Drug-refractory epilepsy (DRE) may be treated by surgical intervention. Intracranial EEG has been widely used to localize the epileptogenic zone (EZ). Most studies of epileptic network focus on the features of EZ nodes, such as centrality and degrees. It is difficult to apply those features to the treatment of individual patients. In this study, we proposed a spatial neighbor expansion approach for EZ localization based on a neural computational model and epileptic network reconstruction. The virtual resection method was also used to validate the effectiveness of our approach. The electrocorticography (ECoG) data from 11 patients with DRE were analyzed in this study. Both interictal data and surgical resection regions were used. The results showed that the rate of consistency between the localized regions and the surgical resections in patients with good outcomes was higher than that in patients with poor outcomes. The average deviation distance of the localized region for patients with good outcomes and poor outcomes were 15 mm and 36 mm, respectively. Outcome prediction showed that the patients with poor outcomes could be improved when the brain regions localized by the proposed approach were treated. This study provides a quantitative analysis tool for patient-specific measures for potential surgical treatment of epilepsy.
Humans ; Epilepsy/surgery* ; Brain/surgery* ; Electrocorticography/methods* ; Drug Resistant Epilepsy/surgery* ; Brain Mapping/methods* ; Electroencephalography/methods*

The main shortcomings of using electrocortical stimulation (ECS) in identifying the motor functional area around the focus in neurosurgery are certainly time-consuming, possibly cerebral cortex injuring and perhaps triggering epilepsy. To solve these problems, we in our research presented an intraoperative motor cortex functional mapping based on electrocorticography (ECoG). At first, using power spectrum estimation, we analyzed the characteristic of ECoG which was related to move task, and selected Mu rhythm as the move-related feature. Then we extracted the feature from original ECoG by multi-resolution wavelet analysis. By calculating the sum value of feature in every channel and observing the distribution of these sum values, we obtained the correlation between the cortex area under the electrode and motor cortex functional area. The results showed that the distribution of the relationship between the cortex under the electrode and motor cortex functional area was almost consistent with those identified by ECS which was called as the gold-standard. It indicated that this method was basically feasible, and it just needed five minutes totally. In conclusion, ECoG-based and passive identification of motor cortical function may serve as a useful adjunct to ECS in the intraoperative mapping.
Brain Mapping ; Electric Stimulation ; Electrocorticography ; Electrodes, Implanted ; Electroencephalography ; Epilepsy ; Humans ; Motor Cortex ; physiology ; Wavelet Analysis

PURPOSE: We investigated whether primary malignancy entities and the extent of tumor resection have an effect on the survival rate and neurological improvement in patients with spinal metastases that extend beyond the vertebral compartment (Tomita's classification > or = type 4). MATERIALS AND METHODS: We retrospectively reviewed 87 patients with advanced spinal metastasis who underwent surgery. They were divided into groups 1 and 2 according to whether they responded to adjuvant therapy or not, respectively. They were subdivided according to the extent of tumor resection: group 1, gross total resection (G1GT); group 1, subtotal resection (G1ST); group 2, gross total resection (G2GT); and group 2, subtotal resection (G2ST). The origin of the tumor, survival rate, extent of resection, and neurological improvement were analyzed. RESULTS: Group 1 had a better survival rate than group 2. The G1GT subgroup showed a better prognosis than the G1ST subgroup. In group 2, the extent of tumor resection (G2GT vs. G2ST) did not affect survival rate. In all subgroups, neurological status improved one month after surgery, however, the G2ST subgroup had worsened at the last follow-up. There was no local recurrence at the last follow-up in the G1GT subgroup. Four out of 13 patients in the G2GT subgroup showed a local recurrence of spinal tumors and progressive worsening of neurological status. CONCLUSION: In patients with spinal metastases (Tomita's classification > or = type 4), individuals who underwent gross total resection of tumors that responded to adjuvant therapy showed a higher survival rate than those who underwent subtotal resection. For tumors not responding to adjuvant therapy, we suggest palliative surgical decompression.
Adolescent ; Adult ; Aged ; Child ; Combined Modality Therapy ; Diagnostic Techniques, Neurological ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Spinal Neoplasms/mortality/*secondary/surgery ; Survival Rate

INTRODUCTIONFunctional magnetic resonance imaging (fMRI) is a neuroradiological technique for the localisation of cortical function. FMRI made its debut in cognitive neuroscience and then eventually to other clinical applications. We report our experience with pre-surgical fMRI on a high field scanner, based purely on a clinical platform.

