The patient was thereby planned for interval AVM resection, and it was decided not to perform preoperative AVM embolization as this could result in an MCA branch infarct. After 6 weeks of his intracranial hemorrhage, the patient underwent neuronavigation guided right frontoparietal AC and resection of AVM. Intraoperatively, the AVM was anatomically found at the right inferior frontal gyrus and was surrounded by gliotic tissue. Postoperatively, after ensuring hemodynamic stability, the patient was shifted to the special care unit for neuro-observation. Repeat DSA was performed postoperatively, which revealed no residual disease [<xref ref-type="fig" rid="F2"> <a href='#F2'>Figure 2</a> </xref>]. The patient experienced no significant complications in the post-operative period other than nausea, for which anti-emetic medications were optimized, and mild wound dehiscence, for which the defect had to be secured with a stitch.</p><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F1'></a> <br /><img src='https://i1.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13268/SNI-15-453-g001.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 1:</h3><p>Preoperative imaging of the right frontal arteriovenous malformation. (a) Magnetic resonance imaging (MRI) T2-weighted Coronal view, (b) MRI T1-weighted with contrast, Coronal view, (c) MRI T1-weighted with contrast, axial view, and (d and e) digital subtraction angiography shows the nidus supplied by the right middle cerebral artery and with early draining into the superior sagittal sinus in the arterial phase.</p></div> </div> </div> </div><div class="clearfix"> </div><div class="row"> <div class="col-xs-12 content-figure col-wrap"> <div class="col-xs-2 figure-body col"><a href='javascript:void(0);' name='F2'></a> <br /><img src='https://i2.wp.com/surgicalneurologyint.com/wp-content/uploads/2024/12/13268/SNI-15-453-g002.png?w=604&ssl=1' data-recalc-dims="1" /></div><div class="col-xs-10 col"> <div class="figure-content"><h3>Figure 2:</h3><p>(a and b) Postoperative digital subtraction angiography showing absence of nidus or early draining vein in early capillary/ late arterial phase.</p></div> </div> </div> </div><div class="clearfix"> </div><p>Neurorehabilitative measures were instituted early on for the patient. His left-sided hemiparesis showed significant improvement in the first few days following surgery, from a Medical Research Council (MRC) muscle strength score of 3/5 in the left upper and lower limbs preoperatively to a score of 4/5 postoperatively. He was thus discharged with advice to follow up in a neurosurgery clinic to monitor his recovery and ensure compliance with physiotherapy. The patient’s motor powers continued to improve on regular clinic follow-ups. He exhibited powers of MRC muscle strength score 4+/5 in his left upper and lower limbs in his latest clinic follow-up, allowing him to walk with minimal assistance.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="DISCUSSION">DISCUSSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Although they are, in essence, congenital lesions,[<xref ref-type="bibr" rid="ref3"> <a href='#ref3'>3</a> </xref>] intracranial AVMs are mostly diagnosed in the adult population.[<xref ref-type="bibr" rid="ref4"> <a href='#ref4'>4</a> </xref>] The potential for hemorrhage, however, is significantly greater in the pediatric population, which, when combined with the longer life expectancy of children, adds to the morbidity and mortality posed by AVMs in this age group.[<xref ref-type="bibr" rid="ref5"> <a href='#ref5'>5</a> </xref>]</p><p>The accepted goal of treatment of intracranial AVMs is the complete removal of both the nidus and all of its arteriovenous shunts to eliminate all pathologic angiogenic capacity at the lesion site.[<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>] There are currently three treatment modalities that can be employed to achieve this purpose: microsurgical resection, stereotactic radiosurgery, and endovascular embolization.[<xref ref-type="bibr" rid="ref6"> <a href='#ref6'>6</a> </xref>] Microsurgical resection has been the longest used of the three modalities in the treatment of intracranial AVMs. It remains the first-line therapy due to it possessing the greatest potential to provide a complete cure. However, it does come with the associated risk of causing iatrogenic neurological injury to surrounding brain tissue.[<xref ref-type="bibr" rid="ref7"> <a href='#ref7'>7</a> </xref>] Stereotactic radiosurgery offers a non-invasive method of treating brain AVMs; however, its response is rather delayed as the aberrant vasculature takes time to sclerose and involute after radiation to the affected area is applied, and so the risk of hemorrhage remains significant till the AVM persists.[<xref ref-type="bibr" rid="ref8"> <a href='#ref8'>8</a> </xref>] Endovascular embolization is mostly employed as an adjunct to surgery and radiation therapy to reduce nidus size before definitive treatment.[<xref ref-type="bibr" rid="ref7"> <a href='#ref7'>7</a> </xref>] The chances of achieving complete lesion obliteration are significantly lower with angio-embolization and so it remains mostly an ancillary modality of treatment than the one of choice.