[KSTP-TV, May 26, 2010] A technology called Magnetic Source Imaging (MSI) is now helping doctors find the source of epileptic seizures. A partnership between Allina’s United Hospital, St. Paul, Minn., the Minnesota Epilepsy Group operates the only device of it’s type in Minnesota.

Dr. Dickens explained how magnetic source imaging works to KSTP’s Megan Newquist. Watch the interview!

The state-of-the-art technology utilized by Minnesota Epilepsy Group was the topic of a recent KSTP-TV special medical report.  Follow this link to view this special report. 

Minnesota Epilepsy Group is designated as a Level IV Epilepsy Center – the highest rating by the National Association of Epilepsy Centers.

As a Level IV epilepsy center, Minnesota Epilepsy Group offers the most comprehensive range of diagnostic and treatment options available.  Services offered through our nationally recognized program include:

• Inpatient Epilepsy
• Magnetoencephalograpy (MEG)
• Intracranial Monitoring
• Outpatient Evaluations for Epilepsy
• Epilepsy Surgery
• Neuropsychology and Psychology
• Research
• Intraoperative Monitoring

Please visit our website at mnepilepsy.org or call us to schedule an appointment.  We may be reached at (651) 241-5290.

Minnesota Epilepsy Group, the largest Level IV pediatric and adult epilepsy program in the Midwest, is in search of both adult and pediatric neurologists specializing in epilepsy care.

Minnesota Epilepsy Group, PA® in St. Paul, Minnesota, is seeking pediatric and adult BC/BE neurology specialist to join three adult and three pediatric epileptologists in an academic private practice dedicated to epilepsy care.  We are affiliated with United Hospital and Children’s Hospitals and Clinics of Minnesota-St. Paul, with a 10 bed adult LTM unit and 10 bed pediatric unit. Fellowship training is required; BE/BC in clinical neurophysiology is desired. 

Scope of practice includes long term video EEG monitoring, inpatient and outpatient clinical care, intraoperative monitoring, magnetic source imaging (magnetoencephalography) in our MSI Center, and research, including pharmaceutical trials.  Clinical university appointment is available through the University of Minnesota.  Competitive salary and benefits are commensurate with prior training and experience.  EO/AA.

The Twin Cities of Minneapolis-St. Paul offers an excellent educational system, cultural diversity, activities for the outdoor enthusiast and ample dining and entertainment.  The vitality and quality of life in Minnesota is surpassed by none.
 
Interested applicants should mail or e-mail a CV and three references to:

Paul Louiselle, Executive Director 

plouiselle@mnepilepsy.net

Minnesota Epilepsy Group, PA®
225 Smith Avenue North, Suite 201
St. Paul, MN, 55102 USA
Phone: 651.241.5290
Fax: 651-241-5140

Epilepsy Care St. Paul

Once again, Minnesota Epilepsy Group has received the highest designation (Level 4 Epilepsy Center) available for epilepsy centers through the National Association of Epilepsy Centers. 

According to the National Association of Epilepsy Centers, a Level Four Epilepsy Center provides more complex forms of intensive neurodiagnostic monitoring, as well as more extensive medical, psychosocial and neuropsychological treatment.  Fourth-level centers also offer a comprehensive evaluation for epilepsy, surgery, including intracranial electrodes, and provide a broad range of surgical procedures for epilepsy.

Minnesota Epilepsy Group offers the most comprehensive level of epilepsy care available in the Midwest.  To learn more about our programs and services, please visit us on the web or give our office a call at (651) 241- 5290.

Minnesota Epilepsy Group, the most comprehensive epilepsy treatment center in the Midwest, routinely participates in research that advances the quality of care delivered to pediatric and adult epilepsy patients.

Following is a presentations made by staff of Minnesota Epilepsy Group at the American Epilepsy Society annual meeting in Boston, MA, December 2 – 6, 2005:

Magnetic Source Imaging Helps Surgical Planning of Brain Tumor Patients

RATIONALE:
Presurgical evaluation of brain tumor patients is challenging, especially when the tumor is adjacent to eloquent cortex, such as language, somatosensory, and motor areas. Previously, functional mapping has relied on invasive methods, such as intraoperative cortical stimulation or stimulation via a grid implant. Neuroimaging methods have been used for presurgical evaluation in recent years, including functional MRI, PET, and magnetoencephalography/magnetic source imaging. MSI has distinct advantages to the other imaging techniques in that it directly maps neuronal activity. This report describes our early experience with MSI in presurgical decision making with brain tumor patients at Minnesota Epilepsy Group, PA.

