Literature Monitor

Patients with epilepsy who also have periventricular nodular heterotopia (PVNH) are difficult to manage surgically because the relative influence of the nodular tissue and the overlying cortex on the generation of seizures is variable. A review of the relevant medical literature suggests that inter-ictal spiking from nodules often occurs in patients with PVNH, but it is rare for patients to experience seizures arising from the nodular tissue alone. It is more likely to find that the onset of seizures occurs simultaneously with overlying neocortex or mesial temporal structures.    

Thompson SA, Kalamangalam GP, Tandon N. Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure. 2016;41:211-216.

Patients with epilepsy who also have periventricular nodular heterotopia (PVNH) are difficult to manage surgically because the relative influence of the nodular tissue and the overlying cortex on the generation of seizures is variable. A review of the relevant medical literature suggests that inter-ictal spiking from nodules often occurs in patients with PVNH, but it is rare for patients to experience seizures arising from the nodular tissue alone. It is more likely to find that the onset of seizures occurs simultaneously with overlying neocortex or mesial temporal structures.    

Thompson SA, Kalamangalam GP, Tandon N. Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure. 2016;41:211-216.

Patients with epilepsy who also have periventricular nodular heterotopia (PVNH) are difficult to manage surgically because the relative influence of the nodular tissue and the overlying cortex on the generation of seizures is variable. A review of the relevant medical literature suggests that inter-ictal spiking from nodules often occurs in patients with PVNH, but it is rare for patients to experience seizures arising from the nodular tissue alone. It is more likely to find that the onset of seizures occurs simultaneously with overlying neocortex or mesial temporal structures.    

Thompson SA, Kalamangalam GP, Tandon N. Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure. 2016;41:211-216.

Despite the fact that hormonal contraceptives interact with certain antiepileptic drugs, a recent study has shown that only 35% of 397 female patients with epilepsy were given any clinician counseling about contraceptive choices during their first clinic visit. And these patients were unlikely to receive contraceptive counseling during subsequent visits. The implications of these findings are troubling:  Many antiepileptic agents decrease the efficacy of hormonal contraceptives by inducing hepatic enzymes, and estrogen-containing contraceptives are known to accelerate the metabolism of lamotrigine, an antiepileptic drug commonly prescribed in women of child-bearing age. Espinera et al also found that when women with epilepsy are given advice about the advantages of IUDs, they are far more likely to switch to IUDs, which are highly effective without AED drug interactions.

Espinera AR, Gavvala J, Bellinski I, et al. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav. 2016;65:1-6.

Despite the fact that hormonal contraceptives interact with certain antiepileptic drugs, a recent study has shown that only 35% of 397 female patients with epilepsy were given any clinician counseling about contraceptive choices during their first clinic visit. And these patients were unlikely to receive contraceptive counseling during subsequent visits. The implications of these findings are troubling:  Many antiepileptic agents decrease the efficacy of hormonal contraceptives by inducing hepatic enzymes, and estrogen-containing contraceptives are known to accelerate the metabolism of lamotrigine, an antiepileptic drug commonly prescribed in women of child-bearing age. Espinera et al also found that when women with epilepsy are given advice about the advantages of IUDs, they are far more likely to switch to IUDs, which are highly effective without AED drug interactions.

Espinera AR, Gavvala J, Bellinski I, et al. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav. 2016;65:1-6.

Despite the fact that hormonal contraceptives interact with certain antiepileptic drugs, a recent study has shown that only 35% of 397 female patients with epilepsy were given any clinician counseling about contraceptive choices during their first clinic visit. And these patients were unlikely to receive contraceptive counseling during subsequent visits. The implications of these findings are troubling:  Many antiepileptic agents decrease the efficacy of hormonal contraceptives by inducing hepatic enzymes, and estrogen-containing contraceptives are known to accelerate the metabolism of lamotrigine, an antiepileptic drug commonly prescribed in women of child-bearing age. Espinera et al also found that when women with epilepsy are given advice about the advantages of IUDs, they are far more likely to switch to IUDs, which are highly effective without AED drug interactions.

Espinera AR, Gavvala J, Bellinski I, et al. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav. 2016;65:1-6.

Young adults with epilepsy are at greater risk for neurodevelopmental and behavioral disorders than some other patient populations, according to a recent case-control study that looked at hospital admissions, outpatients, and ED visits for adults with epilepsy, migraine, or leg fracture. The study cohort consisted of 5666 adult epilepsy patients  between 19 and 25 years of age who were seen in hospitals and EDs, 17,507 patients with migraine, and 5966 patients with leg fractures. The researchers found that 51.8% of patients with epilepsy had behavioral health issues versus 37.6% of those with migraine and 21.6% of patients with fractures. Similarly, patients with epilepsy were 297% more likely to have a neurodevelopmental disorder compared with those with migraine.

