Utility of foramen ovale electrodes in mesial temporal lobe epilepsy

Sameer A. Sheth, Joshua P. Aronson, Mouhsin M. Shafi, H. Wesley Phillips, Naymee Velez-Ruiz, Brian P. Walcott, Churl Su Kwon, Matthew K. Mian, Andrew R. Dykstra, Andrew Cole, Emad N. Eskandar

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives To determine the ability of foramen ovale electrodes (FOEs) to localize epileptogenic foci after inconclusive noninvasive investigations in patients with suspected mesial temporal lobe epilepsy (MTLE). Methods We identified patients with medically intractable epilepsy who had undergone FOE investigation for initial invasive monitoring at our institution between 2005 and 2012. Indications for initiating FOE investigation were grouped into four categories: (1) bilateral anterior temporal ictal activity on scalp electroencephalography (EEG), (2) unclear laterality of scalp EEG onset due to muscle artifact or significant delay following clinical manifestation, (3) discordance between ictal and interictal discharges, and (4) investigation of a specific anatomic abnormality or competing putative focus. The FOE investigation was classified as informative if it provided sufficient evidence to make a treatment decision. Results Forty-two consecutive patients underwent FOE investigation, which was informative in 38 patients (90.5%). Of these 38 patients, 24 were determined to be appropriate candidates for resective surgery. Five were localized sufficiently for surgery, but were considered high risk for verbal memory deficit, and nine were deemed poor surgical candidates because of bilateral ictal origins. The remaining 4 of 42 patients had inconclusive FOE studies and were referred for further invasive investigation. Of the 18 patients who underwent resective surgery, 13 (72%) were seizure-free (Engel class I) at last follow-up (mean 22.5 months). Significance More than 90% of our 42 FOE studies provided sufficient evidence to render treatment decisions. When undertaken with an appropriate hypothesis, FOE investigations are a minimally invasive and efficacious means for evaluating patients with suspected MTLE after an inconclusive noninvasive investigation.

Original languageEnglish (US)
Pages (from-to)713-724
Number of pages12
JournalEpilepsia
Volume55
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Foramen Ovale
Temporal Lobe Epilepsy
Electrodes
Stroke
Scalp
Electroencephalography
Aptitude
Memory Disorders
Artifacts
Seizures
Muscles

Keywords

  • Depth electrodes
  • Epilepsy
  • Foramen ovale
  • Mesial temporal sclerosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Sheth, S. A., Aronson, J. P., Shafi, M. M., Phillips, H. W., Velez-Ruiz, N., Walcott, B. P., ... Eskandar, E. N. (2014). Utility of foramen ovale electrodes in mesial temporal lobe epilepsy. Epilepsia, 55(5), 713-724. https://doi.org/10.1111/epi.12571

Utility of foramen ovale electrodes in mesial temporal lobe epilepsy. / Sheth, Sameer A.; Aronson, Joshua P.; Shafi, Mouhsin M.; Phillips, H. Wesley; Velez-Ruiz, Naymee; Walcott, Brian P.; Kwon, Churl Su; Mian, Matthew K.; Dykstra, Andrew R.; Cole, Andrew; Eskandar, Emad N.

In: Epilepsia, Vol. 55, No. 5, 01.01.2014, p. 713-724.