METHODS:
Four adult patients diagnosed with primary brain tumors underwent functional brain mapping with MSI (148-channel Magnes 2500 WH System, 4-D Neuroimaging, San Diego, CA) preoperatively using standard protocols for localization of language, somatosensory, and primary motor cortex. Data were analyzed using the single equivalent dipole model. Case 1 and Case 2 involved intra-axial, infiltrating tumors of the left frontal lobe, while Case 3 involved a similar lesion in the right frontal lobe. Case 4 had an extra-axial tumor originating from the midline, which appeared to be distorting the cortex.

RESULTS:
In Cases 1 and 2, MSI identified language cortex in close proximity to the tumor, including (for one patient) deep cortical areas not identified on cortical surface stimulation. In both cases, resection of the tumor was accomplished without creating a post-operative language deficit. In Case 3, a right frontal tumor was encroaching on primary motor cortex. MSI identified the margin of the motor area in relation to the tumor, allowing for maximal resection without causing any deficit. In Case 4, the somatosensory cortex was displaced by the tumor. The surgical approach was guided by
MSI data, and confirmed by intra-operative somatosensory mapping.  Following tumor resection, the patient recovered without deficit.

CONCLUSION:
MSI detects and maps the functional cortex in the sulcus. Cortical mapping delineates the superficial functional cortex. MSI plus cortical mapping can provide more accurate and complete functional information for surgical planning. This suggests the potential for practical clinical application of this new non-invasive technology to the presurgical evaluation of brain tumor cases on a routine basis.

Epilepsia 46(8);328[3.153]2005
Authors
Wenbo Zhang, MD, PhD
Deanna L. Dickens, MD
Mary Elizabeth Dunn, MD
Richard Gregory, MD
Keith Davies, MD
John R. Gates, MD

If you would like a complete copy of this abstract, please follow the link to the Minnesota Epilepsy Group website.

Following is a presentation made Gail L. Risse, PhD, at the 61st American Academy of Neurology Annual Meeting, Seattle, WA, April 25 – May 2, 2009

Magnetic Source Imaging (MSI) Activation Of The Mesial Temporal Lobe: Relationship To Wada Memory Performance: Gail L. Risse, PhD, Robert C. Doss, PsyD, Deanna L. Dickens, MD, Wenbo Zhang, MD, PhD

Following is a presentation made by Frank J. Ritter, MD, at the 22nd International Epilepsy Colloquium, Lyons, France, May 3 – 6, 2009:

MEG / MSI Evaluation of Previously Failed Epilepsy Surgery
Frank J. Ritter, MD, Wenbo Zhang, MD, PhD, Michael D. Frost, MD, Jason S. Doescher, MD, Joel Landsteiner, BA

If you are interested in obatining a copy of this research, please send us an e-mail at info@mnepilepsy.net.  We appreciate your interest.

Minnesota Epilepsy Group, the most comprehensive epilepsy treatment center in the Midwest, routinely participates in research that advances the quality of care delivered to pediatric and adult epilepsy patients.

Following is a list of presentations made by staff of Minnesota Epilepsy Group at the 63rd Annual Meeting of the American Epilepsy Society in Boston, MA, December 4 – 9, 2009:

Sylvian Fissure Symmetry And Magnetic Source Imaging (MSI) Determination Of Language Dominance:  Elisabeth Adams, PhD, Wenbo Zhang, MD, PhD, Frank J. Ritter, MD

Longitudinal Outcomes In Patients With Confirmed Non-Epileptic Seizures: Jason Bisping, MD, Robert C. Doss, PsyD, Patricia E. Penovich, MD

Psychogenic Non-Epileptic Seizures in Children: An Examination Of Individual And Family Stressors: Julia Doss, PsyD, Frank J. Ritter, MD

Auditory Naming Performance Is Related To the Degree Of Left Temporal Lobe Abnormality In Epilepsy Patients: Robert C. Doss, PsyD, Gail L. Risse, PhD

Treatment of Landau-Kleffner Syndrome With Pulse Dose Prednisone: Behavioral And Language Outcomes: Ann Hempel, PhD, Frank J. Ritter, MD, Michael D. Frost, MD

Corpus Callosotomy Outcomes: Defining the Criteria For Selection Of Patients Pre-Operatively For Either Partial Or Complete Callosotomy: Sonia Kalirao, MD, Julie E. Hanna, MD

Taking Care Of Women With Epilepsy: Are The Guidelines Being Followed?
Patricia E. Penovich, MD, Julie E. Hanna, MD

Activation of the Mesial Temporal Lobe Using Magnetic Source Imaging (MSI): Possible Relationship to Mesial Temporal Sclerosis And Wada Memory Performance: Gail L. Risse, PhD, Robert C. Doss, PsyD, Deanna L. Dickens, MD, Wenbo Zhang, MD, PhD

Receptive Language Mapping With Magnetic Source Imaging (MSI) And Electrical Cortical Stimulation: Wenbo Zhang, MD, PhD, Gail L. Risse, PhD, Joel Landsteiner, BA, Laura Peterson, Mary E. Dunn, MD, Frank J. Ritter, MD, Michael D. Frost, MD, Jason S. Doescher, MD, Patricia E. Penovich, MD, Robert C. Doss, PsyD, El-Hadi Mouderres, MD, Deanna L. Dickens, MD

If you are interested in obatining a copy of this research, please send us an e-mail at info@mnepilepsy.net.  We appreciate your interest.