Wagner JL, Wilson DA, Kellermann T, el al. Behavioral health in young adults with epilepsy: Implications for transition of care. Epilepsy Behav. 2016;65:7-12.

Young adults with epilepsy are at greater risk for neurodevelopmental and behavioral disorders than some other patient populations, according to a recent case-control study that looked at hospital admissions, outpatients, and ED visits for adults with epilepsy, migraine, or leg fracture. The study cohort consisted of 5666 adult epilepsy patients  between 19 and 25 years of age who were seen in hospitals and EDs, 17,507 patients with migraine, and 5966 patients with leg fractures. The researchers found that 51.8% of patients with epilepsy had behavioral health issues versus 37.6% of those with migraine and 21.6% of patients with fractures. Similarly, patients with epilepsy were 297% more likely to have a neurodevelopmental disorder compared with those with migraine.

Wagner JL, Wilson DA, Kellermann T, el al. Behavioral health in young adults with epilepsy: Implications for transition of care. Epilepsy Behav. 2016;65:7-12.

Young adults with epilepsy are at greater risk for neurodevelopmental and behavioral disorders than some other patient populations, according to a recent case-control study that looked at hospital admissions, outpatients, and ED visits for adults with epilepsy, migraine, or leg fracture. The study cohort consisted of 5666 adult epilepsy patients  between 19 and 25 years of age who were seen in hospitals and EDs, 17,507 patients with migraine, and 5966 patients with leg fractures. The researchers found that 51.8% of patients with epilepsy had behavioral health issues versus 37.6% of those with migraine and 21.6% of patients with fractures. Similarly, patients with epilepsy were 297% more likely to have a neurodevelopmental disorder compared with those with migraine.

Wagner JL, Wilson DA, Kellermann T, el al. Behavioral health in young adults with epilepsy: Implications for transition of care. Epilepsy Behav. 2016;65:7-12.

To determine how well pregnant women with epilepsy adhere to their medication regimen, Ernst et al studied their intake of antiepileptic medication by providing them with an iPod Touch loaded with a mobile app specifically designed to track such data. Eighty-six women with epilepsy monitored their seizures and medication use. The study found that 75% of the women had tracked their medication usage for more than 80% of the days they were enrolled in the experiment. Among this subgroup, adherence to the anti-epilepsy drug regimen was 97.7%; 44% said they had missed taking their medication for at least one day. The investigators speculate that the high adherence rate may have been the result of using the mobile app itself.

Ernst L. Harden CL, Pennell PB, et al.  Medication adherence in women with epilepsy who are planning pregnancy. Epilepsia. 2016; 57(12):2039-2044.

To determine how well pregnant women with epilepsy adhere to their medication regimen, Ernst et al studied their intake of antiepileptic medication by providing them with an iPod Touch loaded with a mobile app specifically designed to track such data. Eighty-six women with epilepsy monitored their seizures and medication use. The study found that 75% of the women had tracked their medication usage for more than 80% of the days they were enrolled in the experiment. Among this subgroup, adherence to the anti-epilepsy drug regimen was 97.7%; 44% said they had missed taking their medication for at least one day. The investigators speculate that the high adherence rate may have been the result of using the mobile app itself.

Ernst L. Harden CL, Pennell PB, et al.  Medication adherence in women with epilepsy who are planning pregnancy. Epilepsia. 2016; 57(12):2039-2044.

To determine how well pregnant women with epilepsy adhere to their medication regimen, Ernst et al studied their intake of antiepileptic medication by providing them with an iPod Touch loaded with a mobile app specifically designed to track such data. Eighty-six women with epilepsy monitored their seizures and medication use. The study found that 75% of the women had tracked their medication usage for more than 80% of the days they were enrolled in the experiment. Among this subgroup, adherence to the anti-epilepsy drug regimen was 97.7%; 44% said they had missed taking their medication for at least one day. The investigators speculate that the high adherence rate may have been the result of using the mobile app itself.

Ernst L. Harden CL, Pennell PB, et al.  Medication adherence in women with epilepsy who are planning pregnancy. Epilepsia. 2016; 57(12):2039-2044.

Among patients who have experienced traumatic brain injury, those who have had immediate or late seizures during an acute hospital stay are at increased of developing later posttraumatic seizures. Researchers found that new onset posttraumatic seizures were mostly likely to occur between the time patients were discharged from inpatient rehabilitation and 1 year (9.2%). By year 5, the cumulative incidence of such seizures was 20.5%. A patient’s race, intracranial pathology, and neurosurgical procedures also factored into their relative risk of posttraumatic seizures.

