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Introduction: Epilepsy
Published in Candace M. Kent, David M. Chan, Analysis of a Model for Epilepsy, 2022
Candace M. Kent, David M. Chan
The regional lesion associated with mesial temporal lobe epilepsy is hippocampal sclerosis (and atrophy). In the past, it was not clear as to whether the chronic occurrence of seizures causes the development of hippocampal sclerosis or hippocampal sclerosis causes the chronic occurrence of seizures. It is now believed that hippocampal sclerosis is a cause [48].
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Temporal lobe epilepsy is a common cause of complex partial seizures and is associated with mesial temporal or hippocampal sclerosis. MRI findings which suggest the diagnosis are hippocampal T2 signal hyperintensity and volume loss. The mesial temporal lobes are best assessed on coronal acquisitions and T2 or FLAIR sequences are most helpful. Nuclear medicine can also have a role with SPECT and PET studies demonstrating hyperperfusion immediately following a seizure. It can be important to identify as the ictal focus can be treated surgically if seizures continue despite anti-epileptic medication.
Brain stimulation and epilepsy: basic overview and novel approaches
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Jürgen Lüders, Imad Najm, Hans O Lüders
Hippocampal sclerosis (HS) is a common cause of pharmacologically intractable epilepsy and not infrequently those patients with HS are not surgical candidates due to either bilateral hippocampal involvement, or concerns with memory deficits when the focus is located in the dominant hippocampus.
Deep learning and radiomics based automatic diagnosis of hippocampal sclerosis
Published in International Journal of Neuroscience, 2023
Dachuan Zhang, Yusheng Tong, Zhaoyu Hu, Guoqing Wu, Juanjuan He, Zhen Fan, Dongyan Wu, Rui Feng, Liqin Lang, Jie Hu, Liang Chen, Jinhua Yu
The first model established is used to distinguish HS from NC. This model can quickly and effectively determine whether subjects have hippocampal sclerosis based on radiological features. Through the selection of radiomics features, the classification performance of the model improved continuously by increasing the number of useful features. In addition to SVM, we used logistic regression (LR) and random forests (RF) for comparative experiments. Table 3 illustrates the classification results by 10-fold cross-validation and independent validation cohorts of the radiomics features. In the 10-fold cross-validation cohort, the SVM achieved an ACC of 0.925 (148/160) and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.969. In addition, the sensitivity (SEN) was 0.941, and the specificity (SPE) was 0.917. We also conducted independent tests on the model. In the independent test set, the radiomics model also achieved an ACC of 0.913 (73/80), the area under the receiver operating characteristic (ROC) curve (AUC) was 0.937, the SEN was 0.920 and the SPE was 0.909. As seen in Table 3, among the three classification models, SVM performed better than LR and RF. We can see that LR, RF and SVM had similar SPE, but SVM had the best SEN, reaching more than 0.9 in both the cross-validation and independent test cohorts. However, the SENs of LR and RF were only 0.854 and 0.774 in the cross-validation cohort and only 0.895 and 0.741 in the independent cohort (Figure 7).
Emerging therapeutic targets for epilepsy: preclinical insights
Published in Expert Opinion on Therapeutic Targets, 2022
Krzysztof Łukawski, Stanisław J. Czuczwar
Non-pharmacological approaches include epilepsy surgery, neurostimulation, dietary therapies and lifestyle changes [2,27]. Epilepsy surgery is an option only for patients with resectable single lesions causing epilepsy, such as hippocampal sclerosis [5]. Also, the age of a patient and medical comorbidities that increase the dangers of surgery must be considered within this treatment strategy of DRE [8]. Neuromodulation, an alternative treatment to epilepsy surgery, includes vagus nerve stimulation, deep brain stimulation and responsive neurostimulation [2]. Data on these modalities are limited and they tend to be palliative, rarely causing seizure freedom [8]. Different dietary therapies have been used in the treatment of DRE such as ketogenic diet, Modified Atkins Diet, Medium Chain Triglyceride diet, and low glycemic diet [8]. The ketogenic diet, a restrictive high-fat, low protein and very low carbohydrate diet, is a well-established treatment for children with DRE, particularly in those with glucose type-1 transporter (GLUT1) deficiency syndrome (GLUT1DS) [28]. However, the ketogenic diet constitutes a treatment with serious potential adverse effects, and often with difficulties in implementing and adhering to it [29]. Minimizing seizure triggers originated from lifestyle (alcohol, nicotine, caffeine, drugs of abuse, mental stress, emotional tension, strobe light, video games, etc) can help control seizures [27].
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
Among the minimally invasive neuroablative interventions with potential clinical relevance, two stereotactic techniques in a broader sense, such as laser interstitial thermal therapy (LITT) and radiosurgery, deserve our attention [83]. The LITT is very precise procedure based on selective targeting of small lesions responsible for seizures (like focal cortical dysplasia, hippocampal sclerosis, hypothalamic hamartoma, etc.) through a cranial burr hole with laser interstitial thermal energy delivered with the help of an advanced imaging guidance system (e.g. NMR) [84]. Recent prospective cohort study confirmed high efficiency of this intervention, with more than 50% reduction in the frequency of seizures in vast majority of the patients with hippocampal sclerosis [85]. Besides, the MR-guided LITT was associated with minimal damage to the surrounding tissues, low level of postoperative pain, reduced duration of hospitalization, and improved neuropsychological functioning [86]. However, based on these preliminary investigations we could not make firm conclusions about long-term risk/benefit ratio of this method [87].