Minnesota Epilepsy Group, the most comprehensive epilepsy treatment center in the Midwest, routinely participates in research that advances the quality of care delivered to pediatric and adult epilepsy patients.

CONTRALATERAL ABNORMALITIES PREDICT OUTCOME OF PEDIATRIC EPILEPSY SURGERY

Jason Doescher, MD
Frank J. Ritter, MD
Patricia E. Penovich, MD
Deanna L. Dickens, MD
Michael D. Frost, MD
Mary Beth Dunn, MD
Ann Hempel, PhD
John R. Gates, MD

This paper has been prepared specifically for the American Epilepsy Society Annual Meeting in Washington, DC, December 2 – 6, 2005.  Please consider this information to be preliminary findings.

Introduction:

Selection of pediatric epilepsy surgical candidates requires analysis of many variables to identify patients likely to significantly benefit with minimal complication. This retrospective review strengthens predictive trends between diagnostic variables and outcomes.

Methods:

We analyzed patients who underwent initial resective epilepsy surgery at Minnesota Epilepsy Group from January 2000 though December 2002. Seizure semiology, ictal/interictal scalp EEG, and MRI were analyzed on all patients. Neuropsychological testing, MRS, PET, and SPECT studies were reviewed if obtained in the presurgical investigation. PET studies utilized glucose, alpha-methyl-L-tryphtophan, and/or flumazenil isotopes. Diagnostic abnormalities were characterized by their lobar location and lateralization to the surgical resection. Lobar determinations included frontal, temporal, parietal, or occipital. Findings were categorized by support, neutrality or conflict with the region of resection. Neutral findings were ipsilateral but not in the region of resection. Any diffuse or contralateral abnormality to the region was defined as a conflicting variable. Diffuse cognitive dysfunction or mental retardation was the only variable excluded. Patients were scored at follow-up intervals of 6, 12, and 24 months following surgery using a Modified Engel classification, percent seizure reduction, change in neuropsychological status, and complication.

Results

Forty-six consecutive pediatric subjects were identified and reviewed. Demographic variables are presented in Table 1. Average age of epilepsy onset was 3.6 years and the average duration of epilepsy was 7 years prior to surgery. Monthly seizure frequency averaged 124. The number of presurgical AED averaged 5.1 and the average number of AED prescribed at the time of surgery was 2.2. These variables are listed in Table 2 based on Engel Classification at 24 months post-operatively.

The distribution of surgical procedures is presented in Figure 2. Surgery was performed on the dominant hemisphere in 39% and non-dominant hemisphere in 37% (Figure 1). Twenty-three (50%) underwent temporal lobe only resections. Extra-temporal resections included 10 (22%) frontal, 1 (3.4%) parietal, and 12 (31%) multi-lobar areas. Thirty-two of 46 patients had complete resection of determined epileptogenic region. Ten of 46 had functional overlap with region of resection and received partial resection. Four had partial resections due to other reasons.

In subjects with available follow-up data, 23/42 (55%) were seizure free at 12 months. At 24 months, 19/34 (56%) were seizure free. Temporal lobe only resections demonstrated seizure freedom in 13/21 (62%) at 12 months and in 12/17 (71%) at 24 months. Extra-temporal resections were associated with seizure freedom in 10/21 (48%) at 12 months and in 7/17 (41%) at 24 months. Age of epilepsy onset, duration, and etiology did not vary between outcome groups of Engel I-II versus Engel III-IV.

The average number of supporting diagnostic variables was 5.3, and the average number of conflicting variables was 1.3. The average number of neutral variables was 2.5. The average net (supporting – conflicting) was 3.8 variables.

Subjects with <2 diagnostic variables in conflict were significantly more likely to be in Engel I or II at 12 months (p <0.001) and 24 months (p <0.001) by Fischer’s Exact Test. Twenty-two of thirty (73%) subjects with <2 conflicting variables were seizure free at 12 months, and 5/30 (17%) were classified as Engel class II. At 24 months following surgery, 19/27 (70%) were seizure free and 5/27 (19%) were classified as Engel II. In subjects with 2 or more conflicting variables despite the number of supporting variables, only 1/12 (8%) was found to be seizure free at 12 months. None of the seven subjects with 2 or more conflicting variables were seizure free at 24 months. Supporting and neutral variables did not differ between the outcome groups.

The majority of conflicting variables were noted through scalp EEG recording, however conflicting MRI and neuropsychological variables also contributed to poor outcome.