[<xref ref-type="bibr" rid="ref10"> <a href='#ref10'>10</a> </xref>]</p><p>AC has become the standard of care for adult patients with eloquent brain lesions in need of resection;[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] however, it has thus far very rarely been practiced in the pediatric population – in one recent extensive systematic review, a total of 142 pediatric patients could be identified to have undergone AC to date.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] The indications for AC were as follows: tumor resection (<i>n</i> = 110, 77.46%), seizure/epilepsy (<i>n</i> = 23, 16.20%), insertion of deep brain stimulation electrodes (<i>n</i> = 8, 5.63%), and AVM resection (<i>n</i> = 1, 0.70%).[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>] In this review, the youngest age at the time of surgery was identified as 7, while the mean age of the study population was 12.23 years.[<xref ref-type="bibr" rid="ref1"> <a href='#ref1'>1</a> </xref>]</p><p>The main limiting factor in the application of AC in the pediatric population is the cognitive immaturity of children and the resulting exaggerated stress and anxiety they experience in the operating room setting.[<xref ref-type="bibr" rid="ref12"> <a href='#ref12'>12</a> </xref>] The need for conversion from local to GA in the pediatric population, however, does not seem too immense, as reported by a systematic review of pediatric ACs by Bhanja <i>et al</i>., who found only four of the 98 cases (4.08%) of pediatric ACs they included in their review ended in conversion to GA with subjective pain, agitation, and discomfort being the main reasons for doing so.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] Of these four patients, one had to undergo conversion to GA due to a residual tumor in a non-eloquent area that needed GA for optimal resection.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] Of note, however, is that in the same review, it was found that 19 of 92 pediatric patients (20.65%) found it difficult to perform all monitoring tasks.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] Nineteen of 98 patients (19.39%) were reported to have developed postoperative complications, including aphasia (<i>n</i> = 4, 4.08%), hemiparesis (<i>n</i> = 2, 2.04%), sensory deficit (<i>n</i> = 3, 3.06%), motor deficit (<i>n</i> = 4, 4.08%), or others (<i>n</i> = 6, 6.12%).[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] Only three of these 98 patients (3.06%), however, continued to experience long-lasting post-operative complications: [<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] For one of them, the complication was not strictly neurologic but rather psychologic, as they suffered from major anxiety disorder after surgery.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>] The rest of the 16 patients saw their complications resolve during the immediate postoperative period and subsequent follow-up.[<xref ref-type="bibr" rid="ref2"> <a href='#ref2'>2</a> </xref>]</p><p>Psychological issues have been studied and reported as major complications following ACs in both adult and pediatric patients.[<xref ref-type="bibr" rid="ref13"> <a href='#ref13'>13</a> </xref>] To reduce peri- and intraoperative anxiety and improve patient compliance, Labuschagne <i>et al</i>., report using simulated theater experiences to introduce pediatric patients to the surgical experience, explore their limitations to complying with the monitoring protocols, and tailor the experience to suit their individual needs.[<xref ref-type="bibr" rid="ref11"> <a href='#ref11'>11</a> </xref>]</p><p>To combat intraoperative anxiety and resulting non-compliance in our case, we ensured the team member responsible for intraoperative neuromonitoring established a good rapport with the patient before the procedure and continuously kept speaking to the patient on topics of his interest during the procedure while monitoring for any deficits. Doing so ensured the patient remained at ease and was willing to follow the neuromonitoring protocol throughout his surgery. Our patient was, however, at the older end of the pediatric age spectrum, so the strategy we employed to make the AC experience more comfortable for him may not be equally applicable to younger patients who, despite having a member of the surgical team by their side to keep them calm during the procedure, might still find the operating room environment too stressful and discomforting to be able to comply to all the requirements and demands of intraoperative neuromonitoring. It is thus warranted to invest in efforts to preoperatively condition pediatric patients scheduled to undergo ACs to the operating room environment and, in the process, perhaps even modify the environment to ensure better intraoperative comfort for and conformity from the patient. More nuanced and subjective strategies, tailored to individual patients’ requirements, might be of benefit in this regard.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="CONCLUSION">CONCLUSION</a></h3><div class="clearfix"></div><div class="hline"></div><p>Intracranial AVM is a rare pediatric pathology that bears massive potential for morbidity and mortality. Surgical resection remains, to date, the gold standard to achieve complete resection of the lesions. AC is gradually becoming the standard for eloquent brain lesion resection. In contrast to its common use in adult patients, AC remains seldom utilized in the pediatric population, with intraoperative stress and anxiety being significant limiting factors to compliance with AC in children. More work needs to be done to explore ways to make the AC experience less stressful and more bearable for pediatric patients.