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Effects of subdural application of lidocaine in patients with focal epilepsy [Case Report]
Madhavan, Deepak; Mirowski, Piotr; Ludvig, Nandor; Carlson, Chad; Doyle, Werner; Devinsky, Orrin; Kuzniecky, Ruben
Antiepileptic drug (AED) delivery directly into the neocortex has recently been shown to be able to both prevent and terminate focal seizures in rats. The present clinical experiment aimed to test the local effects of lidocaine delivered onto the pia mater adjacent to epileptogenic zones in human patients. Administration of lidocaine resulted in a marked diminishment of spike counts on all patients, with a decremental effect of lidocaine on the faster frequency elements of individual spikes and overall testing epochs. The direct cortical application of lidocaine appears to affect local epileptogenic activity in human patients with intractable focal epilepsy
PMID: 18178061
ISSN: 0920-1211
CID: 78353
Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy
Bauman, Joel A; Feoli, Enrique; Romanelli, Pantaleo; Doyle, Werner K; Devinsky, Orrin; Weiner, Howard L
OBJECTIVE: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy. METHODS: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, <19 yr) with refractory localization-related epilepsy and poor surgical prognostic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections. RESULTS: Mean patient age was 9.7 years. Mean duration of total invasive monitoring was 10.5 days (range, 8-14 d). The first monitoring period averaged 6.5 days, and the second averaged 3.9 days. Additional surgery was performed in 13 of 15 patients. Two patients who did not undergo additional surgery had a Class I outcome. Rationales for reinvestigation included incomplete localization, multifocality, and proximity to eloquent cortex. Complications were minimal, including two transfusions. There were no cases of wound infection, cerebral edema, hemorrhage, or major permanent neurological deficit. Minimum duration of follow-up was 31 months. Outcomes were 60% Engel Class I (9 of 15 patients), 27% Class III (4 of 15 patients), and 13% Class IV (2 of 15 patients). CONCLUSION: In a very select group of pediatric patients with poor surgical prognostic factors, the multistage approach can be beneficial. After failed epilepsy surgery, subsequent reoperation with additional intracranial investigation traditionally is used when a single residual focus is suspected. Our results, however, support the contention that multistage epilepsy surgery is safe, effective, and useful in a challenging and select pediatric population with extratemporal medically refractory epilepsy
PMID: 18596454
ISSN: 1524-4040
CID: 86949
Bilateral ischemic optic neuropathy after subdural electrode placement for epilepsy surgery and treatment with erythropoietin [Meeting Abstract]
Widdess-Walsh, P; Turbin, RE; Tutela, AC; Geller, EB; Bennett, HL; Doyle, WK; Devinsky, O
ISI:000252917900355
ISSN: 0013-9580
CID: 87152
Preictal increases in multi-unit firing inpatients with intractable focal epilepsy [Meeting Abstract]
Gopal, AA; Meng, NF; Melinosky, C; Bromfield, E; Cole, AJ; Devinsky, O; Doyle, W; Eskandar, E; Madsen, JR; Ulbert, I; Halgren, E; Cash, SS
ISI:000252917900833
ISSN: 0013-9580
CID: 104243
Effects of the subdural application of lidocaine on EEG spiking in patients with focal epilepsy [Meeting Abstract]
Madhavan, D; Mirowski, PW; Ludvig, N; Carlson, C; Devinsky, O; Doyle, W; Kuzniecky, R
ISI:000252917900829
ISSN: 0013-9580
CID: 104242
Pediatric language mapping: sensitivity of neurostimulation and Wada testing in epilepsy surgery
Schevon, Catherine A; Carlson, Chad; Zaroff, Charles M; Weiner, Howard J; Doyle, Werner K; Miles, Daniel; Lajoie, Josiane; Kuzniecky, Ruben; Pacia, Steven; Vazquez, Blanca; Luciano, Daniel; Najjar, Souhel; Devinsky, Orrin
PURPOSE: Functional mapping of eloquent cortex with electrical neurostimulation is used both intra- and extraoperatively to tailor resections. In pediatric patients, however, functional mapping studies frequently fail to localize language. Wada testing has also been reported to be less sensitive in children. METHODS: Thirty children (4.7 - 14.9 years) and 18 adult controls (18-59 years) who underwent extraoperative language mapping via implanted subdural electrodes at the NYU Comprehensive Epilepsy Center were included in the study. Ten children and 14 adults underwent preoperative Wada testing. Success of the procedures was defined as the identification of at least one language site by neurostimulation mapping and determination of hemispheric language dominance on the Wada test. RESULTS: In children younger than 10.2 years, cortical stimulation identified language cortex at a lower rate than was seen in children older than 10.2 years and in adults (p<0.05). This threshold, demonstrated by survival and chi2 analysis, was sharply defined in our data set. Additionally, Wada testing was more likely to be successful than was extraoperative mapping in this younger age group (p<0.05). CONCLUSIONS: Analysis of our series demonstrates that language cortex is less likely to be identified in children younger than 10 years, suggesting that alternatives to the current methods of cortical electrical stimulation, particularly the use of preoperative language lateralization, may be required in this age group
PMID: 17284300
ISSN: 0013-9580
CID: 71610
Cortical abnormalities in epilepsy revealed by local EEG synchrony
Schevon, C A; Cappell, J; Emerson, R; Isler, J; Grieve, P; Goodman, R; McKhann, G Jr; Weiner, H; Doyle, W; Kuzniecky, R; Devinsky, O; Gilliam, F
