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Biomedical subjects

Jorge G Burneo

Publications and source records attributed to Jorge G Burneo.

At least 19 recordsLinked to original sources
PubMed2006

Race/ethnicity, sex, and socioeconomic status as predictors of outcome after surgery for temporal lobe epilepsy.

BACKGROUND: Several risk factors have been attributed to seizure recurrence after surgery. It is unknown whether race/ethnicity plays a role in outcome. OBJECTIVE: To evaluate whether race/ethnicity plays a role in seizure recurrence after surgery. DESIGN: Cohort study. SETTING: We evaluated data obtained from the epilepsy centers at the University of Alabama at Birmingham and New York University, New York, NY. PATIENTS: All patients included had a diagnosis of mesial temporal sclerosis and underwent temporal lobectomy. MAIN OUTCOME MEASURES: Occurrence of seizure after surgery was registered 1 year after surgery. We used multiple logistic regression analysis to model the presence of seizure recurrence after surgery and generated odds ratios (ORs) for seizure recurrence after surgery for African American and Hispanic patients relative to white patients. An unadjusted model incorporated only race/ethnicity as the independent variable, and an adjusted model included socioeconomic status, age, duration of epilepsy, education, history of febrile seizures, sex, handedness, lateralization of epileptogenic focus, and number of antiepileptics as the independent variables. RESULTS: Two hundred fifty-two patients underwent surgical treatment with pathological confirmation of mesial temporal sclerosis. No differences were found between racial/ethnic groups in terms of seizure recurrence in any models. For African American patients, the ORs were 0.9 (95% confidence interval [CI], 0.4-2.1) for the unadjusted model and 0.8 (95% CI, 0.3-2.0) for the adjusted model; for Hispanic patients, the ORs were 1.6 (95% CI, 0.8-3.2) for the unadjusted model and 1.1 (95% CI, 0.5-2.6) for the adjusted model, relative to white patients. CONCLUSION: Our data suggest that although sex appears to play a role in the outcomes of surgery for temporal lobe epilepsy, race and socioeconomic status do not.

Adult↗
PubMed2006

Magnetic source imaging versus intracranial electroencephalogram in epilepsy surgery: a prospective study.

OBJECTIVE: Noninvasive brain imaging tests can potentially supplement or even replace the use of intracranial electroencephalogram (ICEEG), an invasive, costly procedure used in presurgical epilepsy evaluation. This study prospectively examined the agreement between magnetic source imaging (MSI) and ICEEG localization in epilepsy surgery candidates. METHODS: Patients completing video monitoring with scalp EEG who had intractable partial epilepsy based on ictal electro-clinico-anatomical features were screened. Forty-nine enrolled patients (mean age, 27 years; range, 1-61 years) completed MSI and ICEEG studies. Decisions about ICEEG and surgery were made at a consensus conference where MSI could only influence ICEEG coverage by indicating supplemental coverage to that already planned by an original hypothesis. RESULTS: The positive predictive value of MSI for seizure localization was 82 to 90%, depending on whether computed against ICEEG alone or in combination with surgical outcome. The kappa score of agreement for MSI with ICEEG was 0.2744 (p < 0.01) INTERPRETATION: MSI yields localizing information with a high positive predictive value in epilepsy surgery candidates who typically require ICEEG. This finding suggests that enough clinical validity exists for MSI to potentially replace ICEEG for seizure localization.

Adolescent↗
PubMed2006

Utility of Ictal SPECT in the presurgical evaluation of Rasmussen's encephalitis.

BACKGROUND: Rasmussen's encephalitis is a progressive disease characterized by severe progressive neurological and cognitive deficits. It is a difficult condition to treat with conventional medical treatment and requires, in most of the cases, surgical intervention. METHODS: We present the case of a patient with Rasmussen's encephalitis who presented with epilepsia partialis continua, who did not respond to antiepileptic treatment and was evaluated for possible surgical intervention. RESULTS: The electroencephalographic studies revealed bihemispheric involvement during seizures, although magnetic resonance imaging (MRI) showed a marked right hemispheric atrophy. Hyperperfusion over the right hemisphere was seen with the performance of ictal single photon emission computed tomography (SPECT), which finally guided a right functional hemispherectomy and subsequent seizure control. CONCLUSION: Ictal SPECT could be a useful tool in the armamentarium of tools used for the localization of the epileptogenic focus in patients with Rasmussen's encephalitis and other localization-related epilepsies.