Ritter AC, Wagner AK, Fabio A, et al.  Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Epilepsia. 2016;57(12):1968-1977.

Among patients who have experienced traumatic brain injury, those who have had immediate or late seizures during an acute hospital stay are at increased of developing later posttraumatic seizures. Researchers found that new onset posttraumatic seizures were mostly likely to occur between the time patients were discharged from inpatient rehabilitation and 1 year (9.2%). By year 5, the cumulative incidence of such seizures was 20.5%. A patient’s race, intracranial pathology, and neurosurgical procedures also factored into their relative risk of posttraumatic seizures.

Ritter AC, Wagner AK, Fabio A, et al.  Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Epilepsia. 2016;57(12):1968-1977.

Among patients who have experienced traumatic brain injury, those who have had immediate or late seizures during an acute hospital stay are at increased of developing later posttraumatic seizures. Researchers found that new onset posttraumatic seizures were mostly likely to occur between the time patients were discharged from inpatient rehabilitation and 1 year (9.2%). By year 5, the cumulative incidence of such seizures was 20.5%. A patient’s race, intracranial pathology, and neurosurgical procedures also factored into their relative risk of posttraumatic seizures.

Ritter AC, Wagner AK, Fabio A, et al.  Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Epilepsia. 2016;57(12):1968-1977.

Induced hypothermia does not improve clinical outcomes among patients with convulsive status epilepticus (CSE), according to a new multicenter study published in the New England Journal of Medicine. To reach that conclusion, investigators assigned 270 critically ill patients with CSE on mechanical ventilation to either standard care or standard care plus hypothermia, which lowered their body temperature to 32 to 34⁰C for 24 hours. To measure the impact of hypothermia, researchers used the Glasgow Outcome Scale (GOS) score and defined success as a GOS score of 5, which represents no or minimal neurologic deficit, at 90 days. Forty-nine percent of patients on hypothermia achieved a score of 5, compared to 43% of those on standard care, which was statistically insignificant (P=.43).

Legriel S, Lemiale V, Schenck, M, et al.  Hypothermia for Neuroprotection in Convulsive Status Epilepticus.  N Engl J Med. 2016;375(25):2457-2467.

Induced hypothermia does not improve clinical outcomes among patients with convulsive status epilepticus (CSE), according to a new multicenter study published in the New England Journal of Medicine. To reach that conclusion, investigators assigned 270 critically ill patients with CSE on mechanical ventilation to either standard care or standard care plus hypothermia, which lowered their body temperature to 32 to 34⁰C for 24 hours. To measure the impact of hypothermia, researchers used the Glasgow Outcome Scale (GOS) score and defined success as a GOS score of 5, which represents no or minimal neurologic deficit, at 90 days. Forty-nine percent of patients on hypothermia achieved a score of 5, compared to 43% of those on standard care, which was statistically insignificant (P=.43).

Legriel S, Lemiale V, Schenck, M, et al.  Hypothermia for Neuroprotection in Convulsive Status Epilepticus.  N Engl J Med. 2016;375(25):2457-2467.

Induced hypothermia does not improve clinical outcomes among patients with convulsive status epilepticus (CSE), according to a new multicenter study published in the New England Journal of Medicine. To reach that conclusion, investigators assigned 270 critically ill patients with CSE on mechanical ventilation to either standard care or standard care plus hypothermia, which lowered their body temperature to 32 to 34⁰C for 24 hours. To measure the impact of hypothermia, researchers used the Glasgow Outcome Scale (GOS) score and defined success as a GOS score of 5, which represents no or minimal neurologic deficit, at 90 days. Forty-nine percent of patients on hypothermia achieved a score of 5, compared to 43% of those on standard care, which was statistically insignificant (P=.43).

Legriel S, Lemiale V, Schenck, M, et al.  Hypothermia for Neuroprotection in Convulsive Status Epilepticus.  N Engl J Med. 2016;375(25):2457-2467.

Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.

“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.”

Sensitive Imaging Technology

MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.

Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.

Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.

Reliable Biomarkers

Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.

However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.

Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.

By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.

“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.

—Erica Tricarico

Suggested Reading

Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].

Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.

“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.”

Sensitive Imaging Technology

MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.

Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.

Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.

Reliable Biomarkers

Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.

However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.

Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.

By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.

“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.

—Erica Tricarico

Suggested Reading

Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].

Roughly one out of every two patients with drug-resistant temporal lobe epilepsy will not become completely seizure-free after temporal lobe surgery. The reasons for this remain unclear and are most likely due to multiple factors. Preoperative automated fiber quantification (AFQ), however, may predict postoperative seizure outcome in patients with temporal lobe epilepsy, according to a study published online ahead of print November 15, 2016, in Brain.

