Browsing by Author "Ibrahim, George M."

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    Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: A post hoc analysis of the HOPS study
    (2021) Fallah, Aria; Lewis, Evan; Ibrahim, George M.; Kola, Olivia; Tseng, Chi-Hong; Harris, William B.; Chen, Jia-Shu; Lin, Kao-Min; Cai, Li-Xin; Liu, Qing-Zhu; Lin, Jiu-Luan; Zhou, Wen-Jing; Mathern, Gary W.; Smyth, Matthew D.; O'Neill, Brent R.; Dudley, Roy W. R.; Ragheb, John; Bhatia, Sanjiv; Delev, Daniel; Ramantani, Georgia; Zentner, Josef; Wang, Anthony C.; Dorfer, Christian; Feucht, Martha; Czech, Thomas; Bollo, Robert J.; Issabekov, Galymzhan; Zhu, Hongwei; Connolly, Mary; Steinbok, Paul; Zhang, Jian-Guo; Zhang, Kai; Hidalgo, Eveline Teresa; Weiner, Howard L.; Wong-Kisiel, Lily; Lapalme-Remis, Samuel; Tripathi, Manjari; Chandra, Poodipedi Sarat; Hader, Walter; Wang, Feng-Peng; Yao, Yi; Champagne, Pierre-Olivier; Brunette-Clement, Tristan; Guo, Qiang; Li, Shao-Chun; Budke, Marcelo; Perez-Jimenez, Maria Angeles; Raftopoulos, Christian; Finet, Patrice; Michel, Pauline; Schaller, Karl; Stienen, Martin N.; Baro, Valentina; Malone, Christian Cantillano; Pociecha, Juan; Chamorro, Noelia; Muro, Valeria L.; von Lehe, Marec; Vieker, Silvia; Oluigbo, Chima; Gaillard, William D.; Al-Khateeb, Mashael; Al Otaibi, Faisal; Krayenbuhl, Niklaus; Bolton, Jeffrey; Pearl, Phillip L.; Weil, Alexander G.
    Objective This study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom. Methods We conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-event method and calculated using the Kaplan-Meier survival method. Results Data for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittal hemispherotomy and 600 (89.3%) underwent lateral peri-insular/peri-Sylvian or trans-Sylvian hemispherotomy. Seizure freedom was obtained in 62.4% (95% confidence interval [CI] = 53.5%-70.2%) of the entire cohort at 10-year follow-up. Seizure freedom was 88.8% (95% CI = 78.9%-94.3%) at 1-year follow-up and persisted at 85.5% (95% CI = 74.7%-92.0%) across 5- and 10-year follow-up in the vertical subgroup. In contrast, seizure freedom decreased from 89.2% (95% CI = 86.3%-91.5%) at 1-year to 72.1% (95% CI = 66.9%-76.7%) at 5-year to 57.2% (95% CI = 46.6%-66.4%) at 10-year follow-up for the lateral subgroup. Log-rank test found that vertical hemispherotomy was associated with durable seizure-free progression compared to the lateral approach (p = .01). Patients undergoing the lateral hemispherotomy technique had a shorter time-to-seizure recurrence (hazard ratio = 2.56, 95% CI = 1.08-6.04, p = .03) and increased seizure recurrence odds (odds ratio = 3.67, 95% CI = 1.05-12.86, p = .04) compared to those undergoing the vertical hemispherotomy technique. Significance This pilot study demonstrated more durable seizure freedom of the vertical technique compared to lateral hemispherotomy techniques. Further studies, such as prospective expertise-based observational studies or a randomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long-term seizure outcomes.