Adult↗
PubMed2006

Morbidity associated with the use of intracranial electrodes for epilepsy surgery.

BACKGROUND: Invasive monitoring for the investigation of medically intractable epilepsy may be associated with undesirable morbidity. We performed a review of our recent experience to determine the incidence of major complications. METHODS: We reviewed the clinical records of all patients who underwent invasive EEG monitoring at our institution between 2000 and 2004. RESULTS: One-hundred and sixteen patients (57 males, 59 females) with a mean age of 32 years of age underwent intracranial placement of electrodes for epilepsy surgery investigation. Subdural strips were placed in 115 patients with a mean of eight strips per patient. Subdural grids were inserted in 11 patients and depth electrodes in five. Fourteen of the 15 patients with grids or depth electrodes also had strips. Coverage was unilateral in 37 patients and bilateral in 79 patients. Electrodes were placed over the frontal lobe in 78 cases, temporal in 93, parietal in 24, and occipital in 27 patients. The average duration of investigation was 12.3 days (range 3-29). The evaluation led to the performance of a surgical resection in 85 patients (74%). Complications were seen in four patients with subdural strips (3%), and in two patients with grids (13%), characterized by clinical infection, intracranial hemorrhage, aseptic meningitis, transient neurological deficits, and status epilepticus. Mortality was nil. CONCLUSIONS: In comparison with previously published literature on the topic, the major complication rate in this group of patients appears to be low.

Adolescent↗
PubMed2005

An evaluation of the quality of epilepsy education on the Canadian World Wide Web.

BACKGROUND: Despite the substantial amount of epilepsy-related information available on the Internet, little is known about its quality. Epilepsy-related information in English on the Canadian Internet was reviewed. METHODS: Popular search engines (google.ca, yahoo.ca, ca.altavista.com, simpatico.msn.ca) were interrogated. Web sites aimed primarily at patient and family education, geared toward human epilepsy, and epilepsy in general as opposed to one specific type or aspect of epilepsy, were included. Web sites were then subdivided in to proprietary (directly sponsored by the industry) and nonproprietary, and evaluated according to compliance with the principles of the Health on the Net (HON) Foundation Code of Conduct. Web sites without comprehensive contents were excluded. Comparison between total scores was done using the rank test. Categorized descriptors were assessed with t tests. RESULTS: Five proprietary and fourteen nonproprietary websites were identified. None of them were compliant with all eight principles of the HON code. The average number of principles with which these sites were in compliance was 3.3 (range: 1-6.5, P = 0.4, proprietary vs nonproprietary). CONCLUSIONS: The Internet has the potential to be a very powerful educational tool for patients with epilepsy. However, most of the easily accessed epilepsy web sites do not comply with accepted standards for health web sites.

Canada↗
PubMed2005

Race/ethnicity: a predictor of temporal lobe epilepsy surgery outcome?

PURPOSE: The success of epilepsy surgery in temporal lobe epilepsy reaches a 64% rate of seizure freedom, based on a randomized control trial. Observational studies from epilepsy centers worldwide indicate seizure freedom rates up to 93% when the etiology is unilateral hippocampal sclerosis. Several risk factors are attributed to the recurrence of seizures following the surgical procedure. Nonetheless, whether race influences the outcome of temporal lobe surgery is unknown. The purpose of this study was to evaluate if race plays a role in outcome following surgery. METHODS: Data were obtained from the discharge database of the University of Alabama at Birmingham video/EEG monitoring unit, between 1998 and 2003, as well as the clinical charts. Seizure recurrence was evaluated 1 year following surgery. The sample consisted of all patients with a primary diagnosis of mesial temporal sclerosis (MTS) who underwent anterior temporal lobectomy. Multiple logistic regression analysis was used to model the presence of seizure recurrence after anterior temporal lobectomy for MTS. Two sets of logistic regression models were estimated to generate odds ratios (ORs) for seizure recurrence after an anterior temporal lobectomy for African-Americans or other possible ethnic/racial group present relative to non-Hispanic Caucasians. The first model incorporated only ethnicity as the independent variable and generated unadjusted ORs for seizure recurrence following the surgical procedure. The second set included the independent variables: duration of epilepsy, history of febrile seizures, lateralization of epileptogenic focus, handedness, and age. RESULTS: Seventy patients underwent surgical treatment and all of them had pathologic confirmation of MTS. Follow-up information for six was not available. Analysis of the remaining 64 patients revealed that African-Americans were more likely than non-Hispanic Caucasians to have seizure recurrence after surgery (OR=2.1, 95% CI=0.6-8.0). After potential confounders (duration of epilepsy, history of febrile seizures, lateralization of epileptogenic focus, handedness, and age) were controlled, this finding did not change (OR=1.7, 95% CI=0.3-10.7). CONCLUSION: Our data suggest that race may be an important factor related to seizure outcome following temporal lobectomy.

