Anatomo-Electro-Functional Investigations in Rolandic and Peri-Rolandic Epilepsies: A conceptual framework for Stereo-EEG.

Objective: To develop a hypothesis-driven framework for stereoelectroencephalography (SEEG) exploration in the Rolandic and Peri-Rolandic (RPR) regions and enhance understanding of epileptogenic networks and their functional implications.

Methods: We reviewed 102 consecutive SEEG cases (January 2020 - February 2024). Eight patients (median age: 38 years) with suspected epileptogenic zones (EZ) within the RPR regions were included.

Refining centromedian nucleus stimulation for generalized epilepsy with targeting and mechanistic insights from intraoperative electrophysiology.

Epilepsy affects 65 million people worldwide, with 30% suffering from drug-resistant epilepsy. While surgical resection is the primary treatment, its application is limited in generalized epilepsy. Centromedian nucleus neurostimulation offers a promising alternative, yet its mechanisms remain unclear, limiting target optimization.

Comparative Feasibility and Complication Analyses of Extraoperative (Bedside) Removal of Stereo-Electroencephalography Electrodes.

Introduction: Stereotactic electroencephalography (SEEG) involves the implantation of intracortical electrodes for the precise localization of the epileptogenic zone and is well-established in terms of its safety and efficacy during implantation; however, there is a notable lack of research comparing different electrode removal techniques, specifically regarding complications and feasibility of these approaches. This study evaluates the feasibility and clinical utility of intraoperative versus extraoperative (bedside) removal of stereotactic electroencephalography (SEEG) electrodes.

Methods: The early feasibility study retrospectively reviewed 117 consecutive SEEG patients at our institution, comparing 101 intraoperative cases with 16 extraoperative cases.

Early Versive Head Turn Semiology Related to Ipsilateral Posterior Cingulate: A Case Report and Literature Review.

Versive head turns, characterized by forced and involuntary head movements leading to sustained unnatural positioning, are consistently recognized as reliable indicators of contralateral hemisphere involvement. This study presents a case demonstrating ictal semiology marked by the simultaneous onset of blurred vision, spinning, distorted voice, and an early left-versive head turn. The versive head turn semiology correlated with rapid ictal discharges in the ipsilateral posterior cingulate gyrus and was reproducible with direct cortical stimulation during stereoelectroencephalography evaluation.

The response to anti-seizure medications and the development of pharmacoresistant epilepsy in malformations of cortical development.

Background: Malformations of cortical development (MCD) are a group of congenital brain malformation disorders commonly associated with pharmacoresistant epilepsy (PRE). While studies often focus on surgery outcomes, the pharmacological treatment is still imperative and the odyssey to PRE remains underexplored. We aim to investigate the influence of anti-seizure medications (ASMs) on the development of PRE in this specific patient population.

Differential functional connectivity of amygdala in drug-resistant temporal lobe epilepsy.

Objective: Recent studies highlight the amygdala's crucial role in temporal lobe epilepsy (TLE), particularly in magnetic resonance imaging-negative cases and new TLE subtypes with structural amygdala changes. This study aims to investigate the electrophysiological properties and connectivity patterns of the amygdaloid complex in TLE patients using stereoelectroencephalography (SEEG).

Methods: From March 2020 to December 2023, we collected data from nine patients with drug-resistant TLE who underwent SEEG with dual amygdala trajectories: dorsal amygdala (DA) targeting medial and central nuclei, and ventral amygdala (VA) targeting basal and lateral nuclei.

A Comprehensive Review of the Role of GLP-1 Agonists in Weight Management and Their Effect on Metabolic Parameters Such as Blood Glucose, Cholesterol, and Blood Pressure.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been developed to manage type 2 diabetes mellitus. Although, in the last 10 years, the use of GLP-1 RAs, especially semaglutide and liraglutide, has increased, its clinical implications and how it affects metabolic parameters have yet to be fully consolidated. This narrative review explores the metabolic effects of GLP-1 RAs in weight management, blood glucose, cardiovascular health, lipid profiles, and blood pressure.

