Table 1.
Patients | Preoperative cognition | Epilepsy factors | IC Factors | Postoperative data | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Gender, age at nTMS | Neuropsychological profile: restricted vs. general cognitive impairment | Language dominance | Age at onset of epilepsy | Etiology (including resection, PAD and MRI) | Estimated number of seizures 6 months prior to nTMS | AEDs during nTMS | Overlap in epileptogenic and language zones | ICI | Time from nTMS to ICa | Cognition at 6 monthsb | Engel at 2 years | |
1 | F 22.2 y | Restricted: slight disturbances in verbal functioning | IAP: positive bilateral | 9.3 y | Mild FCD in the left anterior temporal lobe, MRI normal | 96 DS | OXC, CLB, PG | No | Grid | +1.1 mo | 0 | 4 |
2 | M 9.4 y | Restricted: slight executive difficulties | fMRI: left | 3.4 y | Suspected FCD in the left posterior insula in MRI, not resected | 72 MS | OXC, VPA | No | SEEG | +0.4 mo | Not resected | Not resected |
3 | F 24.0 y | Restricted: slight executive difficulties | fMRI: left | 8.1 y | Ganglioglioma G1 in the left lateral frontal lobe, MRI positive | 80 DS | LTG, ZON, VPA, CZP | Yes | Grid | +4.8 mo | + | 1d |
4 | F 15.3 y | General: slightly below average with executive functioning most impaired | fMRI: left | 1 y | FCD2a in the frontolateral and ‐basal cortex and anterior insula, MRI normal | 200 MS | OXC, ZON, LAC | No | Grid, SEEG | −24.4 mo; +1.1 mo | 0 | 4b |
5 | F 14.2 y | Restricted: verbal functioning severely below average | fMRI: left | 9 y | PAD normal in left anterior temporal resection sparing HC, MRI normal | 360 DS | OXC, LEV | No | Grid, SEEG | +3.4 mo; +16.0 m | 0 | 4b |
6 | M 19.0 y | General: severely below average with very effortful speech production | IAP: at least right (left injection only) fMRI: right or bilateral | 0.5 y | Extensive atrophy of the left temporo‐occipital region caused by perinatal herpes encephalitis, MRI positive | 2 GTCS, 20 DS | OXC, CLB | No lateral language finding | SEEG | −4.5 mo | + | 1c |
7 | F 24.7 y | Restricted: slight disturbances in verbal functioning | IAP: left fMRI: left | 14.3 y | FCD1b in the left anterior temporal lobe, MRI normal | 180 DS | CBZ, PG, VPA | No lateral language finding | SEEG | +6.7 mo | 0 | 1c |
8 | F 10.6 y | General: slightly below average | fMRI: bilateral | 5.5 y | FCD1 at the left temporo‐parietal border near insular cortex, MRI positive | 70 DS | LEV, OXC, AZM | No | Grid | +17.1 mo | 0 | 1a |
9 | M 18.7 y | General: severely below average with verbal functioning most impaired | IAP: bilateral, predominant left (weak effect to the left) | 1.7 y | PAD normal in left temporo‐parietal resection, MRI normal | 6 GTCS, 12 DS | LAC, OXC, AZM | Yes | Grid | +2.2 mo | ‐ | 4a |
10 | M 9.1 y | General: severely below average with verbal and executive functioning most impaired | IAP: bilateral, predominant left, fMRI: bilateral | 0.5 y | FCD1c in the left temporal lobe, MRI positive | 700 SS | VPA, RUF | Yes | Grid | +7.6 mo | + | 4 |
11 | F 16.3 y | Restricted: slight executive difficulties | fMRI: bilateral | 5 y | Tuberous sclerosis, a left insular/fronto‐opercular tuber suspected epileptogenic, not resected | 90 DS, 90 MS | OXC, VPA, VGB | No | SEEG | +6.7 mo | Not resected | Not resected |
12 | M 13.3 y | Restricted: verbal functioning slightly below average | fMRI: left | 2.8 y | FCD2a in left frontolateral resection, MRI normal | 16 MS | OXC, VPA | Yes | SEEG | +2.2 mo | ‐ | 1a |
13 | M 12.4 y | Restricted: severe naming difficulties | fMRI: left | 0.4 y | Insufficient sample for PAD in left temporal resection, MRI normal | 12 DS, 2 MS, 12 A | CLB, VPA | Yes | Grid, SEEG | ‐3.9 mo; ‐1.8 mo | 0 | 3a |
14 | M 14.5 y | Restricted: slight verbal difficulties | fMRI: left | 12.8 y | FCD1b in left frontal resections, MRI normal | 24 DS | OXC,ZON, LEV | Yes | SEEG, SEEG | +0.7 mo | 0 | P |
15 | M 17.0 y | General: visual cognition mostly within normal range, other domains severely below average | fMRI: Right or bilateral | 13.4 y | MRI normal, not resected | 24 DS | OXC, LEV, VPA | No language finding | SEEG | +6.4 mo | Not resected | Not resected |
16 | M 13.3 y | General: extremely low functioning with verbal and executive functioning most impaired | Not done | 5.9 y | FCD1b in the left parietal cortex, MRI normal | 40 DS | VPA, OXC, CLB | Yes | SEEG, SEEG, Grid | −8.1 mo; −2.9 mo; +3.0 mo | ‐ | 4 |
17 | M 14.0 y | Restricted: slight executive and verbal difficulties | fMRI: left | 4.4 y | MRI normal, not resected | 10 MS | OCX, VPA, CLN | No language finding, epileptogenic zone unspecified | SEEG | +9.8 mo | Not resected | Not resected |
18 | M 16.3 y | General: severely below average with executive functioning most impaired | fMRI: left | 2.8 y | FCD2 in left frontobasal resection, MRI normal | 180 DS | VPA, LTG, LAC | Yes | SEEG | +6.9 mo | ‐ | P |
19 | M 32.2 y | Restricted: slight disturbances in non‐verbal functioning | fMRI: left | 24.5 y | MRI normal, not resected | 30 DS, 150 A | PG, LEV, OXC | Yes | SEEG | −2.9 mo | Not resected | Not resected |
20 | F 9.8 y | General: extremely low functioning with verbal and executive functioning most impaired | fMRI: left | 1.8 y | MRI normal, not resected | 900 MS | OXC, VPA, CLN | No language finding, epileptogenic zone unspecified | SEEG | −37.1 mo | Not resected | Not resected |
A, aura; AED, antiepileptic drug; AZM, acetazolamide; CBZ, carbamazepine; CLB, clobazam; F, female; FCD, focal cortical dysplasia; fMRI, functional magnetic resonance imaging; G, gradus; GTCS, generalized tonic‐clonic seizure; HC, hippocampus; IAP, intracarotid amobarbital procedure; ICI intracranial investigations; LAC, lacosamide; LEV, levetirasetam; LTG, lamotrigine; mo, months; MRI, magnetic resonance imaging; MS, motor seizure; nTMS, navigated transcranial magnetic stimulation; OXC, oxcarbazepine; P, pending; PAD, pathological diagnosis; PGB, pregabaline; M, male; DS, dyscognitive seizure; RUF, rufinamide; SEEG, stereo‐electroecephalogram; SS, series of epileptic spasms; nTMS, navigated transcranial stimulation; VGB, vigabatrin; VPA, valproate; y, years; ZON, zonisamide
Positive number = nTMS prior to IC; negative number = nTMS after IC
0: no postoperative change; −: notable postoperative decline; +: notable postoperative improvement