Adult↗
PubMed2005

Nonconvulsive status epilepticus after temporal lobectomy.

Acute brain injury can cause nonconvulsive status epilepticus (NCSE). However, this condition has not been reported immediately after brain surgery. We describe a patient who had NCSE in the recovery room after an otherwise successful right temporal lobectomy and emphasize the usefulness of electroencephalography in this situation.

Adult↗
PubMed2004

Cortical reorganization in malformations of cortical development: a magnetoencephalographic study.

BACKGROUND: The evaluation for epilepsy surgery of patients with malformations of cortical development (MCDs) in areas of clinically important cerebral function is a challenge because of the unpredictable localization of critical sensory, motor, and cognitive function. Magnetoencephalography (MEG) source localization of evoked fields can address whether functional reorganization of primary sensory modalities exists in MCDs. METHODS: Consecutive patients with MRI-demonstrated rolandic and calcarine cortex MCDs were identified who had a 148-channel whole-head MEG study to identify the localization of primary somatosensory and visual cortices. Reorganization was considered when localization contrasted that expected upon general anatomic or homuncular rules and was defined against controls. RESULTS: Twelve patients (n = 12) were studied. Six had focal cortical dysplasia, two had polymicrogyria and schizencephaly, and four had isolated polymicrogyria. In the patients with cortical dysplasias, the somatosensory cortices were identified outside the rolandic area. In the two patients with polymicrogyria and schizencephaly, the somatosensory cortices remained in the rolandic areas as long as the anatomy was not distorted by the presence of the schizencephalic cleft. In the patients with isolated polymicrogyria, the somatosensory cortex was mapped without evidence of reorganization. CONCLUSION: In patients with epileptic MCDs involving rolandic and calcarine regions, cortical function may be reorganized if the MCDs are due to an abnormal neuronal or glial proliferation (i.e., cortical dysplasia) but may not be in MCDs caused by abnormal cortical organization (i.e., polymicrogyria).

Adult↗
PubMed2004

Electroclinical and magnetoencephalographic studies in epilepsy patients with polymicrogyria.

RATIONALE: Malformations of cortical development (MCDs) are increasingly recognized as important causes of developmental delay, epilepsy, and other neurological disorders. Polymicrogyria, a type of MCD, is characterized by many small microgyria separated by shallow sulci, a slightly thick cortex, neuronal heterotopia and often enlarged ventricles. The present descriptive study analysis the electroclinical and magnetoencephalographic findings of patients with epilepsy and polymicrogyria without schizencephaly. METHODS: We studied six patients; mean age was 27 years, who had evidence of polymicrogyria in neuroimaging studies. A single equivalent-current dipole (ECD) model was used to estimate the location of epileptiform spike dipole sources. Analysis was performed on selected data segments containing MEG spikes. MEG results were combined with MRI to create magnetic source images (MSI). RESULTS: In all cases we present results of MRI, MEG, Video-EEG monitoring, and other functional neuroimaging studies if performed. CONCLUSIONS: MSI can be used to accurately localize sources of epileptiform discharges. As such MSI can play a role of directly determining the functional epileptogenic significance of abnormalities depicted in imaging.

Adolescent↗
PubMed2004

Reporting race/ethnicity in epilepsy clinical trials.

The increasing necessity to address and answer questions regarding disparities in epilepsy among different racial/ethnic groups is not being fulfilled. The present study found that only 6.6% of clinical trials in epilepsy reported the race/ethnicity of study participants, and only 1.9% did try to analyze possible differences between them.

Clinical Trials as Topic↗
PubMed2004

Ictal single-photon emission computed tomography imaging in extra temporal lobe epilepsy using statistical parametric mapping.

PURPOSE: To examine the application of statistical parametric mapping (SPM) to analyze ictal single-photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. METHODS: The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in-house-developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel-by-voxel basis for statistically significant increases in blood flow associated with each patient's ictal scan. The results were then mapped back onto the patient's magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co-registered to MRI (SISCOM). RESULTS: Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. CONCLUSIONS: This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.

Adolescent↗
PubMed2003

Temporal lobectomy in congenital porencephaly associated with hippocampal sclerosis.