Glymphatic system dysfunction in epilepsy related to focal cortical dysplasia and its relationship with antiseizure medication response.

Purpose: Glymphatic function has not been explored in patients with focal cortical dysplasia (FCD)-related epilepsy. This study aimed to investigate the glymphatic system's involvement in these patients and to evaluate its correlation with response patterns to different antiseizure medications (ASMs) using diffusion tensor imaging along the perivascular space (DTI-ALPS).

Methods: Fifty-two patients with FCD-related epilepsy (10 with drug-responsive epilepsy and 42 with drug-resistant epilepsy) and 24 healthy controls (HC) were included.

Structural connectivity changes in focal epilepsy: Beyond the epileptogenic zone.

Objective: Epilepsy is recognized increasingly as a network disease, with changes extending beyond the epileptogenic zone (EZ). However, more studies of structural connectivity are needed to better understand the behavior and nature of this condition.

Methods: In this study, we applied differential tractography, a novel technique that measures changes in anisotropic diffusion, to assess widespread structural connectivity alterations in a total of 42 patients diagnosed with medically refractory epilepsy (MRE), including 27 patients with focal epilepsy and 15 patients with multifocal epilepsy that were included to validate our hypothesis.

Thalamic stereoelectroencephalography for neuromodulation target selection: Proof of concept and review of literature of pulvinar direct electrical stimulation.

In patients with drug-resistant epilepsy (DRE) who are not candidates for resective surgery, various thalamic nuclei, including the anterior, centromedian, and pulvinar nuclei, have been extensively investigated as targets for neuromodulation. However, the therapeutic effects of different targets for thalamic neuromodulation on various types of epilepsy are not well understood. Here, we present a 32-year-old patient with multifocal bilateral temporoparieto-occipital epilepsy and bilateral malformations of cortical development (MCDs) who underwent bilateral stereoelectroencephalographic (SEEG) recordings of the aforementioned three thalamic nuclei bilaterally.

Safety of Concomitant Cortical and Thalamic Stereoencephalography Explorations in Patients With Drug-Resistant Epilepsies.

Background And Objectives: Intracranial electrophysiology of thalamic nuclei has demonstrated involvement of thalamic areas in the propagation of seizures in focal drug-resistant epilepsy. Recent studies have argued that thalamus stereoencephalography (sEEG) may aid in understanding the epileptogenic zone and treatment options. However, the study of thalamic sEEG-associated hemorrhage incidence has not been investigated in a cohort study design.

Functional profile of perilesional gray matter in focal cortical dysplasia: an fMRI study.

Objectives: We aim to investigate the functional profiles of perilesional gray matter (GM) in epileptic patients with focal cortical dysplasia (FCD) and to correlate these profiles with FCD II subtypes, surgical outcomes, and different antiseizure medications (ASMs) treatment response patterns.

Methods: Nine patients with drug-responsive epilepsy and 30 patients with drug-resistant epilepsy (11 were histologically confirmed FCD type IIa, 19 were FCD type IIb) were included. Individual-specific perilesional GM and contralateral homotopic GM layer masks were generated.

Challenging Cortical Explorations in Difficult-to-Localize Seizures: The Rationale and Usefulness of Perisylvian Paralimbic Explorations With Orthogonal Stereoelectroencephalography Depth Electrodes.

Background And Objective: Stereoelectroencephalography (SEEG) is an invasive monitoring method designed to define and localize the epileptogenic zone (EZ) and explore the putative network responsible for the electroclinical seizures using anatomo-functional-electroclinical correlations. When indicated by semiology in selected patients, exploration of both limbic and paralimbic (PL) regions is indispensable. However, the PL cortex is located in deep and highly vascularized areas in proximity to the anterior Sylvian fissure and middle cerebral artery branches.

Stereoelectroencephalography-guided laser ablation in neocortical epilepsy: Electrophysiological correlations and outcome.