Abnormally strong functional linkage between cortical areas has been postulated to play a role in the pathogenesis of partial epilepsy. We explore the possibility that such linkages may be manifest in the interictal EEG apart from epileptiform disturbances or visually evident focal abnormalities. We analyzed samples of interictal intracranial EEG (ICEEG) recorded from subdural grids in nine patients with medically intractable partial epilepsy, measuring interelectrode synchrony using the mean phase coherence algorithm. This analysis revealed areas of elevated local synchrony, or 'hypersynchrony' which had persistent spatiotemporal characteristics that were unique to each patient. Measuring local synchrony in a subdural grid results in a map of the cortical surface that provides information not visually apparent on either EEG or structural imaging. We explore the relationship of hypersynchronous areas to the clinical evidence of seizure localization in each case, and speculate that local hypersynchrony may be a marker of epileptogenic cortex, and may prove to be a valuable aid to clinical ICEEG interpretation
PMCID:1994936
PMID: 17224281
ISSN: 1053-8119
CID: 139498
Morphology and synaptic input of substance P receptor-immunoreactive interneurons in control and epileptic human hippocampus
Toth, K; Wittner, L; Urban, Z; Doyle, W K; Buzsaki, G; Shigemoto, R; Freund, T F; Magloczky, Z
Substance P (SP) is known to be a peptide that facilitates epileptic activity of principal cells in the hippocampus. Paradoxically, in other models, it was found to be protective against seizures by activating substance P receptor (SPR)-expressing interneurons. Thus, these cells appear to play an important role in the generation and regulation of epileptic seizures. The number, distribution, morphological features and input characteristics of SPR-immunoreactive cells were analyzed in surgically removed hippocampi of 28 temporal lobe epileptic patients and eight control hippocampi in order to examine their changes in epileptic tissues. SPR is expressed in a subset of inhibitory cells in the control human hippocampus, they are multipolar interneurons with smooth dendrites, present in all hippocampal subfields. This cell population is considerably different from SPR-positive cells of the rat hippocampus. The CA1 (cornu Ammonis subfield 1) region was chosen for the detailed morphological analysis of the SPR-immunoreactive cells because of its extreme vulnerability in epilepsy. The presence of various neurochemical markers identifies functionally distinct interneuron types, such as those responsible for perisomatic, dendritic or interneuron-selective inhibition. We found considerable colocalization of SPR with calbindin but not with parvalbumin, calretinin, cholecystokinin and somatostatin, therefore we suppose that SPR-positive cells participate mainly in dendritic inhibition. In the non-sclerotic CA1 region they are mainly preserved, whereas their number is decreased in the sclerotic cases. In the epileptic samples their morphology is considerably altered, they possessed more dendritic branches, which often became beaded. Analyses of synaptic coverage revealed that the ratio of symmetric synaptic input of SPR-immunoreactive cells has increased in epileptic samples. Our results suggest that SPR-positive cells are preserved while principal cells are present in the CA1 region, but show reactive changes in epilepsy including intense branching and growth of their dendritic arborization
PMCID:2753206
PMID: 17097238
ISSN: 0306-4522
CID: 149315
Communication between Broca's and Wernicke's areas detected with intracranial electrophysiology in awake humans [Meeting Abstract]
Sahin NT; Pinker S; Cash S; Thesen T; Wang C; Devinsky O; Kuzniecky R; Doyle W; Halgren E
ORIGINAL:0006214
ISSN: 1053-8119
CID: 74452
Epidural pentobarbital delivery can prevent locally induced neocortical seizures in rats: the prospect of transmeningeal pharmacotherapy for intractable focal epilepsy
Ludvig, Nandor; Kuzniecky, Ruben I; Baptiste, Shirn L; John, Jenine E; von Gizycki, Hans; Doyle, Werner K; Devinsky, Orrin
PURPOSE: To determine whether epidural pentobarbital (PB) delivery can prevent and/or terminate neocortical seizures induced by locally administered acetylcholine (Ach) in freely moving rats. METHODS: Rats were implanted permanently with an epidural cup placed over the right parietal cortex with intact dura mater. Epidural screw-electrodes, secured to the cup, recorded local neocortical EEG activity. In the seizure-termination study, Ach was delivered into the epidural cup, and after the development of electrographic and behavioral seizures, the Ach solution was replaced with either PB or artificial cerebrospinal fluid (aCSF; control solution). In the seizure-prevention study, the epidural Ach delivery was preceded by a 10-min exposure of the delivery site to PB or aCSF. Raw EEG recordings, EEG power spectra, and behavioral events were analyzed. RESULTS: Ach-induced EEG seizures associated with convulsions, which were unaffected by epidural aCSF applications, were terminated by epidurally delivered PB within 2-2.5 min. Epidural deliveries of PB before Ach applications completely prevented the development of electrographic and behavioral seizures, whereas similar deliveries of aCSF exerted no influence on the seizure-generating potential of Ach. CONCLUSIONS: This study showed for the first time that epidural AED delivery can prevent, as well as terminate, locally induced neocortical seizures. The findings support the viability of transmeningeal pharmacotherapy for the treatment of intractable neocortical epilepsy
PMID: 17116017
ISSN: 0013-9580
CID: 69701