BACKGROUND: Clinical and neuroimaging features of patients with epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis have been previously described. OBJECTIVE: To present the clinical characteristics and surgical outcome of 6 patients with intractable epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis. PATIENTS AND METHODS: Twenty-four patients with porencephaly and epilepsy were studied. Of these, 6 had an epileptogenic focus in the temporal region. All patients underwent video electroencephalogram monitoring, magnetic resonance imaging studies, and neuropsychological evaluation. Of the subset of patients with temporal lobe epilepsy, 1 patient underwent intracranial electroencephalogram monitoring. Temporal lobe resection was performed in 5 patients. Outcomes were evaluated using the Engel classification. RESULTS: Freedom from seizures was achieved in all patients. Pathologic analysis of the resected tissue confirmed the presurgical diagnosis of mesial temporal sclerosis. CONCLUSION: Patients with extratemporal porencephaly and intractable seizures should be evaluated early and be considered for temporal lobectomy if clinical, magnetic resonance imaging, and electroencephalogram findings support the diagnosis of temporal lobe onset seizures.

Adolescent↗
PubMed2003

Significance of fornix atrophy in temporal lobe epilepsy surgery outcome.

BACKGROUND: Previous magnetic resonance imaging (MRI) studies have shown concurrent fornix atrophy in a large proportion of patients with hippocampal atrophy. The contribution of the fornix as an independent preoperative determinant of surgical outcome is unknown. OBJECTIVE: To evaluate the contribution of the fornix as a determinant of surgical outcome in patients with preoperatively determined temporal lobe epilepsy. METHODS: We selected 78 patients who had undergone anterior temporal lobectomy for intractable temporal lobe epilepsy at the University of Alabama at Birmingham Epilepsy Center during a 24-month period. All patients underwent standard presurgical investigations and intracranial investigations when needed. Magnetic resonance imaging volumetric studies were performed prior to surgery using previously published techniques. Patients were assessed regularly for postoperative seizure control. Outcome after at least 3 years was evaluated using Engel's classification for epilepsy. The chi2 test was used to compare categorical data. RESULTS: Seventy-eight patients were included in this study. Eight patients were excluded because of inadequate follow-up. Thirty-five patients (44.9%) had unilateral isolated hippocampal atrophy exclusively on MRI volumetry, 29 (37.2%) had unilateral hippocampal atrophy with ipsilateral fornix atrophy, and 6 (7.7%) had isolated fornix atrophy without hippocampal atrophy. Twenty-eight patients (80%) in the unilateral hippocampal atrophy group were seizure free (ie, Engel class 1: patients who are completely seizure free with no aura and who do not receive antiepileptic drugs) compared with 21 patients (73%) in the fornix and hippocampal atrophy group (P =.57). All 6 patients with isolated fornix atrophy achieved an Engel's class 1 outcome. CONCLUSIONS: These findings suggest that identification of fornix atrophy with or without associated hippocampal atrophy is not an important preoperative determinant of surgical outcome. However, in the presence of a normal hippocampus, fornix atrophy may be valuable in predicting seizure-free outcome.

Adolescent↗
PubMed2003

Sonko-Nanay and epilepsy among the Incas.

The ancient American Inca culture was characterized by great cultural and organizational achievements. Medicine was also highly developed and epilepsy was a well-recognized disorder. Spanish chroniclers have given insightful accounts of the native point of view. Sonko-Nanay, a term that possibly refers to an epileptic event, is discussed in this article.

Epilepsy↗
PubMed2003

Confirmation of nonconvulsive limbic status epilepticus with the sodium amytal test.

Is it a seizure? This question can be difficult for a clinician to answer, and it may be more critical if the possible seizure lasts >30 min. Long-duration questionable seizure activity changes the question to, "Is it status epilepticus?" Status epilepticus (SE) can be divided into convulsive and nonconvulsive types. Convulsive SE is the most easily recognized, whereas nonconvulsive SE is more clinically variable and controversial. The term nonconvulsive SE is more often applied to patients who are severely obtunded or comatose with minimal or no motor movements, or in a stupor of altered consciousness reflecting generalized ictal activity. Nonconvulsive SE also can be caused by focal seizure activity, sometimes restricted to deep small volumes of brain in which scalp EEG may not be diagnostic. We present the case of a patient who had dominant limbic hippocampal SE, but in whom the diagnosis could not be confirmed until a modified novel use of the sodium amytal test was performed.

Adult↗