MATERIALS AND METHODSThe protocols included motor, auditory, visual and language fMRI. The choice of protocols was dependant on clinical request and lesion locale.

RESULTSRetrospective analysis and audit of the fi rst 30 consecutive patients over a 12-month period revealed that about 85% of patients had a successful examination. In a pictorial essay, we demonstrate that patients with weakness in performing a motor task showed abnormal activations of the pre-motor and supplementary motor areas.

CONCLUSIONFMRI data greatly enhances the pre-surgical planning process and the conduct of surgery when it is incorporated into the surgical navigation system in the operating theatre.

Adult ; Aged ; Diagnostic Techniques, Neurological ; Female ; Hospitals, General ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Preoperative Period ; Psychomotor Performance ; physiology ; Retrospective Studies ; Singapore

BACKGROUND: Anteromesial temporal resection (AMTR) is well established as effective in patients with intractable mesial temporal epilepsy. However, little electroclinical information is available relevant to poor surgical outcome after AMTR. We examined the postoperative electroclinical features based on postoperative MRI and video-EEG monitoring (VEM) in patients with poor surgical outcome. METHODS: We reviewed clinical features and postoperative VEM results in 20 patients with failure in AMTR. According to the postoperative electroclinical features, we classified them into mesial temporal (MT), bitemporal (BT), extramesial temporal (XMT), combined (C), and unclassified groups. The postoperative VEM results were compared among the groups. Surgical outcome was assessed in five patients who underwent reoperation. RESULTS: Patients comprised 6 MT, 2 BT, 6 XMT, 1 C, and 6 unclassified. Aura and automatism were more frequent in MT (50.0%, 83.3%) than in XMT (16.7%, 33.3%). Theta to delta rhythm, during the ictal onset and build-up period, was more frequent in MT (83.3%, 66.7%) than in XMT (33.3%, 33.3%). The ictal onset and build-up pattern of ictal EEG were most frequently localized to the frontotemporal region in MT (66.7%, 100.0%), while there was no predominantly localized region in XMT. The surgical outcome after reoperation was better in MT group than in XMT and C groups. CONCLUSIONS: Postoperative MRI and VEM are useful to assess the postoperative electroclinical features in failed AMTR. Reoperation of the residual mesiotemporal structures after confirming epileptogenic foci may have good surgical outcome.
Automatism ; Delta Rhythm ; Electroencephalography ; Epilepsy ; Humans ; Reoperation ; Seizures

Distinction between neuropathic pain and nociceptive pain helps facilitate appropriate management of pain; however, diagnosis of neuropathic pain remains a challenge. The aim of this study was to develop a Korean version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and assess its reliability and validity. The translation and cross-cultural adaptation of the original LANSS pain scale into Korean was established according to the published guidelines. The Korean version of the LANSS pain scale was applied to a total of 213 patients who were expertly diagnosed with neuropathic (n = 113) or nociceptive pain (n = 100). The Korean version of the scale had good reliability (Cronbach's alpha coefficient = 0.815, Guttman split-half coefficient = 0.800). The area under the receiver operating characteristic curve was 0.928 with a 95% confidence interval of 0.885-0.959 (P < 0.001), suggesting good discriminate value. With a cut-off score > or = 12, sensitivity was 72.6%, specificity was 98.0%, and the positive and negative predictive values were 98% and 76%, respectively. The Korean version of the LANSS pain scale is a useful, reliable, and valid instrument for screening neuropathic pain from nociceptive pain.
*Cross-Cultural Comparison ; Diagnosis, Differential ; *Diagnostic Techniques, Neurological ; England ; Female ; Humans ; Male ; Middle Aged ; Neuralgia/classification/*diagnosis ; Nociceptive Pain/*diagnosis ; Observer Variation ; Pain Measurement/*methods ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Surveys and Questionnaires ; Symptom Assessment/methods ; *Translating

At the Department of internal neurology of Cho Ray Hospital from Dec 2000 to Jan 2003. 130 patients with acute hemisphere cerebral ischemic stroke were studied. Among them, 34 patients could not evaluated by transcranial Doppler sonography, only 79 had transcranial Doppler sonography (TDS) results and MRI results, which confirmed cerebral infarctus. TDS found 30 normal cases, 28 cases with asymmetric indices reduced, 18 cases increased, 1 case of localized acceleration, 2 cases of obstructive cerebral artery in the side of clinical symptom. MRI found 17 normal cases, 62 cases of stricture of cerebral arteries. Sensitivity and specificity of TDS accounted for 74.2% and 82.4% in comparing with cerebro-vascularogramme made by MRI.
Cerebrovascular Accident ; Brain Ischemia ; Cerebral Angiography ; Ultrasonography, Doppler, Transcranial

BACKGROUNDTo study the characters of high-frequency oscillations (HFOs) in the seizure onset zones (SOZ) and the nonseizure onset zones (NSOZ) in the electrocorticography (ECoG) of patients with neocortical epilepsy.