</p><p></p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Ethical approval">Ethical approval</a></h3><div class="clearfix"></div><div class="hline"></div><p>The Institutional Review Board approval is not required.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Declaration of patient consent">Declaration of patient consent</a></h3><div class="clearfix"></div><div class="hline"></div><p>The authors certify that they have obtained all appropriate patient consent.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Financial support and sponsorship">Financial support and sponsorship</a></h3><div class="clearfix"></div><div class="hline"></div><p>Nil.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Conflicts of interest">Conflicts of interest</a></h3><div class="clearfix"></div><div class="hline"></div><p>There are no conflicts of interest.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Use of artificial intelligence (AI)-assisted technology for manuscript preparation">Use of artificial intelligence (AI)-assisted technology for manuscript preparation</a></h3><div class="clearfix"></div><div class="hline"></div><p>The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.</p><h3 class="blogheading Main-Title"><a href="javascript:void(0);" name="Disclaimer">Disclaimer</a></h3><div class="clearfix"></div><div class="hline"></div><p>The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.</p></div> </div></div><div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"></div> </div><div class="row"> <div class="blogparagraph col-lg-9 col-sm-8 col-xs-12"> <h3 class="blogheading pull-left Main-Title"><a name="References" href="javascript:void(0);">References</a></h3> <div class="clearfix"></div> <div class="hline"></div> <p><a href='javascript:void(0);' name='ref1' style='text-decoration: none;'>1.</a> Al Fudhaili AN, Al-Busaidi F, Madan ZM, Al Issa MS, Al Mamria MH, Al-Saadi T. Awake craniotomy surgery in pediatrics: A systematic review. World Neurosurg. 2023. 179: 82-7</p><p><a href='javascript:void(0);' name='ref2' style='text-decoration: none;'>2.</a> Bhanja D, Sciscent BY, Daggubati LC, Ryan CA, Pahapill NK, Hazard SW. Awake craniotomies in the pediatric population: A systematic review. J Neurosurg Pediatr. 2023. 32: 428-36</p><p><a href='javascript:void(0);' name='ref3' style='text-decoration: none;'>3.</a> Blamek S, Larysz D, Miszczyk L. Stereotactic linac radiosurgery and hypofractionated stereotactic radiotherapy for pediatric arteriovenous malformations of the brain: Experiences of a single institution. Childs Nerv Syst. 2013. 29: 651-6</p><p><a href='javascript:void(0);' name='ref4' style='text-decoration: none;'>4.</a> Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP. Management of brain arteriovenous malformations: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017. 48: e200-24</p><p><a href='javascript:void(0);' name='ref5' style='text-decoration: none;'>5.</a> Di Rocco C, Tamburrini G, Rollo M. Cerebral arteriovenous malformations in children. Acta Neurochir (Wien). 2000. 142: 145-56 discussion 156-8</p><p><a href='javascript:void(0);' name='ref6' style='text-decoration: none;'>6.</a> Garza-Mercado R, Cavazos E, Tamez-Montes D. Cerebral arteriovenous malformations in children and adolescents. Surg Neurol. 1987. 27: 131-40</p><p><a href='javascript:void(0);' name='ref7' style='text-decoration: none;'>7.</a> Hofmeister C, Stapf C, Hartmann A, Sciacca RR, Mansmann U, terBrugge K. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000. 31: 1307-10</p><p><a href='javascript:void(0);' name='ref8' style='text-decoration: none;'>8.</a> Kano H, Kondziolka D, Flickinger JC, Park KJ, Iyer A, Yang HC. Stereotactic radiosurgery for arteriovenous malformations after embolization: A case-control study. J Neurosurg. 2012. 117: 265-75</p><p><a href='javascript:void(0);' name='ref9' style='text-decoration: none;'>9.</a> Kim SH, Choi SH. Anesthetic considerations for awake craniotomy. Anesth Pain Med (Seoul). 2020. 15: 269-74</p><p><a href='javascript:void(0);' name='ref10' style='text-decoration: none;'>10.</a> Kondziolka D, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM. Arteriovenous malformations of the brain in children: A forty year experience. Can J Neurol Sci. 1992. 19: 40-5</p><p><a href='javascript:void(0);' name='ref11' style='text-decoration: none;'>11.</a> Labuschagne J, Lee CA, Mutyaba D, Mbanje T, Sibanda C. Awake craniotomy in a child: Assessment of eligibility with a simulated theatre experience. Case Rep Anesthesiol. 2020. 2020: 6902075</p><p><a href='javascript:void(0);' name='ref12' style='text-decoration: none;'>12.</a> Mofatteh M, Mashayekhi MS, Arfaie S, Chen Y, Hendi K, Kwan AT. Stress, anxiety, and depression associated with awake craniotomy: A systematic review. Neurosurgery. 2023. 92: 225-40</p><p><a href='javascript:void(0);' name='ref13' style='text-decoration: none;'>13.</a> O’Leary KD, Philippopoulos AJ, Koslofsky A, Ahmed Y. How often do awake craniotomies in children and adolescents lead to panic and worry?. Childs Nerv Syst. 2024. 40: 359-70</p></div> </div></div>
Case 37-2024: A 41-Year-Old Man with Seizures and Agitation