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    Development of an online calculator for the prediction of seizure freedom following pediatric hemispherectomy using the Hemispherectomy Outcome Prediction Scale (HOPS)
    (2024) Weil, Alexander G.; Dimentberg, Evan; Lewis, Evan; Ibrahim, George M.; Kola, Olivia; Tseng, Chi-Hong; Chen, Jia-Shu; Lin, Kao-Min; Cai, Li-Xin; Liu, Qing-Zhu; Lin, Jiu-Luan; Zhou, Wen-Jing; Mathern, Gary W.; Smyth, Matthew D.; O'Neill, Brent R.; Dudley, Roy; Ragheb, John; Bhatia, Sanjiv; Delev, Daniel; Ramantani, Georgia; Zentner, Josef; Wang, Anthony C.; Dorfer, Christian; Feucht, Martha; Czech, Thomas; Bollo, Robert J.; Issabekov, Galymzhan; Zhu, Hongwei; Connolly, Mary; Steinbok, Paul; Zhang, Jian-Guo; Zhang, Kai; Hidalgo, Eveline Teresa; Weiner, Howard L.; Wong-Kisiel, Lily; Lapalme-Remis, Samuel; Tripathi, Manjari; Sarat Chandra, Poodipedi; Hader, Walter; Wang, Feng-Peng; Yao, Yi; Champagne, Pierre Olivier; Brunette-Clement, Tristan; Guo, Qiang; Li, Shao-Chun; Budke, Marcelo; Perez-Jimenez, Maria Angeles; Raftopoulos, Christian; Finet, Patrice; Michel, Pauline; Schaller, Karl; Stienen, Martin N.; Baro, Valentina; Cantillano Malone, Christian; Pociecha, Juan; Chamorro, Noelia; Muro, Valeria L.; von Lehe, Marec; Vieker, Silvia; Oluigbo, Chima; Gaillard, William D.; Al Khateeb, Mashael; Al Otaibi, Faisal; Krayenbuhl, Niklaus; Bolton, Jeffrey; Pearl, Phillip L.; Fallah, Aria
    ObjectivesAlthough hemispheric surgeries are among the most effective procedures for drug-resistant epilepsy (DRE) in the pediatric population, there is a large variability in seizure outcomes at the group level. A recently developed HOPS score provides individualized estimation of likelihood of seizure freedom to complement clinical judgement. The objective of this study was to develop a freely accessible online calculator that accurately predicts the probability of seizure freedom for any patient at 1-, 2-, and 5-years post-hemispherectomy.MethodsRetrospective data of all pediatric patients with DRE and seizure outcome data from the original Hemispherectomy Outcome Prediction Scale (HOPS) study were included. The primary outcome of interest was time-to-seizure recurrence. A multivariate Cox proportional-hazards regression model was developed to predict the likelihood of post-hemispheric surgery seizure freedom at three time points (1-, 2- and 5- years) based on a combination of variables identified by clinical judgment and inferential statistics predictive of the primary outcome. The final model from this study was encoded in a publicly accessible online calculator on the International Network for Epilepsy Surgery and Treatment (iNEST) website ().ResultsThe selected variables for inclusion in the final model included the five original HOPS variables (age at seizure onset, etiologic substrate, seizure semiology, prior non-hemispheric resective surgery, and contralateral fluorodeoxyglucose-positron emission tomography [FDG-PET] hypometabolism) and three additional variables (age at surgery, history of infantile spasms, and magnetic resonance imaging [MRI] lesion). Predictors of shorter time-to-seizure recurrence included younger age at seizure onset, prior resective surgery, generalized seizure semiology, FDG-PET hypometabolism contralateral to the side of surgery, contralateral MRI lesion, non-lesional MRI, non-stroke etiologies, and a history of infantile spasms. The area under the curve (AUC) of the final model was 73.0%.SignificanceOnline calculators are useful, cost-free tools that can assist physicians in risk estimation and inform joint decision-making processes with patients and families, potentially leading to greater satisfaction. Although the HOPS data was validated in the original analysis, the authors encourage external validation of this new calculator.
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    Hemispherectomy Outcome Prediction Scale: Development and validation of a seizure freedom prediction tool
    (2021) Weil, Alexander G.; Lewis, Evan C.; Ibrahim, George M.; Kola, Olivia; Tseng, Chi-Hong; Zhou, Xinkai; Lin, Kao-Min; Cai, Li-Xin; Liu, Qing-Zhu; Lin, Jiu-Luan; Zhou, Wen-Jing; Mathern, Gary W.; Smyth, Matthew D.; O'Neill, Brent R.; Dudley, Roy; Ragheb, John; Bhatia, Sanjiv; Delev, Daniel; Ramantani, Georgia; Zentner, Josef; Ojemann, Jeffrey; Wang, Anthony C.; Dorfer, Christian; Feucht, Martha; Czech, Thomas; Bollo, Robert J.; Issabekov, Galymzhan; Zhu, Hongwei; Connelly, Mary; Steinbok, Paul; Zhang, Jian-Guo; Zhang, Kai; Hidalgo, Eveline Teresa; Weiner, Howard L.; Wong-Kisiel, Lily; Lapalme-Remis, Samuel; Tripathi, Manjari; Sarat Chandra, Poodipedi; Hader, Walter; Wang, Feng-Peng; Yao, Yi; Olivier Champagne, Pierre; Guo, Qiang; Li, Shao-Chun; Budke, Marcelo; Perez-Jimenez, Maria Angeles; Raftapoulos, Christian; Finet, Patrice; Michel, Pauline; Schaller, Karl; Stienen, Martin N.; Baro, Valentina; Cantillano Malone, Christian; Pociecha, Juan; Chamorro, Noelia; Muro, Valeria L.; von Lehe, Marec; Vieker, Silvia; Oluigbo, Chima; Gaillard, William D.; Al Khateeb, Mashael; Al Otaibi, Faisal; Krayenbuhl, Niklaus; Bolton, Jeffrey; Pearl, Phillip L.; Fallah, Aria
    Objective To develop and validate a model to predict seizure freedom in children undergoing cerebral hemispheric surgery for the treatment of drug-resistant epilepsy.