“We have identified three important factors that contribute to persistent postoperative seizures: diffusion abnormalities of the ipsilateral dorsal fornix outside the future margins of resection, diffusion abnormalities of the contralateral parahippocampal white matter bundle, and insufficient resection of the uncinate fasciculus,” said lead author Simon S. Keller, MSc, PhD, and colleagues. Dr. Keller is a Lecturer in Molecular and Clinical Pharmacology at the University of Liverpool in the United Kingdom. “These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.”

Sensitive Imaging Technology

MRI techniques such as quantitative volumetric imaging have provided limited insight into what causes recurrent seizures after temporal lobe surgery. AFQ is a diffusion tensor imaging (DTI) tractography technique that permits a comprehensive analysis of tissue characteristics along the length of white matter tract bundles. This technique may allow for a more sensitive measure of neuroanatomic white matter alterations in patients with neurologic disorders than whole-tract approaches.

Dr. Keller and colleagues conducted a comprehensive DTI study to evaluate the local tissue physical characteristics of preoperative temporal lobe white matter tracts by applying DTI and AFQ in patients with temporal lobe epilepsy who underwent surgical treatment and postoperative follow-up. The primary goal of their research was to identify preoperative diffusion markers of postoperative seizure outcome. Their secondary goal was to determine whether the extent of resection of the temporal lobe tract bundles was associated with seizure outcome.

Forty-three patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls were included in the study. Patients underwent preoperative imaging, amygdalohippocampectomy, and postoperative assessment using the International League Against Epilepsy seizure outcome scale. The fimbria-fornix, parahippocampal, white matter bundle, and uncinate fasciculus were reconstructed from preoperative imaging. In addition, scalar diffusion metrics were calculated along the length of each tract.

Reliable Biomarkers

Results revealed that 51.2% of patients had a completely seizure-free outcome, and 48.8% of patients had persistent postoperative seizures. More men were rendered seizure-free, relative to women. Compared to controls, both patient groups showed strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe.

However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could project individual patient outcomes with 84% sensitivity and 89% specificity.

Pathologic changes in the dorsal fornix were observed beyond the margins of resection. In addition, contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Diffusion characteristics of the ipsilateral uncinate could potentially classify patients from controls with a sensitivity of 98%.

By coregistering the preoperative fiber maps to postoperative surgical lacuna maps, Dr. Keller and colleagues observed that the extent of the surgical uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller surgical resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network.

“An important future step will be to perform a pragmatic prospective study of consecutive patients with consideration of these new findings,” said Dr. Keller and colleagues.

—Erica Tricarico

Suggested Reading

Keller SS, Glenn RG, Weber B, et al. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain. 2016 Nov 15 [Epub ahead of print].

Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.

Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.

Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.

Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.

Self-management techniques may help patients with epilepsy and intellectual disabilities suggests a recent review of the medical literature. Michelle Dannenberg and associates found that, while the research on self-management intervention is very limited, 5 high quality pilot and randomized controlled feasibility studies did suggest that such interventions have the potential to improve patients’ knowledge base, reduce the frequency of seizures, and improve their quality of life.

Dannenberg M, Mengoni SE, Gates B et al. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure.2016; 41:16-25.

Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.

Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.

Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.

Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.

Pathogenic variants of the SCN8A gene may contribute to a variety of epilepsy types, as well as nonseizure neurodevelopmental disorders, according a recent genetic analysis. Five variants of the gene called sodium channel alpha subunit 8, which codes for the ion pore region of the voltage-gated sodium channel, were detected in the genetic sequencing data from 275 epilepsy panels performed by the Emory Genetics Laboratory. Four of the 5 affected individuals had epilepsy and developmental delay/intellectual disability. The fifth patient had a less severe form of epilepsy that did not impair their cognitive abilities.

Butler KM, da Silva C, Shafir Y et al. De novo and inherited SCN8A epilepsy mutations detected by gene panel analysis. Epilepsy Res. 2016;129:17-25.

The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.

Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.

The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.

Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.

The precise indications for intracranial electroencephalography (IEEG) remain unresolved and vary among epilepsy surgical centers. The International League Against Epilepsy has issued recommendations on the diagnostic usefulness of IEEG that discuss the application of a variety of modalities and that provide a consensus among experts on its efficacy, safety, ease, and cost benefits. The goal of the guidelines is to reduce over- and underuse of IEEE while at the same time allowing flexibility among the epilepsy centers that perform the procedure.

Jayakar P, Gotman J, Harvey AS et al. Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques. Epilepsia. 2016;57(11):1735-1747.