Thu, 28 Nov 2024 00:00:00 -0000

A 41-year-old man with epilepsy presented with increased seizure activity. In the hospital, the patient struck a staff member and said, “I thought they were trying to kill me.” A diagnosis was made.
Vagal Nerve Stimulation in the Pediatric Population and Correlation between Family and Treatment Team Perspectives: Single-Center Experience

Tue, 26 Nov 2024 04:53:52 -0000

Background Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacologic treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving the quality-of-life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team. Methods This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed 1 year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92 years; 11 (52.4%) patients were females. Family and physician assessments were collected blinded to each other using the Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes. Results In this study, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (p < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (p < 0.001), while the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (p < 0.001). The number of antiepileptic medications taken decreased from a median of four to three (p < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an increase in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with “concentration” exhibiting a significant positive correlation (r = 0.498, p = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (r = − 0.062, p = 0.791), indicating a divergence of views. Conclusion VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.

<p align="right">J Neurol Surg A Cent Eur Neurosurg<br/>DOI: 10.1055/a-2344-8309</p><p> Background Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacologic treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving the quality-of-life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team. Methods This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed 1 year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92 years; 11 (52.4%) patients were females. Family and physician assessments were collected blinded to each other using the Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes. Results In this study, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (p < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (p < 0.001), while the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (p < 0.001). The number of antiepileptic medications taken decreased from a median of four to three (p < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an increase in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with “concentration” exhibiting a significant positive correlation (r = 0.498, p = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (r = − 0.062, p = 0.791), indicating a divergence of views. Conclusion VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.<br/><a href="/DOI/DOI?10.1055/a-2344-8309">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2344-8309">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2344-8309">Full text</a></p>
Sensory–Motor Polyneuropathy in an 11-year- old Girl with a Pathogenic Variant in SMC1A: A Case Report

Thu, 14 Nov 2024 10:37:32 -0000

Pathogenic variants in the SMC1A gene are often dominant-negative and cause an X-linked form of Cornelia de Lange syndrome (CdLS) with growth retardation and typical facial features. However, rare SMC1A variants cause a developmental and epileptic encephalopathy (DEE) with intractable early-onset epilepsy that is absent in CdLS. Here we describe an 11-year-old girl with epilepsy, walking disorder, and neurodevelopmental disorder. A neurophysiological examination of nerve conduction velocity showed a mixed, sensory–motor, chronic 4-limb polyneuropathy. Whole-exome sequencing identified the variant c.3145C > T p.(Arg1049*) in SMC1A (NM_006306.3), which can be classified as pathogenic. To the best of our knowledge, among 79 individuals with SMC1A-related DEE reported in the literature, altered peripheral nerve conduction has never been described. In this article, we propose that severe sensory–motor polyneuropathy could be an expansion of the SMC1A-related phenotype.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/a-2447-1508</p><p>Pathogenic variants in the SMC1A gene are often dominant-negative and cause an X-linked form of Cornelia de Lange syndrome (CdLS) with growth retardation and typical facial features. However, rare SMC1A variants cause a developmental and epileptic encephalopathy (DEE) with intractable early-onset epilepsy that is absent in CdLS. Here we describe an 11-year-old girl with epilepsy, walking disorder, and neurodevelopmental disorder. A neurophysiological examination of nerve conduction velocity showed a mixed, sensory–motor, chronic 4-limb polyneuropathy. Whole-exome sequencing identified the variant c.3145C > T p.(Arg1049*) in SMC1A (NM_006306.3), which can be classified as pathogenic. To the best of our knowledge, among 79 individuals with SMC1A-related DEE reported in the literature, altered peripheral nerve conduction has never been described. In this article, we propose that severe sensory–motor polyneuropathy could be an expansion of the SMC1A-related phenotype.<br/><a href="/DOI/DOI?10.1055/a-2447-1508">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2447-1508">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2447-1508">Full text</a></p>
Progressive Myoclonus Epilepsy and Beyond: A Systematic Review of SEMA6B-related Disorders

