The use of high frequency oscillations to guide neocortical resections in children with medically-intractable epilepsy: How do we ethically apply surgical innovations to patient care?
TLDR
The use of HFO signatures to guide neocortical resections represents a novel approach for the treatment of epilepsy and is explored and highlighted in the context of the broader challenges in the application of surgical innovation to patient care.Abstract:
Purpose Resective surgical strategies are increasingly applied to treat medically-intractable epilepsy in children as uncontrolled seizures are associated with poor cognitive, developmental and behavioral outcomes. Innovative surgical strategies are, however, needed to improve outcomes and minimize the morbidity of such procedures. Method The current article utilizes an axiological approach to explore and highlight ethical issues in the use of high frequency oscillations (HFOs) to guide surgical resections in children with medically-intractable epilepsy. We frame our discussion in the context of the broader challenges in the application of surgical innovation to patient care. Results Despite a paucity of knowledge regarding their pathogenesis, limited evidence suggests the use of HFOs as biomarkers of epileptogenicity in resective procedures can improve seizure outcome. Clinicians must therefore weigh deficiencies in knowledge against the limited evidence supporting the utility of HFOs and make ethical decisions for the treatment of individual patients. Important ethical considerations for clinicians include the extent of deviation from established practice, the extent of evidence required to establish clinical validity, and the impact of technique implementation on equitable distribution of healthcare. Conclusion The use of HFO signatures to guide neocortical resections represents a novel approach for the treatment of epilepsy. It is hoped that the issues discussed herein will contribute to and advance meaningful dialog on the ethical application of this surgical innovation to the treatment of a very vulnerable patient population.read more
Citations
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Journal ArticleDOI
High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis.
Yvonne Höller,Raoul Kutil,Lukas Klaffenböck,Aljoscha Thomschewski,Peter Höller,Arne C. Bathke,Julia Jacobs,Alexandra Taylor,Raffaele Nardone,Eugen Trinka +9 more
TL;DR: A systematic review of all studies that related the resection of HFO-generating areas to postsurgical outcome found that automated detection and application of a detection threshold in order to detect channels with a frequent occurrence of H FOs is important to yield a marker that could be useful in presurgical evaluation.
Journal ArticleDOI
High frequency oscillations in the intra-operative ECoG to guide epilepsy surgery ("The HFO Trial") : study protocol for a randomized controlled trial
Maryse A. van 't Klooster,Frans S. S. Leijten,Geertjan Huiskamp,H.E. Ronner,Johannes C. Baayen,Peter C. van Rijen,M.J.C. Eijkemans,Kees P.J. Braun,Maeike Zijlmans +8 more
TL;DR: It is expected that the use of HFOs as a biomarker for tailoring will increase the success rate of epilepsy surgery while reducing resection volume, which may reduce neurological deficits and yield a better quality of life.
Journal ArticleDOI
Current and Emerging Potential of Magnetoencephalography in the Detection and Localization of High-Frequency Oscillations in Epilepsy
TL;DR: A thorough critical review of the recent MEG literature that investigates HFOs in patients with epilepsy, summarizing the different methodological approaches and the main findings and highlighting the emerging potential of MEG in the non-invasive detection and localization of HFO's for the presurgical evaluation of patients with medically refractory epilepsy.
Journal ArticleDOI
Surgical innovation: the ethical agenda: A systematic review.
TL;DR: It is suggested that the concept of the learning health care system might provide guidance for thinking about surgical innovation and may particularly enrich the necessary future discussion on surgical innovation: integration of research and practice and a moral emphasis on “learning activities".
Journal ArticleDOI
Recent Advances in Epilepsy Surgery and Achieving Best Outcomes Using High-Frequency Oscillations, Diffusion Tensor Imaging, Magnetoencephalography, Intraoperative Neuromonitoring, Focal Cortical Dysplasia, and Bottom of Sulcus Dysplasia.
References
More filters
Journal Article
The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research
K. John. Ryan,J. V. Brady,R. E. Cooke,D. I. Height,Albert R. Jonsen,P. King,K. Lebacqz,D. W. Louisell,D. W. Seldin,E. Stellar,R. H. Turtle +10 more
TL;DR: The Belmont Report is a statement of basic ethical principles and guidelines that should assist in resolving the ethical problems that surround the conduct of research with human subjects that were identified by the Commission in the course of its deliberations.
