Special Issue "Diagnosis and Surgical Treatment of Epilepsy"

A special issue of Brain Sciences (ISSN 2076-3425).

Deadline for manuscript submissions: closed (31 January 2018).

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Dr. Warren W. Boling
E-Mail Website
Guest Editor
Department of Neurosurgery, Loma Linda University Medical Center, 25455 Barton Road, 108A, Loma Linda, CA 92354, USA
Interests: functional neurosurgery; neurosciences research
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Epilepsy is a common neurological disease that can affect all ages. Although the majority of people with epilepsy can have excellent seizure control with medication, about 30% will fail anti-epileptic drugs. For those with medically intractable epilepsy, the recurrent seizures lead to elevated mortality and injury risks and the seizures themselves are socially disabling. Fortunately for many people with intractable epilepsy, epilepsy can be cured or seizures better controlled with surgery.

Localization of the seizure focus followed by surgical resection provides the best opportunity to cure the epilepsy. Better understanding of the neuro-anatomy and physiology of epilepsy improves our ability to define the epileptic network and effectively treat the epilepsy. Minimal access surgical approaches result in more rapid recovery from surgery, less pain, and more satisfied patients.

For individuals without an opportunity for cure of their epilepsy, new and emerging technologies can improve the quality of life by preventing injuries and reducing seizure frequency and severity.

This Special Issue will highlight advances in the diagnosis and surgical treatment of epilepsy, including imaging and electroencephalography (EEG) approaches to define the epileptic focus, understand the epileptic network, and characterize the anatomical substrate of epilepsy.

Dr. Warren W. Boling
Guest Editor

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Keywords

  • Medically Intractable Epilepsy
  • EEG
  • Epilepsy Surgery
  • MRI
  • Epilepsy
  • Seizures

Published Papers (10 papers)

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Editorial

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Open AccessEditorial
Diagnosis and Surgical Treatment of Epilepsy
Brain Sci. 2018, 8(7), 115; https://doi.org/10.3390/brainsci8070115 - 21 Jun 2018
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available