Mon, 04 Nov 2024 07:30:51 -0000

Progressive myoclonus epilepsy (PME) is a rare, clinically and genetically heterogeneous epilepsy syndrome, and pathogenic variants in the semaphorin 6B (SEMA6B) gene have recently been reported to be among the causes of PME. Cases with pathogenic variants in the SEMA6B gene are extremely rare, only a limited number of cases have been reported in the literature. In this systematic review, we aimed to present a summary of a PME case in which a heterozygous nonsense variant of c.2086C > T p.(Gln696*) in the SEMA6B gene was detected in the etiology and other cases with SEMA6B pathogenic variant in the literature. Except for our case, 35 cases from 12 studies were included. The main clinical findings in these patients were cognitive problems, seizures, gait and speech disturbances, and cognitive and/or motor regression, and they had a wide spectrum of severity. Response to antiseizure medications was also highly variable, almost half of the patients had pharmacoresistant seizures. Patients were divided into four different phenotypic groups according to their clinical presentations: PME (18/36), developmental and epileptic encephalopathy (13/36), neurodevelopmental disorder (4/36), and epilepsy (1/36), respectively. In conclusion, although SEMA6B has been associated with PME, it may actually cause a much broader phenotypic spectrum. Due to their extreme rarity, our knowledge of SEMA6B-related disorders is limited. As with all other rare diseases, each new SEMA6B-related disorder case could contribute to a better understanding of the disease. A better understanding of the disease may allow the development of specific treatment options in the future.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/a-2442-5741</p><p>Progressive myoclonus epilepsy (PME) is a rare, clinically and genetically heterogeneous epilepsy syndrome, and pathogenic variants in the semaphorin 6B (SEMA6B) gene have recently been reported to be among the causes of PME. Cases with pathogenic variants in the SEMA6B gene are extremely rare, only a limited number of cases have been reported in the literature. In this systematic review, we aimed to present a summary of a PME case in which a heterozygous nonsense variant of c.2086C > T p.(Gln696*) in the SEMA6B gene was detected in the etiology and other cases with SEMA6B pathogenic variant in the literature. Except for our case, 35 cases from 12 studies were included. The main clinical findings in these patients were cognitive problems, seizures, gait and speech disturbances, and cognitive and/or motor regression, and they had a wide spectrum of severity. Response to antiseizure medications was also highly variable, almost half of the patients had pharmacoresistant seizures. Patients were divided into four different phenotypic groups according to their clinical presentations: PME (18/36), developmental and epileptic encephalopathy (13/36), neurodevelopmental disorder (4/36), and epilepsy (1/36), respectively. In conclusion, although SEMA6B has been associated with PME, it may actually cause a much broader phenotypic spectrum. Due to their extreme rarity, our knowledge of SEMA6B-related disorders is limited. As with all other rare diseases, each new SEMA6B-related disorder case could contribute to a better understanding of the disease. A better understanding of the disease may allow the development of specific treatment options in the future.<br/><a href="/DOI/DOI?10.1055/a-2442-5741">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2442-5741">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2442-5741">Full text</a></p>
Endoscopic Epilepsy Surgery: Systematic Review and Meta-Analysis

Mon, 28 Oct 2024 09:45:53 -0000

Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or > 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43–0.71, I2 = 77.1%, τ2 = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62–82%, I2 = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32–65%, I2 = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups (p = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92–73.06%), with a moderate level of heterogeneity (I 2 = 62.9%, tau2 = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.

<p align="right">Asian J Neurosurg<br/>DOI: 10.1055/s-0044-1791996</p><p>Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or > 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43–0.71, I2 = 77.1%, τ2 = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62–82%, I2 = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32–65%, I2 = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups (p = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92–73.06%), with a moderate level of heterogeneity (I 2 = 62.9%, tau2 = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.<br/><a href="/DOI/DOI?10.1055/s-0044-1791996">[...]</a><br/><br/></p><p>Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00053244">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1791996">Abstract</a> | <span style="font-weight: bold; color: #ff0000;">open access</span> <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1791996">Full text</a></p>
Precision Medicine in Angelman Syndrome

Sat, 28 Sep 2024 08:43:27 -0000

Angelman syndrome (AS) is a rare neurogenetic disorder caused by a loss of function of UBE3A on the maternal allele. Clinical features include severe neurodevelopmental delay, epilepsy, sleep disturbances, and behavioral disorders. Therapy currently evolves from conventional symptomatic, supportive, and antiseizure treatments toward alteration of mRNA expression, which is subject of several ongoing clinical trials.This article will provide an overview of clinical research and therapeutic approaches on AS.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/a-2399-0191</p><p>Angelman syndrome (AS) is a rare neurogenetic disorder caused by a loss of function of UBE3A on the maternal allele. Clinical features include severe neurodevelopmental delay, epilepsy, sleep disturbances, and behavioral disorders. Therapy currently evolves from conventional symptomatic, supportive, and antiseizure treatments toward alteration of mRNA expression, which is subject of several ongoing clinical trials.This article will provide an overview of clinical research and therapeutic approaches on AS.<br/><a href="/DOI/DOI?10.1055/a-2399-0191">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2399-0191">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2399-0191">Full text</a></p>
Intraoperative MRI in pediatric epilepsy and neuro-oncology: a systematic review and meta-analysis

Fri, 20 Sep 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery: Pediatrics
Volume: 34
Issue: 6
Pages: 628-641
Epilepsy Surgery: Bridging the Gap with Minimally Invasive Techniques

Mon, 09 Sep 2024 05:15:50 -0000

<p align="right">Neuropediatrics 2024; 55: 277-278<br/>DOI: 10.1055/s-0044-1789235</p><p><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/10.1055/s-014-60235">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1789235">Full text</a></p>
The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study

