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Functional and structural connectivity of human neocortex in epileptosurgery
Šulc, Vlastimil ; Hořínek, Daniel (advisor) ; Doležalová, Irena (referee) ; Tintěra, Jaroslav (referee)
1 ABSTRACT The presented dissertation deals with prognostic factors influencing a favorable postoperative outcome in patients undergoing surgical treatment of epilepsy and the possibilities of improving the methods used in the localization of epileptogenic lesions. This work is based on the results of four published studies. The first study evaluated the factors influencing the long-term outcomes of epilepsy surgery in MRI-negative (nonlesional) extratemporal lobe epilepsy (nETLE). The aim of the study was to evaluate the benefit of non-invasive diagnostic tests and their relationship with a favorable surgical outcome in a group nETLE patients. Univariate analysis showed that localized interictal epileptiform discharges (IEDs) on the scalp EEG were associated with a favorable surgical outcome. Diagnostic difficulty in this group of patients is highlighted by the fact that, although 9 of 24 patients undergoing surgery had a favorable outcome, and only nine of 85 patients with nETLE achieved such a favorable outcome. The second work evaluated the benefit of SPECT (Single Photon Emission Tomography) statistical processing over traditional subtraction methods in patients with MRI-negative temporal lobe epilepsy (nTLE) and MRI-negative extratemporal epilepsy (nETLE). 49 consecutive patients who underwent...
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The Effect of early treatment on psychomotor development in children with epileptic encephalopathy
Beňová, Barbora ; Kršek, Pavel (advisor) ; Příhodová, Iva (referee) ; Aulická, Štefania (referee)
Children with focal intractable epilepsy caused by MCD, FCD and TSC are in a high risk of development of cognitive delay, as a result of both drug resistant epilepsy and genetically determined abnormal structure of the neuronal networks. Epilepsy surgery represents an established and safe treatment method of focal drug resistant epilepsy, and increases the chances for these patients to be rid of epileptic seizures, anti-epileptic medication and cognitive comorbidities. Current data on genetic background of focal MCD and FCD and their comorbidities provide space to expand the diagnostic process in epilepsy surgery candidates. However, available information on genetic causes of MCD and FCD do not allow us to infer prognostic estimates on chances of seizure freedom and optimal cognitive development. Future studies should elucidate these uncertainties.
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Rehabilitation of Pediatric Patients after Epilepsy Surgery with Postoperative Motor Deficits.
Duchoslav, Anna ; Kudr, Martin (advisor) ; Krivošíková, Mária (referee)
In its general section, the thesis 'Rehabilitation of Pediatric Patients after Epilepsy Surgery with Postoperative Motor Deficits' discusses epilepsy, treatment of intractable epilepsy and epilepsy surgery. Furthermore, a chapter on possible complications of epilepsy surgery in relation to the locomotor apparatus is included in the general section. The special section deals with rehabilitation in neurology, selected physiotherapy concepts and the relationship between epilepsy and movement activity. The aim of this thesis is to assess the effectiveness of the chosen rehabilitation procedure in five pediatric patients with post-operative motor deficiency. The Gross Motor Function Measure - 88, the Barthel Index and the Box and Blocks Test were used for objective motor assessment.
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Optimizing of epilepsy surgery in paediatric patients
Bělohlávková, Anežka ; Kršek, Pavel (advisor) ; Doležalová, Irena (referee) ; Vojtěch, Zdeněk (referee)
Optimizing of Epilepsy Surgery in Paediatric Patients Abstract Epilepsy surgery represents an effective treatment of intractable focal epilepsy. The presented work aims to describe the state of the art and enhance diagnostic and therapeutic algorithm in paediatric patients. The ultimate goal is to improve the outcome of surgeries. The work depicts the evolution of the paediatric epilepsy surgery program in Motol Epilepsy Center over the course of years 2000-2017. Complexity of patients (younger age, epileptogenic zone in proximity of eloquent cortex, multifocal MRI findings) and surgeries (hemispherotomy) alike increased over time. However, the outcomes in terms of postoperative seizure-freedom and complications remained stable. Cognitive abilities of patients improved by 9.1 IQ/DQ points one year after surgery. Patients with preexisting intellectual deficit reached the most significant increase. We developed a novel paradigm of intraoperative cortical electrical stimulation mapping. Furthermore, we introduced a technique employing visual detection of SEEG electrodes during the surgery. These procedures aim to achieve a complete resection while avoiding complications. We developed and standardized Czech versions of questionnaires IPES a QOLIE-AD-48 assessing quality of life in children with epilepsy. We...