Research output: Contribution to journalArticle

Sheth, SA, Aronson, JP, Shafi, MM, Phillips, HW, Velez-Ruiz, N, Walcott, BP, Kwon, CS, Mian, MK, Dykstra, AR, Cole, A & Eskandar, EN 2014, 'Utility of foramen ovale electrodes in mesial temporal lobe epilepsy', Epilepsia, vol. 55, no. 5, pp. 713-724. https://doi.org/10.1111/epi.12571
Sheth SA, Aronson JP, Shafi MM, Phillips HW, Velez-Ruiz N, Walcott BP et al. Utility of foramen ovale electrodes in mesial temporal lobe epilepsy. Epilepsia. 2014 Jan 1;55(5):713-724. https://doi.org/10.1111/epi.12571
Sheth, Sameer A. ; Aronson, Joshua P. ; Shafi, Mouhsin M. ; Phillips, H. Wesley ; Velez-Ruiz, Naymee ; Walcott, Brian P. ; Kwon, Churl Su ; Mian, Matthew K. ; Dykstra, Andrew R. ; Cole, Andrew ; Eskandar, Emad N. / Utility of foramen ovale electrodes in mesial temporal lobe epilepsy. In: Epilepsia. 2014 ; Vol. 55, No. 5. pp. 713-724.
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abstract = "Objectives To determine the ability of foramen ovale electrodes (FOEs) to localize epileptogenic foci after inconclusive noninvasive investigations in patients with suspected mesial temporal lobe epilepsy (MTLE). Methods We identified patients with medically intractable epilepsy who had undergone FOE investigation for initial invasive monitoring at our institution between 2005 and 2012. Indications for initiating FOE investigation were grouped into four categories: (1) bilateral anterior temporal ictal activity on scalp electroencephalography (EEG), (2) unclear laterality of scalp EEG onset due to muscle artifact or significant delay following clinical manifestation, (3) discordance between ictal and interictal discharges, and (4) investigation of a specific anatomic abnormality or competing putative focus. The FOE investigation was classified as informative if it provided sufficient evidence to make a treatment decision. Results Forty-two consecutive patients underwent FOE investigation, which was informative in 38 patients (90.5{\%}). Of these 38 patients, 24 were determined to be appropriate candidates for resective surgery. Five were localized sufficiently for surgery, but were considered high risk for verbal memory deficit, and nine were deemed poor surgical candidates because of bilateral ictal origins. The remaining 4 of 42 patients had inconclusive FOE studies and were referred for further invasive investigation. Of the 18 patients who underwent resective surgery, 13 (72{\%}) were seizure-free (Engel class I) at last follow-up (mean 22.5 months). Significance More than 90{\%} of our 42 FOE studies provided sufficient evidence to render treatment decisions. When undertaken with an appropriate hypothesis, FOE investigations are a minimally invasive and efficacious means for evaluating patients with suspected MTLE after an inconclusive noninvasive investigation.",
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AU - Walcott, Brian P.

AU - Kwon, Churl Su

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AU - Cole, Andrew

AU - Eskandar, Emad N.

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N2 - Objectives To determine the ability of foramen ovale electrodes (FOEs) to localize epileptogenic foci after inconclusive noninvasive investigations in patients with suspected mesial temporal lobe epilepsy (MTLE). Methods We identified patients with medically intractable epilepsy who had undergone FOE investigation for initial invasive monitoring at our institution between 2005 and 2012. Indications for initiating FOE investigation were grouped into four categories: (1) bilateral anterior temporal ictal activity on scalp electroencephalography (EEG), (2) unclear laterality of scalp EEG onset due to muscle artifact or significant delay following clinical manifestation, (3) discordance between ictal and interictal discharges, and (4) investigation of a specific anatomic abnormality or competing putative focus. The FOE investigation was classified as informative if it provided sufficient evidence to make a treatment decision. Results Forty-two consecutive patients underwent FOE investigation, which was informative in 38 patients (90.5%). Of these 38 patients, 24 were determined to be appropriate candidates for resective surgery. Five were localized sufficiently for surgery, but were considered high risk for verbal memory deficit, and nine were deemed poor surgical candidates because of bilateral ictal origins. The remaining 4 of 42 patients had inconclusive FOE studies and were referred for further invasive investigation. Of the 18 patients who underwent resective surgery, 13 (72%) were seizure-free (Engel class I) at last follow-up (mean 22.5 months). Significance More than 90% of our 42 FOE studies provided sufficient evidence to render treatment decisions. When undertaken with an appropriate hypothesis, FOE investigations are a minimally invasive and efficacious means for evaluating patients with suspected MTLE after an inconclusive noninvasive investigation.

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