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Dario J. Englot, Edward F. Chang, and Kurtis I. Auguste

.). Results Our literature analysis revealed 74 clinical studies including outcome data from 3321 distinct patients who underwent VNS surgery for medically refractory epilepsy. 1–7 , 9–14 , 16 , 19–27 , 31–37 , 39–43 , 45–47 , 49–54 , 56–60 , 62–69 , 72–75 , 77–82 , 84–93 Among these were 15 articles producing Class I, II, or III clinical evidence, whereas the remainder were retrospective studies. Class I, II, and III Evidence of VNS Efficacy All identified studies reporting Class I, II, and III evidence of VNS efficacy in medically refractory epilepsy are

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Dario J. Englot, Seunggu J. Han, Michael T. Lawton, and Edward F. Chang

C erebral cavernous malformations are endothelial-lined vascular malformations composed of dilated sinusoids filled with blood and no intervening brain tissue and may be associated with intracranial hemorrhage. 4 , 39 , 42 Seizures, the most common presenting symptom of supratentorial CCMs, are thought to arise from the excitotoxic effects of blood products on perilesional parenchyma. 52–54 Overall, epilepsy affects 35%–70% of patients with CCMs, with approximately 40% of individuals progressing to medically refractory epilepsy. 13 , 37 , 44 It is well

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Dario J. Englot, Mitchel S. Berger, Nicholas M. Barbaro, and Edward F. Chang

-square testing to prognosticate significant factors for seizure outcome ( Table 3 ). We found a positive predictive value related to preoperative seizure control; patients whose seizures were well controlled on AEDs were more likely than those with medically refractory epilepsy to be seizure free after surgery, with an OR of 2.12 (95% CI 1.33–3.38). Next, simple partial seizures predicted a lower rate of seizure freedom compared with complex partial, secondarily generalized, or mixed events combined (OR 0.46, 95% CI 0.26–0.80). Also, a shorter duration of seizures before

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Dario J. Englot, David Ouyang, Doris D. Wang, John D. Rolston, Paul A. Garcia, and Edward F. Chang

F ocal epilepsy is a common and debilitating neurological disorder. Seizures are refractory to AEDs in 20%–40% of patients with epilepsy, leading to cognitive impairment, diminished quality of life, and increased risk of death. 3 , 6 , 18 Evaluation for surgical therapy is the standard of care for patients with localized, medically refractory epilepsy, as resection results in seizure freedom in two-thirds of patients with TLE and in one-third to one-half of patients with frontal lobe epilepsy. 19 , 28 In 2001, a randomized controlled trial of patients

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Dario J. Englot, John D. Rolston, Doris D. Wang, Kevin H. Hassnain, Charles M. Gordon, and Edward F. Chang

rate of resistance to antiepileptic medications and our poor ability to localize epileptic foci for resection. 15 Given the 500,000 yearly admissions to US hospitals for TBI, there is a dire need for improved treatment strategies for PTE. Here, we analyzed a large, prospectively collected registry of patients with medically refractory epilepsy who had received VNS therapy, and we compared seizure outcomes in patients with PTE versus non-PTE using a case-control study design. The specific type of injury was not specified for the registry data, so the analysis applies

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Nathan C. Rowland, Dario J. Englot, Tene A. Cage, Michael E. Sughrue, Nicholas M. Barbaro, and Edward F. Chang

refractory epilepsy in children and the third most common in adults, only 5%–10% of all focal epilepsy cases worldwide can be definitively traced to FCD. 3 , 27 Thus, the efficacy of various presurgical assessments, including electrophysiological and imaging modalities, as well as surgical techniques, ranging from lesionectomy to hemispherectomy, has been challenging to characterize in a standardized manner. While our analyses are limited by the abundance of retrospective, nonrandomized data cohorts in the literature, our methodology and conclusions provide an approach

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John D. Rolston, Dario J. Englot, Doris D. Wang, Tina Shih, and Edward F. Chang

E pilepsy affects nearly 1 in 100 people, leading to substantial morbidity, mortality, and economic burden. 2 , 17 , 18 Up to one-third of these patients are not helped by antiepileptic medications. 17 , 18 For patients with medically refractory epilepsy, a potentially curative option is resection of the epileptic foci when they can be clearly delineated and safely resected. 27 However, many patients are not suitable candidates for resection, and morbidity exists for surgery. 3 , 16 Because of this, there is a substantial need for additional treatment

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Dario J. Englot, John D. Rolston, Doris D. Wang, Peter P. Sun, Edward F. Chang, and Kurtis I. Auguste

recommendation that pediatric patients with intractable TLE or other medically refractory epilepsy syndromes be referred to a comprehensive epilepsy center for surgical evaluation. Furthermore, surgery should be considered in some cases of medically controlled lesional TLE, such as for tissue diagnosis in tumor cases, rupture risk with vascular malformations, notable growth and mass effect, or in a setting of significant toxicity or side effects from AEDs. In the present study, we also observed that significant predictors of postsurgical seizure freedom in pediatric TLE

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Dario J. Englot, Stephen T. Magill, Seunggu J. Han, Edward F. Chang, Mitchel S. Berger, and Michael W. McDermott

surgery. Indeed, new postoperative seizures in patients without previous epilepsy were more common after gross-total resection, although the small number of patients with new seizures in this comparison limits our ability to draw clear conclusions. Also, it is unknown if new postoperative seizures may be related to greater brain manipulation with more aggressive resection. Notably, most studies demonstrating a connection between extent of resection and seizure outcome in glioma and glioneuronal tumors focus on patients with medically refractory epilepsy, whereas our

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Michael C. Dewan, Robert Shults, Andrew T. Hale, Vishad Sukul, Dario J. Englot, Peter Konrad, Hong Yu, Joseph S. Neimat, William Rodriguez, Benoit M. Dawant, Srivatsan Pallavaram, and Robert P. Naftel

assistance) may help determine which technology offers superior clinical results, economic output, and patient satisfaction. With the ultimate goal of seizure freedom, further efforts to create an instrument that maximizes efficiency while reducing costs and discomfort should be pursued. Conclusions We report on an institutional cohort of 15 patients with complex medically refractory epilepsy who underwent SEEG via a novel frameless technology. The localization accuracy, ease of use, and up-front cost profile depict the omnidirectional platform as a feasible and capable