Journal ArticleDOI
Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy
Robert S. Fisher,Vicenta Salanova,Thomas C. Witt,Robert M. Worth,Thomas R. Henry,Robert E. Gross,Kalarickal J. Oommen,Ivan Osorio,Jules M. Nazzaro,Douglas Labar,Michael G. Kaplitt,Michael R. Sperling,Evan Sandok,John H. Neal,Adrian Handforth,John M. Stern,Antonio DeSalles,Steve Chung,Andrew G. Shetter,Donna Bergen,Roy A.E. Bakay,Jaimie M. Henderson,Jacqueline A. French,Gordon H. Baltuch,William E. Rosenfeld,Andrew Youkilis,William J. Marks,Paul A. Garcia,Nicolas Barbaro,Nathan B. Fountain,Carl W. Bazil,Robert R. Goodman,Guy M. McKhann,K. Babu Krishnamurthy,Steven Papavassiliou,Charles M. Epstein,John R. Pollard,Lisa Tonder,Joan Grebin,Robert J. Coffey,Nina M. Graves,Marc A. Dichter,William Elias,Paul Francel,Robert C. Frysinger,Kevin Graber,John Grant,Gary Heit,Susan T. Herman,Padmaja Kandula,Andres M. Kanner,Jeanne Ann King,Eric Kobylarz,Karen Lapp,Suzette M. LaRoche,Susan Lippmann,Rama Maganti,Timothy Mapstone,Dragos Sabau,Lara M. Schrader,Ashwini Sharan,Mike Smith,David M. Treiman,Steve Wilkinson,Steven Wong,Andro Zangaladze,Shelley Adderley,Brian Bridges,Mimi Callanan,Dawn Cordero,Cecelia Fields,Megan Johnson,MaryAnn Kavalir,Patsy Kretschmar,Carol Macpherson,Kathy Mancl,Marsha Manley,Stephanie Marsh,Jean Montgomery,Pam Mundt,Phani Priya Nekkalapu,Bill Nikolov,Bruce Palmer,Linda Perdue,Alison Randall,David Smith,Linda Smith,Kristen Strybing,Leigh Stott,Robin Taylor,Stacy Thompson,Zornitza Timenova,Bree Vogelsong,Virginia Balbona,Donna K. Broshek,Deborah A. Cahn-Weiner,Lisa Clift,Mary Davidson,Evan Drake,Sally Frutiger,Lynette Featherstone,Chris Grote,Dan Han,Dianne Henry,Jessica Horsfall,Andrea Hovick,Jennifer Gray,David Kareken,Kristin Kirlin,Debbie Livingood,Michele Meyer,Nancy Minniti,Jeannine Morrone Strupinsky,William Schultz,James Scott,Joseph I. Tracy,Stuart Waltonen,Penelope Ziefert,Carla Van Amburg,Mark E Burdelle,Sandra Clements,Robert Cox,Raeleen Dolin,Michelle Fulk,Harinder R. Kaur,Lawrence J. Hirsch,Thomas J. Hoeppner,Andrea Hurt,Mary Komosa,Scott E. Krahl,Laura Ponticello,Mark Quigg,Helene Quinn,Marvin A. Rossi,Patty Schaefer,Christopher Skidmore,Diane Sundstrom,Patricia Trudeau,Monica Volz,Norman C. Wang,Lynette Will,Carol Young +141 more
TL;DR: A multicenter, double‐blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization‐related epilepsy is reported.
Journal ArticleDOI
High-frequency electroencephalographic oscillations correlate with outcome of epilepsy surgery.
Julia Jacobs,Maeike Zijlmans,Rina Zelmann,Claude-Édouard Chatillon,Jeffrey Hall,André Olivier,François Dubeau,Jean Gotman +7 more
TL;DR: This work investigated whether HFOs can delineate epileptogenic areas even outside the SOZ by correlating the resection of HFO‐generating areas with surgical outcome.
Journal ArticleDOI
Interictal high-frequency oscillations (80–500 Hz) are an indicator of seizure onset areas independent of spikes in the human epileptic brain
TL;DR: High‐frequency oscillations known as ripples and fast ripples can be recorded from macroelectrodes inserted in patients with intractable focal epilepsy and are most likely linked to epileptogenesis.
Journal ArticleDOI
Local Generation of Fast Ripples in Epileptic Brain
TL;DR: The data illustrate that hypothesized clusters of highly interconnected neurons are capable of overcoming interneuron feedback inhibition, resulting in generation of epileptiform bursts, eventually leading to seizure activity.
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