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Movement Disorders Clinical Practice Mar 2024
Topics: Humans; Essential Tremor; Thalamus; Magnetic Resonance Imaging; Psychosurgery
PubMed: 38169118
DOI: 10.1002/mdc3.13970 -
Movement Disorders Clinical Practice Mar 2024
Topics: Humans; Essential Tremor; Thalamus; Psychosurgery; Magnetic Resonance Imaging; High-Intensity Focused Ultrasound Ablation
PubMed: 38168110
DOI: 10.1002/mdc3.13969 -
Epilepsia Feb 2024Corpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug-resistant epilepsy (DRE). The invasive nature of the procedure... (Observational Study)
Observational Study
OBJECTIVES
Corpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug-resistant epilepsy (DRE). The invasive nature of the procedure contributes to underutilization despite its potential superiority to other palliative procedures. The goal of this study was to use a multi-institutional epilepsy surgery database to characterize the use of CC across participating centers.
METHODS
Data were acquired from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database, a prospective observational study collecting data on children 0-18 years referred for surgical evaluation of DRE across 22 U.S. pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and analyzed statistically.
RESULTS
Eighty-three patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset was 2.3 years (0-9.4); mean age for Phase I evaluation and surgical intervention were 9.45 (.1-20) and 10.46 (.2-20.6) years, respectively. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC procedures (57%) were via open craniotomy, followed by laser interstitial thermal therapy (LiTT) (20%) and mini-craniotomy/endoscopic (mc/e) (22%). Mean operative times were significantly longer for LiTT, whereas mean estimated blood loss was greater in open cases. Complications occurred in 11 cases (13%) and differed significantly between surgical techniques (p < .001). There was no statistically significant difference in length of postoperative stay across approaches. Mean follow-up was 12.8 months (range 1-39). Favorable Engel outcomes were experienced by 37 (78.7%) of the patients who underwent craniotomy, 10 (58.8%) with LiTT, and 12 (63.2%) with mc/e; these differences were not statistically significant.
SIGNIFICANCE
CC is an effective surgical modality for children with DRE. Regardless of surgical modality, complication rates are acceptable and seizure outcomes generally favorable. Newer, less-invasive, surgical approaches may lead to increased adoption of this efficacious therapeutic option for pediatric DRE.
Topics: Humans; Child; Child, Preschool; Treatment Outcome; Drug Resistant Epilepsy; Seizures; Epilepsy; Psychosurgery; Laser Therapy; Corpus Callosum; Retrospective Studies
PubMed: 38062633
DOI: 10.1111/epi.17853 -
Journal of Clinical Neuroscience :... Jan 2024
Topics: Humans; Hemispherectomy; Psychosurgery; Stereotaxic Techniques
PubMed: 38043177
DOI: 10.1016/j.jocn.2023.11.032 -
World Neurosurgery Mar 2024Temporal lobe epilepsy is the most common reason behind drug-resistant seizures and temporal lobectomy (TL) is performed after all other efforts have been taken for a...
BACKGROUND
Temporal lobe epilepsy is the most common reason behind drug-resistant seizures and temporal lobectomy (TL) is performed after all other efforts have been taken for a Temporal lobe epilepsy. Our study aims to develop multiple machine learning (ML) models capable of predicting postoperative outcomes following TL surgery.
METHODS
Data from the American College of Surgeons National Surgical Quality Improvement Program database identified patients who underwent TL surgery. We focused on 3 outcomes: prolonged length of stay (LOS), nonhome discharges, and 30-day readmissions. Six ML algorithms, TabPFN, XGBoost, LightGBM, Support Vector Machine, Random Forest, and Logistic Regression, coupled with the Optuna optimization library for hyperparameter tuning, were tested. Models with the highest area under the receiver operating characteristic (AUROC) values were included in the web application. SHapley Additive exPlanations was used to evaluate importance of predictor variables.
RESULTS
Our analysis included 423 patients. Of these patients, 111 (26.2%) experienced prolonged LOS, 33 (7.8%) had nonhome discharges, and 29 (6.9%) encountered 30-day readmissions. The top-performing models for each outcome were those built with the Random Forest algorithm. The Random Forest models yielded AUROCs of 0.868, 0.804, and 0.742 in predicting prolonged LOS, nonhome discharges, and 30-day readmissions, respectively.
CONCLUSIONS
Our study uses ML to forecast adverse postoperative outcomes following TL. We developed accessible predictive models that enhance prognosis prediction for TL surgery. Making ML models available for this purpose represents a significant advancement in shifting toward a more patient-centric, data-driven paradigm.
Topics: Humans; Epilepsy, Temporal Lobe; Prognosis; Length of Stay; Psychosurgery; Machine Learning
PubMed: 38006940
DOI: 10.1016/j.wneu.2023.11.077 -
Psychiatry Investigation Nov 2023This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant...
OBJECTIVE
This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant obsessive-compulsive disorder (OCD).