To read the conclusions of this analysis and to find the tables referenced within this summary, please follow this link to the Minnesota Epilepsy Group website.  If you would like to schedule an appointment with one of our pediatric or adult epilepsy physicians, please give our office a call at 651-241-5290.

Levetiracetam Monotherapy

Minnesota Epilepsy Group, the most comprehensive epilepsy treatment center in the Midwest, routinely participates in research that advances the quality of care delivered to pediatric and adult epilepsy patients.

Authors
Beth Korby, RN C
Patricia E. Penovich, MD
John R. Gates, MD
Deanna L. Dickens, MD
Gerald L. Moriarty, MD

This paper has been prepared specifically for the American Epilepsy Society Annual Meeting in Boston, MA, December 5 – 10, 2003

Introduction
Keppra has been an effective add-on AED well tolerated by most patients. We have been using Keppra in monotherapy for some time. There have been no controlled trials and few reports of its efficacy in monotherapy. We reviewed our experience at Minnesota Epilepsy Group, P.A. of LEV-M over a 40 month period of time after LEV approval.

Methods
We reviewed the charts of 50 active adult patients who are or were on LEV-M for efficacy, AEs and behavioral problems (BP). We looked at dosages and levels to see if they had any correlation with outcomes. 9 of the 50 patients had primary CNS neoplasms. Their information was reviewed as a subgroup as well. IQ testing was not available on all patients. They ranged from profoundly retarded to highly functioning college educated adults. Patients were screened for the following BPs: irritability, aggression, change in mood, and psychosis.

Results
To read the results of this study, please follow the link for a complete copy of the abstract.  To learn more about Minnesota Epilepsy Group, please visit us on www.mnepilepsy.org!

Minnesota Epilepsy Group, the most comprehensive epilepsy treatment center in the Midwest, routinely participates in research that advances the quality of care delivered to pediatric and adult epilepsy patients.

How Many Palliative Surgical Procedures For Intractable Epilepsy?

Authors
Frank J. Ritter, MD
Michael D. Frost, MD
Willie T. Anderson, MD
John R. Gates, MD
Patricia E. Penovich, MD
Mary E. Dunn, MD

This abstract has been prepared specifically for the American Epilepsy Society Annual Meeting in Boston, MA, December 5 – 10, 2003.

INTRODUCTION
Corpus callosotomy and vagal nerve stimulation are palliative surgeries for patients with pharmacoresistant epilepsy. Although seizure freedom is ideal, there are patients for whom this is an unrealistic expectation. Many of these patients have frequent and/or severe seizures that disrupt their lives and may cause injury. These patients are
considered for palliative surgical procedures because they would benefit from a reduction in seizure frequency/severity. Whether the palliative surgical procedure is beneficial or not, some of theses patients continue to have seizures that disrupt their lives and /or cause injury. It is in this subset of patients that we have performed both palliative surgeries. This is a review of the outcomes following the surgeries to determine if the second palliative surgical procedure resulted in a decrease in seizure frequency or severity, decreased the number of antiepileptic medications taken, or subjectively improved quality of life. If there was an improvement in seizures or quality of life, we tried to determine if it was attributed to the surgical procedure.

METHODS
Files of all patients who had surgery were reviewed to find those who had both a corpus callosotomy and a vagal nerve stimulator. Patients with less than 12 months follow-up were excluded. The records were reviewed for the following: demographics, prior and current antiepileptic medications, other treatments, age at surgeries, seizure and epilepsy
syndrome, seizure frequency, results of surgery, length of follow-up, subjective evaluation of patients (parent/caregiver) quality of life. We defined a positive outcome for vagal nerve stimulator (VNS) as a 50% or greater decrease in the seizure type targeted. A positive outcome for corpus callosotomy (CC) was an 80% or greater
decrease in seizure frequency and a decrease in seizure severity of the seizure type targeted. Improvement was attributed to medication if there had been no improvement for 1 year following surgery and within the titration period of an additional medication there was a greater than 50% improvement in seizure control, and that improvement was
sustained for at least 6 months.

RESULTS
20 patients met inclusion criteria, 13 males, 7 females. Ninety percent, 18/20, had Lennox-Gastaut Syndrome, with multiple seizure types. Two had multifocal partial and secondarily generalize seizures. The patients had been treated with a median of 11 previous antiepileptic medications, 50% had an unsuccessful trial of the ketogenic diet.
They were taking an average of 3.5 antiepileptic medications. Seventy percent 14/20, had corpus callosotomy( 10 complete, 4 partial) prior to VNS, and 30%, 6/20, had VNS prior to CC(4 complete, 2 partial anterior).

To read the complete abstract, please follow the link provided.  To learn more about Minnesota Epilepsy Group, please visit us at www.mnepilepsy.org.