Wed, 04 Sep 2024 06:42:42 -0000

Introduction Acute altered mental status (AAMS) is often a challenge for clinicians, since the underlying etiologies cannot always easily be inferred based on the patient's clinical presentation, medical history, or early examinations. The aim of this study is to evaluate the role of electroencephalogram (EEG) as a diagnostic tool in AAMS of unknown etiology in children. Materials and Methods We conducted a prospective study involving EEG assessments on children presenting with AAMS between May 2017 and October 2019. Inclusion criteria were age 1 month to 18 years and acute (<1 week) and persistent (>5 minutes) altered mental status. Patients with a known etiology of AAMS were excluded. A literature review was also performed. Results Twenty patients (median age: 7.7 years, range: 0.5–15.4) were enrolled. EEG contributed to the diagnosis in 14/20 cases, and was classified as diagnostic in 9/20 and informative in 5/20. Specifically, EEG was able to identify nonconvulsive status epilepticus (NCSE) in five children and psychogenic events in four. EEG proved to be a poorly informative diagnostic tool at AAMS onset in six children; however, in five of them, it proved useful during follow-up. Conclusions Limited data exist regarding the role of EEG in children with AAMS of unknown etiology. In our population, EEG proved to be valuable tool, and was especially useful in the prompt identification of NCSE and psychogenic events.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/a-2380-6743</p><p> Introduction Acute altered mental status (AAMS) is often a challenge for clinicians, since the underlying etiologies cannot always easily be inferred based on the patient's clinical presentation, medical history, or early examinations. The aim of this study is to evaluate the role of electroencephalogram (EEG) as a diagnostic tool in AAMS of unknown etiology in children. Materials and Methods We conducted a prospective study involving EEG assessments on children presenting with AAMS between May 2017 and October 2019. Inclusion criteria were age 1 month to 18 years and acute (<1 week) and persistent (>5 minutes) altered mental status. Patients with a known etiology of AAMS were excluded. A literature review was also performed. Results Twenty patients (median age: 7.7 years, range: 0.5–15.4) were enrolled. EEG contributed to the diagnosis in 14/20 cases, and was classified as diagnostic in 9/20 and informative in 5/20. Specifically, EEG was able to identify nonconvulsive status epilepticus (NCSE) in five children and psychogenic events in four. EEG proved to be a poorly informative diagnostic tool at AAMS onset in six children; however, in five of them, it proved useful during follow-up. Conclusions Limited data exist regarding the role of EEG in children with AAMS of unknown etiology. In our population, EEG proved to be valuable tool, and was especially useful in the prompt identification of NCSE and psychogenic events.<br/><a href="/DOI/DOI?10.1055/a-2380-6743">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2380-6743">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2380-6743">Full text</a></p>
Characterization of the Epileptogenic Phenotype and Response to Antiseizure Medications in Lissencephaly Patients

Fri, 30 Aug 2024 07:26:39 -0000

Background Patients with lissencephaly typically present with severe psychomotor retardation and drug-resistant seizures. The aim of this study was to characterize the epileptic phenotype in a genotypically and radiologically well-defined patient cohort and to evaluate the response to antiseizure medication (ASM). Therefore, we retrospectively evaluated 47 patients of five genetic forms (LIS1/PAFAH1B1, DCX, DYNC1H1, TUBA1A, TUBG1) using family questionnaires, standardized neuropediatric assessments, and patients' medical reports. Results All but two patients were diagnosed with epilepsy. Median age at seizure onset was 6 months (range: 2.1–42.0), starting with epileptic spasms in 70%. Standard treatment protocols with hormonal therapy (ACTH or corticosteroids) and/or vigabatrin were the most effective approach for epileptic spasms, leading to seizure control in 47%. Seizures later in the disease course were most effectively treated with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, resulting in seizure freedom in 20%. Regarding psychomotor development, lissencephaly patients presenting without epileptic spasms were significantly more likely to reach various developmental milestones compared to patients with spasms. Conclusion Classic lissencephaly is highly associated with drug-resistant epilepsy starting with epileptic spasms in most patients. The standard treatment protocols for infantile epileptic spasms syndrome lead to freedom from seizures in around half of the patients. Due to the association of epileptic spasms with an unfavorable course of psychomotor development, early and reliable diagnosis and treatment of spasms should be pursued. For epilepsies occurring later in childhood, ASM with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, appears to be most effective.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/s-0044-1789014</p><p> Background Patients with lissencephaly typically present with severe psychomotor retardation and drug-resistant seizures. The aim of this study was to characterize the epileptic phenotype in a genotypically and radiologically well-defined patient cohort and to evaluate the response to antiseizure medication (ASM). Therefore, we retrospectively evaluated 47 patients of five genetic forms (LIS1/PAFAH1B1, DCX, DYNC1H1, TUBA1A, TUBG1) using family questionnaires, standardized neuropediatric assessments, and patients' medical reports. Results All but two patients were diagnosed with epilepsy. Median age at seizure onset was 6 months (range: 2.1–42.0), starting with epileptic spasms in 70%. Standard treatment protocols with hormonal therapy (ACTH or corticosteroids) and/or vigabatrin were the most effective approach for epileptic spasms, leading to seizure control in 47%. Seizures later in the disease course were most effectively treated with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, resulting in seizure freedom in 20%. Regarding psychomotor development, lissencephaly patients presenting without epileptic spasms were significantly more likely to reach various developmental milestones compared to patients with spasms. Conclusion Classic lissencephaly is highly associated with drug-resistant epilepsy starting with epileptic spasms in most patients. The standard treatment protocols for infantile epileptic spasms syndrome lead to freedom from seizures in around half of the patients. Due to the association of epileptic spasms with an unfavorable course of psychomotor development, early and reliable diagnosis and treatment of spasms should be pursued. For epilepsies occurring later in childhood, ASM with valproic acid and lamotrigine, followed by vigabatrin and phenobarbital, appears to be most effective.<br/><a href="/DOI/DOI?10.1055/s-0044-1789014">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1789014">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1789014">Full text</a></p>
Evaluation of the Behavioral Effect of Psychostimulants in Children with Autism Spectrum Disorder: A Cross-Sectional Study