Research

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Open AccessArticle
Neural State Monitoring in the Treatment of Epilepsy: Seizure Prediction—Conceptualization to First-In-Man Study
Brain Sci. 2019, 9(7), 156; https://doi.org/10.3390/brainsci9070156 - 01 Jul 2019
Cited by 1
Abstract
This research study is part of a therapy development effort in which a novel approach was taken to develop an implantable electroencephalographic (EEG) based brain monitoring and seizure prediction system. Previous attempts to predict seizures by other groups had not been demonstrated to [...] Read more.
This research study is part of a therapy development effort in which a novel approach was taken to develop an implantable electroencephalographic (EEG) based brain monitoring and seizure prediction system. Previous attempts to predict seizures by other groups had not been demonstrated to be statistically more successful than chance. The primary clinical findings from this group were published in a clinical paper; however much of the fundamental technology, including the strategy and techniques behind the development of the seizure advisory system have not been published. Development of this technology comprised several steps: a vast high quality database of EEG recordings was assembled, a structured approach to algorithm development was undertaken, an implantable 16-channel subdural neural monitoring and seizure advisory system was designed and built, preclinical studies were conducted in a canine model, and a First-In-Man study involving implantation of 15 patients followed for two years was conducted to evaluate the algorithm. The algorithm was successfully trained to correctly provide a) notification of a high likelihood of seizure in 11 of 14 patients, and b) notification of a low likelihood of seizure in 5 of 14 patients (NCT01043406). Continuous neural state monitoring shows promise for applications in seizure prediction and likelihood estimation, and insights for further research and development are drawn. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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Open AccessArticle
Epilepsy and Neuromodulation—Randomized Controlled Trials
Brain Sci. 2018, 8(4), 69; https://doi.org/10.3390/brainsci8040069 - 18 Apr 2018
Cited by 6
Abstract
Neuromodulation is a treatment strategy that is increasingly being utilized in those suffering from drug-resistant epilepsy who are not appropriate for resective surgery. The number of double-blinded RCTs demonstrating the efficacy of neurostimulation in persons with epilepsy is increasing. Although reductions in seizure [...] Read more.
Neuromodulation is a treatment strategy that is increasingly being utilized in those suffering from drug-resistant epilepsy who are not appropriate for resective surgery. The number of double-blinded RCTs demonstrating the efficacy of neurostimulation in persons with epilepsy is increasing. Although reductions in seizure frequency is common in these trials, obtaining seizure freedom is rare. Invasive neuromodulation procedures (DBS, VNS, and RNS) have been approved as therapeutic measures. However, further investigations are necessary to delineate effective targeting, minimize side effects that are related to chronic implantation and to improve the cost effectiveness of these devices. The RCTs of non-invasive modes of neuromodulation whilst showing much promise (tDCS, eTNS, rTMS), require larger powered studies as well as studies that focus at better targeting techniques. We provide a review of double-blinded randomized clinical trials that have been conducted for neuromodulation in epilepsy. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
Open AccessArticle
l-Carnitine Modulates Epileptic Seizures in Pentylenetetrazole-Kindled Rats via Suppression of Apoptosis and Autophagy and Upregulation of Hsp70
Brain Sci. 2018, 8(3), 45; https://doi.org/10.3390/brainsci8030045 - 14 Mar 2018
Cited by 3
Abstract
l-Carnitine is a unique nutritional supplement for athletes that has been recently studied as a potential treatment for certain neuropsychiatric disorders. However, its efficacy in seizure control has not been investigated. Sprague Dawley rats were randomly assigned to receive either saline (Sal) [...] Read more.
l-Carnitine is a unique nutritional supplement for athletes that has been recently studied as a potential treatment for certain neuropsychiatric disorders. However, its efficacy in seizure control has not been investigated. Sprague Dawley rats were randomly assigned to receive either saline (Sal) (negative control) or pentylenetetrazole (PTZ) 40 mg/kg i.p. × 3 times/week × 3 weeks. The PTZ group was further subdivided into two groups, the first received oral l-carnitine (l-Car) (100 mg/kg/day × 4 weeks) (PTZ + l-Car), while the second group received saline (PTZ + Sal). Daily identification and quantification of seizure scores, time to the first seizure and the duration of seizures were performed in each animal. Molecular oxidative markers were examined in the animal brains. l-Car treatment was associated with marked reduction in seizure score (p = 0.0002) that was indicated as early as Day 2 of treatment and continued throughout treatment duration. Furthermore, l-Car significantly prolonged the time to the first seizure (p < 0.0001) and shortened seizure duration (p = 0.028). In addition, l-Car administration for four weeks attenuated PTZ-induced increase in the level of oxidative stress marker malondialdehyde (MDA) (p < 0.0001) and reduced the activity of catalase enzyme (p = 0.0006) and increased antioxidant GSH activity (p < 0.0001). Moreover, l-Car significantly reduced PTZ-induced elevation in protein expression of caspase-3 (p < 0.0001) and β-catenin (p < 0.0001). Overall, our results suggest a potential therapeutic role of l-Car in seizure control and call for testing these preclinical results in a proof of concept pilot clinical study. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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Open AccessArticle
Epilepsy: A Call for Help
Brain Sci. 2018, 8(2), 22; https://doi.org/10.3390/brainsci8020022 - 28 Jan 2018
Abstract
Epilepsy is a considerable individual and social economic burden. In properly selected patients, epilepsy surgery can provide significant relief from disease, including remission. However, the surgical treatment of epilepsy lags in terms of knowledge and technology. The problem arises due to its slow [...] Read more.
Epilepsy is a considerable individual and social economic burden. In properly selected patients, epilepsy surgery can provide significant relief from disease, including remission. However, the surgical treatment of epilepsy lags in terms of knowledge and technology. The problem arises due to its slow adaptation and dissemination. This article explores this issue of a wide treatment gap and its causes. It develops a framework for a rational decision-making process that is appropriate for extant circumstances and will result in the speedy delivery of surgical care for suitable patients with medically intractable epilepsy. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available