METHODS
We searched and compiled clinical research results of neuroablation therapy reported to date. We extracted outcomes related to clinical efficacy, side effects, and surgical complications. Additionally, we summarized key claims and findings.
RESULTS
Neuroablative intervention is a potential treatment approach for refractory OCD. Recent advancements, such as real-time magnetic resonance monitoring and minimally invasive techniques employing ultrasound and laser, offer distinct advantages in terms of safety and comparative efficacy when compared to conventional methods. However, the absence of randomized controlled trials and long-term outcome data underscores the need for cautious consideration when selecting neuroablation.
CONCLUSION
Neuroablative intervention shows promise for refractory OCD, but vigilant consideration is essential in both patient selection and surgical method choices due to the potential for rare yet serious complications.
PubMed: 37997327
DOI: 10.30773/pi.2023.0214 -
Acta Neurochirurgica Dec 2023To report the progressive introduction of the exoscope (EX) from surface lesionectomy to antero-mesial temporal lobectomy (AMTL) in an epilepsy surgery practice.
BACKGROUND AND OBJECTIVES
To report the progressive introduction of the exoscope (EX) from surface lesionectomy to antero-mesial temporal lobectomy (AMTL) in an epilepsy surgery practice.
METHODS
We describe a population of ten consecutive patients undergoing EX surgery, with a minimum follow-up of 6 months, that was compared to a similar population of patients referred to operative microscopic surgery (OM).
RESULTS
All surgeries were performed with the use of EX or OM alone. Transient neurological complications for surgery in eloquent regions were recorded in one patient for each population. Nine and seven patients undergoing, respectively, EX and OM surgery resulted in Engel class Ia (90% vs. 70%). The mean duration of EX and OM surgery resulted in 265.5 and 237.9 min, respectively, with a mean of 308.3 and 253.3 min for AMTL cases, respectively.
CONCLUSIONS
This preliminary study revealed that ORBEYE EX can be safe and effective in different types of epilepsy surgeries. The transition from OM to EX is fast, even though it is slower for the more challenging mesial temporal structure removal. Ergonomic and operative team interaction is improved by the use of EX. Our data need to be confirmed by larger studies.
Topics: Humans; Epilepsy, Temporal Lobe; Treatment Outcome; Epilepsy; Anterior Temporal Lobectomy; Psychosurgery; Retrospective Studies
PubMed: 37945998
DOI: 10.1007/s00701-023-05885-z -
European Psychiatry : the Journal of... Nov 2023The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of National Psychiatric Associations (NPAs)....
BACKGROUND
The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of National Psychiatric Associations (NPAs). The aim of this study to identify and investigate current contents of ethical codes and practices in the countries belonging to EPA.
METHODS
The study is an expert survey sent out to 44 representatives of 30 NPAs covering the following topics: the existence of national bodies dealing with ethical issues in psychiatry, the availability of documents relevant to ethical issues, the types of ethical issues addressed at the national level, and the current and envisaged ethical debates.
RESULTS
Out of 44 experts invited to participate in the study, 31 NPAs from 30 countries responded (response rate 70.45%). In the majority of countries, the general mission statement serves as the main document covering ethical issues in psychiatry. Most frequently, internal documents were reported to address medical malpractice, workplace bullying, plagiarism, academic fraud, sexual abuse, and discrimination/racism. Furthermore, internal documents cover the ethical assessment of potentially controversial procedures, including psychosurgery, euthanasia, and pregnancy termination. The most important topics for debate at the level of NPAs/EPA were associated with violations of clinical practice standards and human rights.
CONCLUSIONS
NPAs are active in the field of professional ethics, defining ethical standards related to interactions among professionals and services provided by mental health care professionals. Future collaboration of NPAs, under the umbrella of the EPA, could allow to develop a database of local ethical documents that would be translated into English and accessible to all EPA members.
Topics: Humans; Psychiatry; Europe; Surveys and Questionnaires
PubMed: 37909413
DOI: 10.1192/j.eurpsy.2023.2470 -
Advances and Technical Standards in... 2023Corpus callosotomy (CC) is an effective surgical treatment for medically resistant generalized or multifocal epilepsy (MRE). The premise of CC extrapolates from the...
Corpus callosotomy (CC) is an effective surgical treatment for medically resistant generalized or multifocal epilepsy (MRE). The premise of CC extrapolates from the observation that the corpus callosum is the predominant commissural pathway that allows spread and synchroneity of epileptogenic activity between the hemispheres. Candidacy for CC is typically reserved for patients seeking palliative epilepsy treatment with the goal of reducing the frequency of drop attacks, although reduction of other seizure semiologies (absence, complex partial seizures, and tonic-clonic) has been observed. A reduction in morbidity affiliated with evolution of surgical techniques to perform CC has improved the safety profile of the procedure without necessarily sacrificing efficacy.
Topics: Humans; Epilepsy; Seizures; Treatment Outcome; Corpus Callosum; Psychosurgery
PubMed: 37770691
DOI: 10.1007/978-3-031-36785-4_13