Tue, 06 Aug 2024 11:02:20 -0000

Background Autism spectrum disorder (ASD) is often accompanied by comorbid conditions such as attention deficit hyperactivity disorder and epilepsy. In this context, patients are often treated with psychostimulants in an attempt to control behavioral symptoms. This study aims to understand the behavioral effects of psychostimulants in children with ASD and investigate if interictal epileptiform discharges on electroencephalogram (EEG) can act as a modifying factor in this behavior. Methods Sixty-eight patients with ASD who were being accompanied in the Department of Child and Adolescent Psychiatry of the Centro Hospitalar Universitário de São João and had previously done an EEG assessment answered a questionnaire regarding their behavioral response to psychostimulants. Results In total, 47.4% of patients reported improved agitation, 56.1% enhanced concentration, and 8.8% improved sleep. Conversely, 28.1% experienced worsened agitation, 15.8% worsened concentration, and 17.5% worsened sleep. The remaining reported no alterations. The age of diagnosis correlated significantly with improved agitation, with a higher diagnosis age being associated with a higher probability of improvement. Extended-release methylphenidate and genetic variations were significantly associated with worsening of agitation. Regarding speech, 86% exhibited no changes, while 14% showed alterations, mostly, 87.5%, characterized as negative. For other behavioral alterations, 45.6% reported negative changes, 3.5% reported positive changes, and 50.9% reported no additional alterations. Female gender was significantly associated with other negative behavioral changes. A significant correlation was found between treatment duration and the probability of improvement in agitation, concentration, and other behavioral changes.

<p align="right">Neuropediatrics<br/>DOI: 10.1055/s-0044-1788891</p><p> Background Autism spectrum disorder (ASD) is often accompanied by comorbid conditions such as attention deficit hyperactivity disorder and epilepsy. In this context, patients are often treated with psychostimulants in an attempt to control behavioral symptoms. This study aims to understand the behavioral effects of psychostimulants in children with ASD and investigate if interictal epileptiform discharges on electroencephalogram (EEG) can act as a modifying factor in this behavior. Methods Sixty-eight patients with ASD who were being accompanied in the Department of Child and Adolescent Psychiatry of the Centro Hospitalar Universitário de São João and had previously done an EEG assessment answered a questionnaire regarding their behavioral response to psychostimulants. Results In total, 47.4% of patients reported improved agitation, 56.1% enhanced concentration, and 8.8% improved sleep. Conversely, 28.1% experienced worsened agitation, 15.8% worsened concentration, and 17.5% worsened sleep. The remaining reported no alterations. The age of diagnosis correlated significantly with improved agitation, with a higher diagnosis age being associated with a higher probability of improvement. Extended-release methylphenidate and genetic variations were significantly associated with worsening of agitation. Regarding speech, 86% exhibited no changes, while 14% showed alterations, mostly, 87.5%, characterized as negative. For other behavioral alterations, 45.6% reported negative changes, 3.5% reported positive changes, and 50.9% reported no additional alterations. Female gender was significantly associated with other negative behavioral changes. A significant correlation was found between treatment duration and the probability of improvement in agitation, concentration, and other behavioral changes.<br/><a href="/DOI/DOI?10.1055/s-0044-1788891">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1788891">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1788891">Full text</a></p>
Factors influencing disparities in epilepsy surgery: analysis of the National Inpatient Sample and Kids’ Inpatient Database

Fri, 05 Jul 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery
Volume: 141
Issue: 6
Pages: 1536-1545
The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