Review

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Open AccessReview
Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa
Brain Sci. 2018, 8(4), 59; https://doi.org/10.3390/brainsci8040059 - 01 Apr 2018
Cited by 8
Abstract
Epilepsy is an important and common worldwide public health problem that affects people of all ages. A significant number of individuals with epilepsy will be intractable to medication. These individuals experience an elevated mortality rate and negative psychosocial consequences of recurrent seizures. Surgery [...] Read more.
Epilepsy is an important and common worldwide public health problem that affects people of all ages. A significant number of individuals with epilepsy will be intractable to medication. These individuals experience an elevated mortality rate and negative psychosocial consequences of recurrent seizures. Surgery of epilepsy is highly effective to stop seizures in well-selected individuals, and seizure freedom is the most desirable result of epilepsy treatment due to the positive improvements in psychosocial function and the elimination of excess mortality associated with intractable epilepsy. Globally, there is inadequate data to fully assess epilepsy-related quality of life and stigma, although the preponderance of information we have points to a significant negative impact on people with epilepsy (PWE) and families of PWE. This review of the psychosocial impact of epilepsy focuses on regions of Asia and Sub-Saharan Africa that have been analyzed with population study approaches to determine the prevalence of epilepsy, treatment gaps, as well as factors impacting psychosocial function of PWE and their families. This review additionally identifies models of care for medically intractable epilepsy that have potential to significantly improve psychosocial function. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
Open AccessReview
Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy
Brain Sci. 2018, 8(4), 49; https://doi.org/10.3390/brainsci8040049 - 21 Mar 2018
Cited by 8
Abstract
Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized [...] Read more.
Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. This process includes classifying the seizure type, lateralizing and localizing the seizure onset focus (epileptogenic zone), confirming the safety of the prospective brain surgery in terms of potential neurocognitive deficits (language and memory functions), before devising a surgical plan. Each one of the above steps requires special tests. In this paper, we have reviewed the process of presurgical evaluation in patients with drug-resistant focal onset epilepsy. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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Open AccessFeature PaperReview
Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy
Brain Sci. 2018, 8(2), 35; https://doi.org/10.3390/brainsci8020035 - 20 Feb 2018
Cited by 1
Abstract
Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a [...] Read more.
Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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Open AccessReview
Stimulation and Neuromodulation in the Treatment of Epilepsy
Brain Sci. 2018, 8(1), 2; https://doi.org/10.3390/brainsci8010002 - 21 Dec 2017
Cited by 1
Abstract
Invasive brain stimulation technologies are allowing the improvement of multiple neurological diseases that were non-manageable in the past. Nowadays, this technology is widely used for movement disorders and is undergoing multiple clinical and basic science research for development of new applications. Epilepsy is [...] Read more.
Invasive brain stimulation technologies are allowing the improvement of multiple neurological diseases that were non-manageable in the past. Nowadays, this technology is widely used for movement disorders and is undergoing multiple clinical and basic science research for development of new applications. Epilepsy is one of the conditions that can benefit from these emerging technologies. The objective of this manuscript is to review literature about historical background, current principles and outcomes of available modalities of neuromodulation and deep brain stimulation in epilepsy patients. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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Other

Open AccessCase Report
Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection?
Brain Sci. 2018, 8(3), 42; https://doi.org/10.3390/brainsci8030042 - 12 Mar 2018
Cited by 3
Abstract
The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the [...] Read more.
The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the hippocampus without long-term intracranial electroencephalogram (EEG) monitoring. Encephaloceles were detected by magnetic resonance imaging (MRI) and confirmed by maxillofacial head computed tomography (CT) scans. Seizures were captured by scalp video-EEG recording. One case underwent intraoperative electrocorticography (ECoG) with pathology demonstrating neuronal heterotopia. We propose that in some patients with skull base temporal encephaloceles, minimal surgical resection of herniated and adjacent temporal cortex (lesionectomy) is sufficient to render seizure freedom. In future cases, where an associated malformation of cortical development is suspected, newer techniques such as minimally invasive EEG monitoring with stereotactic-depth EEG electrodes should be considered to tailor the surrounding margins of the resected epileptogenic zone. Full article
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy) Printed Edition available
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