METHODSOnly patients with neocortical epilepsy who were seizure-free after surgery as determined with ECoG were included. We selected patients with normal magnetic resonance imaging before surgery in order to avoid the influence of HFOs by other lesions. Three minutes preictal and 10 min interictal ECoG as recorded in 39 channels in the SOZ and 256 channels in the NSOZ were analyzed. Ripples and fast ripples (FRs) were analyzed by Advanced Source Analysis software (ASA, The Netherlands). Average duration of HFOs was analyzed in SOZ and NSOZ separately.

RESULTSFor ripples, the permillage time occupied by HFOs was 0.83 in NSOZ and 1.17 in SOZ during the interictal period. During preictal period, they were 2.02 in NSOZ and 7.93 in SOZ. For FRs, the permillage time occupied by HFOs was 0.02 in NSOZ and 0.42 in SOZ during the interictal period. During preictal period, they were 0.03 in NSOZ and 2 in SOZ.

CONCLUSIONSHigh-frequency oscillations are linked to SOZ in neocortical epilepsy. Our study demonstrates the prevalent occurrence of HFOs in SOZ. More and more burst of HFOs, especially FRs, means the onset of seizures.

Adolescent ; Adult ; Child ; Electrocorticography ; Electroencephalography ; Epilepsy ; physiopathology ; Female ; Humans ; Male ; Seizures ; physiopathology ; Young Adult

This study investigates the sensitivity and specificity of predicting epileptic seizures from intracranial electroencephalography (iEEG). A monitoring system is studied to generate an alarm upon detecting a precursor of an epileptic seizure. The iEEG traces of ten patients suffering from medically intractable epilepsy were used to build a prediction model. From the iEEG recording of each patient, power spectral densities were calculated and classified using support vector machines. The prediction results varied across patients. For seven patients, seizures were predicted with 100% sensitivity without any false alarms. One patient showed good sensitivity but lower specificity, and the other two patients showed lower sensitivity and specificity. Predictive analytics based on the spectral feature of iEEG performs well for some patients but not all. This result highlights the need for patient-specific prediction models and algorithms.
Drug Resistant Epilepsy ; Electrocorticography* ; Electroencephalography ; Epilepsy* ; Humans ; Seizures ; Sensitivity and Specificity ; Support Vector Machine

BACKGROUND AND PURPOSE: The purpose of this study was to characterize abnormal cortical activity during sleep in restless legs syndrome (RLS) patients and to determine the effects of treatment with a dopamine agonist. Based on whole-brain electroencephalograms, we attempted to verify alterations in the functional network as well as the spectral power of neural activities during sleep in RLS patients and to determine whether the changes are reversed by treatment with pramipexole. METHODS: Twelve drug-naïve RLS patients participated in the study. Overnight polysomnography was performed before and after treatment: the first recording was made immediately prior to administering the first dose of pramipexole, and the second recording was made 12–16 weeks after commencing pramipexole administration. Sixteen age-matched healthy participants served as a control group. The spectral power and interregional phase synchrony were analyzed in 30-s epochs. The functional characteristics of the cortical network were quantified using graph-theory measures. RESULTS: The delta-band power was significantly increased and the small-world network characteristics in the delta band were disrupted in RLS patients compared to the healthy controls. These abnormalities were successfully treated by dopaminergic medication. The delta-band power was significantly correlated with the RLS severity score in the RLS patients prior to treatment. CONCLUSIONS: Our findings suggest that the spectral and functional network characteristics of neural activities during sleep become abnormal in RLS patients, and these abnormalities can be successfully treated by a dopamine agonist.
Delta Rhythm* ; Dopamine Agonists* ; Dopamine* ; Electroencephalography ; Healthy Volunteers ; Humans ; Polysomnography ; Restless Legs Syndrome*