Wed, 03 Jul 2024 13:59:44 -0000

Background Stereoelectroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of the SINO robot for SEEG electrode implantation is not yet defined. The aim of the current study was to assess the value of the SINO robot in conjunction with Angio Render technology for SEEG electrode implantation and to assess its efficacy. Methods Between June 2018 and October 2020, 58 patients underwent SEEG electrode implantation to resect or ablate their epileptogenic zone (EZ). The SINO robot and the Angio Render technology was used to guide the electrodes and visualize the individual vasculature in a three-dimensional (3D) fashion. The 3D view functionality was used to increase the safety and accuracy of the electrode implantation, and for reducing the risk of hemorrhage by avoiding blood vessels. Results In this study, 634 SEEG electrodes were implanted in 58 patients, with a mean of 10.92 (range: 5–18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39–1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80–2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 minutes (range: 3.02–14.61 minutes). The mean depth of electrodes was 56.96 ± 3.62 mm (range: 27.23–124.85 mm). At a follow-up of at least 1 year, in total, 81.57% (47/58) patients achieved an Engel class I seizure freedom. There were two patients with asymptomatic intracerebral hematomas following SEEG electrode placement, with no late complications or mortality in this cohort. Conclusions The SINO robot in conjunction with Angio Render technology-in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.

<p align="right">J Neurol Surg A Cent Eur Neurosurg<br/>DOI: 10.1055/a-2299-7781</p><p> Background Stereoelectroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of the SINO robot for SEEG electrode implantation is not yet defined. The aim of the current study was to assess the value of the SINO robot in conjunction with Angio Render technology for SEEG electrode implantation and to assess its efficacy. Methods Between June 2018 and October 2020, 58 patients underwent SEEG electrode implantation to resect or ablate their epileptogenic zone (EZ). The SINO robot and the Angio Render technology was used to guide the electrodes and visualize the individual vasculature in a three-dimensional (3D) fashion. The 3D view functionality was used to increase the safety and accuracy of the electrode implantation, and for reducing the risk of hemorrhage by avoiding blood vessels. Results In this study, 634 SEEG electrodes were implanted in 58 patients, with a mean of 10.92 (range: 5–18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39–1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80–2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 minutes (range: 3.02–14.61 minutes). The mean depth of electrodes was 56.96 ± 3.62 mm (range: 27.23–124.85 mm). At a follow-up of at least 1 year, in total, 81.57% (47/58) patients achieved an Engel class I seizure freedom. There were two patients with asymptomatic intracerebral hematomas following SEEG electrode placement, with no late complications or mortality in this cohort. Conclusions The SINO robot in conjunction with Angio Render technology-in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.<br/><a href="/DOI/DOI?10.1055/a-2299-7781">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2299-7781">Abstract</a> | <span style="font-weight: bold; color: #ff0000;">open access</span> <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2299-7781">Full text</a></p>
Characterizing the safety profile of vagus nerve stimulation devices for epilepsy from 21,448 manufacturer and user reports

Fri, 14 Jun 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery
Volume: 141
Issue: 6
Pages: 1505-1519
Combined neuromodulation and resection for functional cortex epilepsy: a case series

Fri, 07 Jun 2024 00:00:00 -0000

Journal Name: Journal of Neurosurgery
Volume: 141
Issue: 6
Pages: 1527-1535
Epilepsy in Association with Giant Skull Base Tumors: A Retrospective Case Series of Giant Skull Base Tumors in the Anterior and Middle Fossa

Fri, 03 May 2024 07:18:09 -0000

Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.

<p align="right">J Neurol Surg B Skull Base<br/>DOI: 10.1055/a-2297-8981</p><p> Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.<br/><a href="/DOI/DOI?10.1055/a-2297-8981">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000181">Table of contents</a> | <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2297-8981">Abstract</a> | <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2297-8981">Full text</a></p>
The clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy

Mon, 06 Nov 2023 07:33:48 -0000

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Management of brain tumour related epilepsy (BTRE): a narrative review and therapy recommendations

Wed, 25 Jan 2023 05:08:18 -0000

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Perisylvian arteriovenous malformation mimicking carotid cavernous fistula operative video

Mon, 15 Feb 2021 15:44:27 -0000

Brain arteriovenous malformations (AVM) commonly present for medical attention after a patient experiences a rupture that results in a focal neurologic deficit, an epileptic event, or is found incidentally on cranial imaging performed for an unrelated reason. In contrast, carotid-cavernous fistulas (CCF) can develop high-flow arteriovenous shunting with symptoms attributable to venous hypertension. We discuss a unique case of a 54-year-old female presenting with signs and symptoms suggestive of a CCF but was found to have a perisylvian AVM with an enlarged draining vein draining into the cavernous sinus. Our case report demonstrates a combined endovascular and open surgical approach to a unique presentation of a brain AVM with the resolution of ocular symptoms.
Ultra-high-field MRI improves detection of epileptic lesions

Thu, 08 Oct 2020 00:00:00 -0000