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Functional and structural connectivity of human neocortex in epileptosurgery
Šulc, Vlastimil ; Hořínek, Daniel (advisor) ; Doležalová, Irena (referee) ; Tintěra, Jaroslav (referee)
1 ABSTRACT The presented dissertation deals with prognostic factors influencing a favorable postoperative outcome in patients undergoing surgical treatment of epilepsy and the possibilities of improving the methods used in the localization of epileptogenic lesions. This work is based on the results of four published studies. The first study evaluated the factors influencing the long-term outcomes of epilepsy surgery in MRI-negative (nonlesional) extratemporal lobe epilepsy (nETLE). The aim of the study was to evaluate the benefit of non-invasive diagnostic tests and their relationship with a favorable surgical outcome in a group nETLE patients. Univariate analysis showed that localized interictal epileptiform discharges (IEDs) on the scalp EEG were associated with a favorable surgical outcome. Diagnostic difficulty in this group of patients is highlighted by the fact that, although 9 of 24 patients undergoing surgery had a favorable outcome, and only nine of 85 patients with nETLE achieved such a favorable outcome. The second work evaluated the benefit of SPECT (Single Photon Emission Tomography) statistical processing over traditional subtraction methods in patients with MRI-negative temporal lobe epilepsy (nTLE) and MRI-negative extratemporal epilepsy (nETLE). 49 consecutive patients who underwent...
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Identification of the predictors of cognitive dysfunction in children with intractable epilepsy
Novák, Vilém ; Kršek, Pavel (advisor) ; Nevšímalová, Soňa (referee) ; Aulická, Štefania (referee)
Epilepsy affects approximately 0,5-1% of children. Epileptic seizures originate in and propagate along certain neural pathways involved in physiological processes of cognition. Consequently, cognitive impairment frequently accompanies epilepsy in childhood and contributes to diminished quality of life of these patients.The main goal of this PhD thesis was to study multiple aspects of cognitive impairment in children suffering from intractable focal epilepsy. In the first and primary study, we described for the first time the negative impact of quasi- periodic epileptiform discharges in sleep (termed "hurdles" in our work) on cognitive functions in children with focal structural epilepsy. We have also shown that epileptiform activity in sleep has a more prominent negative impact on cognitive functions than epileptiform activity in wake. Although "hurdles" are by definition generalized, they do not predict worse outcomes of epilepsy surgery, compared to controls. In the second study, we analyzed the relationship between the extent of epileptogenic zone, functional brain plasticity (evaluated by fMRI) and cognitive dysfunction in children with drug resistant temporal epilepsy. Comparing patients with isolated focal cortical dysplasia (FCD) and patients with combined pathology (FCD and hippocampal...
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The Effect of early treatment on psychomotor development in children with epileptic encephalopathy
Beňová, Barbora ; Kršek, Pavel (advisor) ; Příhodová, Iva (referee) ; Aulická, Štefania (referee)
Children with focal intractable epilepsy caused by MCD, FCD and TSC are in a high risk of development of cognitive delay, as a result of both drug resistant epilepsy and genetically determined abnormal structure of the neuronal networks. Epilepsy surgery represents an established and safe treatment method of focal drug resistant epilepsy, and increases the chances for these patients to be rid of epileptic seizures, anti-epileptic medication and cognitive comorbidities. Current data on genetic background of focal MCD and FCD and their comorbidities provide space to expand the diagnostic process in epilepsy surgery candidates. However, available information on genetic causes of MCD and FCD do not allow us to infer prognostic estimates on chances of seizure freedom and optimal cognitive development. Future studies should elucidate these uncertainties.
