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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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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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A practical value of different intraoperative electrophysiological methods in pediatric epilepsy surgery patients
Leško, Róbert ; Kršek, Pavel (advisor) ; Netuka, David (referee) ; Doležalová, Irena (referee)
Epilepsy, as the most common chronic neurological disease, affects a significant part of population (0.5-1%). Drug resistant epilepsy has a significant negative effect on the quality of life, psychiatric comorbidities, neurocognitive performance and the risk of SUDEP in children. Therefore, resective epilepsy surgery, the only curative treatment of this condition, can fundamentally reverse this unfavorable prognosis. An inevitable prerequisite for a good postoperative result is complete removal of the epileptogenic zone (EC) and preservation of eloquent areas (EC). At present, even with improving and new preoperative non-invasive methods, we don't have an exclusive diagnostic method for theirs delineation. The aim of this PhD study is to assess benefit of individual intraoperative electrophysiological (iEF) methods in pediatric patients with focal intractable epilepsy. The first study evaluates the importance of intraoperative electrocorticography (iECoG) in the localization of EZ. The study proved that iECoG serves as a reliable tool to guide surgical resection and may predict results of epilepsy surgery. iECoG-based modification of surgical plan is not associated with increased risk of significant complications. The second presented study analyzed the contribution of intraoperative electrical...
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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 the inhibitory cortical system in the transitory neo-allocortical regions
Salaj, Martin ; Druga, Rastislav (advisor) ; Mareš, Jan (referee) ; Kršek, Pavel (referee)
Aims. The main goal was to describe interneuronal population expressing calcium binding proteins calretinin (CR) and parvalbumin (PV) in the perirhinal (PRC) and retrosplenial (RSC) cortex of the rat. These two cortical areas differ strikingly in their connectivity and function, which could be caused also by different composition of the interneuronal populations. Having a precise knowledge of the cellular composition of any cerebral area forms one of the basic input parameters and tenets for computational modeling of neuronal networks and for understanding some pathological conditions, like generating and spreading of epileptic activity. Methods. The brains of 8 male 3-month-old Wistar rats were used in this study. The brains were cut into 50 μm thick coronal section and these were stained for NISSL (cresyl violet), CR and PV. We performed qualitative and quantitative analysis on these sections, using stereological and densitometric approach. All data acquired were statistically evaluated. Results. PRC possesses higher absolute and relative densities of CR+ and PV+ neurons than RSC, but the CR : PV ratio is higher in the RSC, which is similar to the neocortex. The bipolar/bitufted neurons are most common type of CR+ population, while the majority of PV+ neurons show multipolar morphology....
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Analysis of value of functional neuroimaging methods in diagnostics of focal intractable epilepsy
Kudr, Martin ; Kršek, Pavel (advisor) ; Brázdil, Milan (referee) ; Hájek, Milan (referee)
Epilepsy is one of the most common neurological disorders with prevalence 0,5 to 1 %. Considerable number of patients (particularly children) suffers from intractable focal epilepsy caused by focal cortical dysplasia (FCD) - a localized malformation of cortical development. The only treatment option in these patients remains resective epilepsy surgery. Its goal is to remove the epileptogenic zone (EZ) defined as the area of the cerebral cortex that is indispensable for the generation of epileptic seizures. There is currently no exclusive diagnostic test for localizing EZ localization; the localization hypothesis is based on combination of more diagnostic methods. Neuroimaging methods (especially magnetic resonance imaging - MRI) are crucial for localizing EZ; however, functional neuroimaging methods analyzing different functional aspects of the brain tissue can be equally important. The goal of this PhD study is to analyze value of functional neuroimaging methods (especially SPECT and SISCOM respectively and FDG-PET) for the EZ localization in patients with focal intractable epilepsy. In the first presented study we analyzed value of ictal SPECT examination for the EZ localization in a large cohort of pediatric patients with FCD operated on in Miami Children's Hospital, Florida. The study proved that...
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