Objective: We aimed to study the correlation between seizure outcomes in patients with drug-resistant epilepsy (DRE) who underwent laser interstitial thermal therapy (LITT) and stereoelectroencephalographic electrophysiologic patterns with respect to the extent of laser ablation.

Methods: We retrospectively analyzed 16 consecutive DRE patients who underwent LITT. A seizure onset zone (SOZ) was obtained from multidisciplinary patient management conferences and again was confirmed independently by two epileptologists based on conventional analysis.

Trans-Interhemispheric Stereoelectroencephalography Depth Electrode Placement for Mesial Frontal Lobe Explorations in Medically Refractory Epilepsy: A Technical Note and Case Series.

Background: Stereoelectroencephalography (SEEG) is an established and safe methodology for extra-operative invasive monitoring in patients with medical refractory epilepsy. SEEG has several advantages such as the ability to record deep cortical structures, mapping the epileptogenic zone in a three-dimensional manner, and analyze bihemispheric regions without the need for bilateral craniotomies. In patients with bilateral hemispheric hypotheses, especially the mesial surface of frontal lobes, bilateral lead placement is compulsory to further define and localize the epileptogenic zone.

Clinical significance of ictal magnetoencephalography in patients undergoing epilepsy surgery.

Objective: The significance of ictal magnetoencephalography (MEG) is not well appreciated. We evaluated the relationships between ictal MEG, MRI, intracranial electroencephalography (ICEEG), surgery and postoperative seizure outcome.

Methods: A total of 45 patients (46 cases) with ictal MEG who underwent epilepsy surgery was included.

Epileptic seizures in patients with anti-IgLON5 disease.

Background: Anti-IgLON5 is a rare neurologic disease that can present with epileptic seizures. However, epileptic seizures have not been characterized and are underreported. We aimed to investigate the clinical characteristics and demographics of epileptic seizures in patients with anti-IgLON5 disease.

Focal thalamocortical circuit abnormalities in sleep related epilepsy caused by focal cortical dysplasia type II.

Purpose To investigate the variations of the thalamocortical circuit between the focal cortical dysplasia (FCD) type II patients with sleep-related epilepsy (SRE) and those without SRE (non-SRE). Methods Patients with epilepsy who had histologically proven FCD type II were enrolled. Those without diffusion tensor image and 3-dimensional (3D) T1 MRI sequences were excluded.

Contributions of Magnetoencephalography to Understanding Mechanisms of Generalized Epilepsies: Blurring the Boundary Between Focal and Generalized Epilepsies?

According to the latest operational 2017 ILAE classification of epileptic seizures, the generalized epileptic seizure is still conceptualized as "originating at some point within and rapidly engaging, bilaterally distributed networks." In contrast, the focal epileptic seizure is defined as "." Hence, one of the main concepts of "generalized" and "focal" epilepsy comes from EEG descriptions before the era of source localization, and a presumed simultaneous bilateral onset and bi-synchrony of epileptiform discharges remains a hallmark for generalized seizures.

Response to antiseizure medications in epileptic patients with malformation of cortical development.

Background: Malformation of cortical development (MCD) is one of the most common causes of pharmacoresistant epilepsy. Improving the knowledge of antiseizure medications (ASMs) treatment response in epileptic patients with MCD is crucial for optimal treatment options, either pharmacological therapy or non-pharmacological intervention.

Aim: To investigate the patterns of medical treatment outcome and the predictors for seizure freedom (SF) with ASM regimens in epilepsy caused by MCD.

Update on the Neuroimaging and Electroencephalographic Biomarkers of Epileptogenesis: A Literature Review.

Epilepsy is one of the most common debilitating neurological disorders that lead to severe socio-cognitive dysfunction. While there are currently more than 30 antiseizure medications available for the treatment and prevention of seizures, none address the prevention of epileptogenesis that leading to the development of epilepsy following a potential brain insult. Hence, there is a growing need for the identification of accurate biomarkers of epileptogenesis that enable the prediction of epilepsy following a known brain insult.