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Comparison of diagnostic yield of different MRI protocols and PET in relation to time an finance demands in patients with temporal epilepsy
FILÍPKOVÁ, Brigita
This Thesis called Comparison of diagnostic yield of different MRI protocols and PET in relation to time and finance demands in patients with temporal epilepsy deals with time and economic aspects of diagnostics of pharmacoresistant temporal epilepsies. Temporal epilepsies are the most frequent focal epilepsies (up to 85 %) and pharmacologic control is only successful in about 25 % cases. On the other hand it is the best type of epilepsy to be solved surgically. Timely and precise diagnostics enables a timely surgical intervention. The time and economic demands increase the same way as the demands for technical staff. The Thesis was aimed at finding a protocol advantageous in terms of both, time and cost saving, maintaining the diagnostic yield in comparison of two neuroimaging methods - functional (PET) and morphological (MR), where we also compared two protocols for brain examination - a standard one and a special epileptological one. Methodology: A retrospective study of 44 patients with clinically confirmed focal epilepsy examined by MR and PET, who underwent a microsurgical intervention and have been without fits since then. We compared the individual protocols on MR - standard (sequence T2/PD tse tra, FLAIR tra, T2* tra and T1 se sag) and epileptological (extended by 3DT1 ge, T2 tse fs cor and FLAIR cor) in terms of possible diagnostics (examination read by an experienced radiologist) and evaluated their time and cost demands. We also evaluated a PET examination, which is performed by one protocol, the same way. The results demonstrate the difference in examination time and costs between the standard and the epileptological protocols on MR and between the MR and PET methods. There are also results of reading MR and PET images and their correlates presented there. We may conclude that the epileptological protocol on MR cannot be substituted by a standard protocol. Time may be saved by better organization of work or by suitable adjustment of parameters of the individual sequences maintaining sufficient MR image quality. We are also convinced that both the methods, MR and PET are important for safe diagnosis. Cost saving is impossible in pre-operation diagnostics.
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Effects of surgery treatment of epilepsy on psychosocial condition of the patients.
ŠIŠKOVÁ, Lenka
The thesis "Effects of surgery treatment of epilepsy on psychosocial condition of the patients" deals with the disease which causes many social effects on the patients. The most frequent ones are limitations in the working life and mental problems. I am interested in the epilepsy issue and therefore I have selected this topic which continues the bachelor thesis written in 2008. The objective of my work was to determine effects of epileptosurgery on the work life and on the mental area. Two hypotheses were established which assumed that the surgical treatment improved the patient´s life both in the working and in the mental spheres. The hypotheses were tested by means of quantitative research; questionnaires were used for the collection of data and the respondents were adult patients, who underwent surgical treatment of epilepsy and have been in the care of the Center of Epilepsy Na Homolce in Prague, and patients in the care of neurology departments in České Budějovice and in Strakonice. The results have shown that the epileptosurgery failed to improve the lives of the patients in the working sphere and thus the first hypothesis was not confirmed. Many of the patients are still unemployed and they still find it difficult to find jobs. The offer of vacancies has not increased much after the surgery. Those who work often feel stress and anxiety as a result. Some patients even lost jobs after the surgery or their working positions do not correspond to the achieved qualification level, experience and potential. The improvement in the mental area has been confirmed and many of the patients no more suffer from mental problems they had before the surgery. In some of the respondents mental disorders diminished or disappeared entirely. They are more self-confident, more even-tempered and they need less professional help. In this area I see the effects of surgical treatment as very beneficial. The results of my thesis might be used in publications for the general public, as well as for professionals specializing in the field.
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