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Papers by Zebunnessa Rahman

Research paper thumbnail of Localisation and stimulation of the parietal eye field

Epileptic Disorders

Localisation of the human parietal eye fields (PEF) has not been as well studied as the human fro... more Localisation of the human parietal eye fields (PEF) has not been as well studied as the human frontal eye fields (FEF). Stimulation studies in rhesus monkeys have suggested the localisation of the PEF to be within the intraparietal sulcus. Functional MRI studies have demonstrated this region to be highly active and potentially connected in saccadic and gaze shifting tasks. Here, we present a case of a patient with left versive seizures evaluated with SEEG, in whom electrical stimulation within the right intraparietal sulcus resulted in horizontal and downward conjugate eye movements contralateral to stimulation. We illustrate clinical differences between the FEF and PEF on cortical stimulation. In addition to the frontal eye field, it is important to recognise other cortical regions involved in eye movement which can cause conjugate contralateral eye movement.

Research paper thumbnail of ‘The epileptology of primary brain tumours’: A study of the nature and impact of epilepsy, seizure outcome and the feasibility of using t ranscranial magnetic s timulation as a biomarker of treatment res po nse in patients with a primary brain tumour

University of Sydney, Aug 17, 2020

Research paper thumbnail of Investigating the Precise Localization of the Grasping Action in the Mid-Cingulate Cortex and Future Directions

Frontiers in Human Neuroscience, 2022

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the graspin... more ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients (n = 23) with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients (male: female 4:1; median age 31) exhibited contralateral grasping actions during electrical stimulation. All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure (VAC) line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex (MCC) di...

Research paper thumbnail of O-EG002. 8-Year experience of stereoelectroencephalography at Westmead Hospital and the Children’s Hospital at Westmead

Clinical Neurophysiology, 2021

Research paper thumbnail of Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit

Journal of Clinical Neuroscience, 2018

Background: Sudden Unexpected Death in Epilepsy Patients (SUDEP), a phenomenon in which postmorte... more Background: Sudden Unexpected Death in Epilepsy Patients (SUDEP), a phenomenon in which postmortem analysis does not reveal a structural or toxicological cause for death, is one of the leading causes of death in epilepsy patients. Regions of the brain that regulate autonomic functions have been thought to play a role in the onset of SUDEP.

Research paper thumbnail of Reduced complications from intracranial grid insertion by using a small grid size and a precise protocol during monitoring

Acta Neurochirurgica, 2015

A study of the risk factors associated with complications during intracranial EEG monitoring led ... more A study of the risk factors associated with complications during intracranial EEG monitoring led to a change in protocol for monitoring and implantation at our centres. We conducted a study to identify any reduction in complications following the changed protocols involving the use of smaller subdural electrode arrays, continuous ICP monitoring, use of a central line, and intake of prophylactic antibiotics and dexamethasone. We prospectively collected data on patient outcomes between 2005 and 2012 (group B) compared with patients between 1988 and 2004 (group A) before the protocol changes. Seventy-one patients in group A and 58 patients in group B underwent intracranial electrode implantation. Complications directly related to grids occurred in 25 % of group A vs. 8.6 % in group B (p < 0.05) and those indirectly related to grids were 11.2 % in group A vs. none in group B. The rate of transient complications requiring no treatment was 12.5 % in group A versus 1.7 % in group B. The rate of transient complications requiring treatment was 10 % in group A and 6.9 % in group B. There were two deaths in group A. The infection rate was higher in group B than group A (5.2 % vs. 2.8 %; p = 0.90). Since 2008 there have been no infective complications. Complications directly related to intracranial EEG monitoring were significantly reduced using the revised protocol (p < 0.05). Regression analysis identifying only the size of the grids (≤4 × 8 grid arrays) implanted was an independent predictor of more complications in group A (P < 0.05). Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol.

Research paper thumbnail of Epilepsy in patients with primary brain tumors: The impact on mood, cognition, and HRQOL

Epilepsy & behavior : E&B, 2015

A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impa... more A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impact on health-related quality of life (HRQOL). Presence of epilepsy and adverse reactions from tumor and epilepsy treatments may cause additional decline in HRQOL. We aimed to study the impact of epileptic seizures on cognition, mood, and HRQOL in patients with brain tumor-related epilepsy. Patients were grouped on an ordinal scale according to epilepsy burden from none to severe based on the presence of epileptic seizures and seizure frequency: L1, no epilepsy; L2, with epilepsy, seizure-free in the last 6months with antiepileptic drugs; and L3, with epilepsy, at least one seizure in the last 6months with AEDs. Health-related quality of life was measured by Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Quality of Life in Epilepsy-31 (QOLIE-31) tools, cognition by the Montreal Cognitive Assessment (MoCA) tool and Frontal Assessment Battery (FAB), mood by the Hospital Anxiety...

Research paper thumbnail of A study of perfusion changes with Insula Epilepsy using SPECT

Seizure, 2019

The non-invasive localisation of insular lobe epilepsy is a challenge. We aimed to determine if i... more The non-invasive localisation of insular lobe epilepsy is a challenge. We aimed to determine if ictal SPECT is a reliable adjunctive test in insular cases and to explore its role in the tailoring of intracranial strategies. Method: From a dataset of patients who underwent SEEG between December 2012 and December 2016, we collected patients with focal insular onset epilepsy. We examined semiology, EEG, PET and SPECT hyperperfusion pattern with SISCOM. We also reviewed relevant literature. Results: 5 patients were identified, 4 females, from a dataset of 51 patients. Median age of seizure onset was 8 years old (8 months to 10 years). All patients had an ictal SPECT during pre-surgical work-up: median injection time was 7 s (3-17 sec) from clinical onset, and median seizure duration was 42 s (11-85 sec). Insula cortex showed focal hyperaemia in four patients, all bilateral, with the greatest hyperperfusion contralateral to the ictal onset in two cases, using SISCOM threshold at 1.5 standard deviation. Other sites with hyperaemia included basal ganglia and middle temporal gyrus. The SEEG confirmed insular onset seizures in all the cases. All patients had epilepsy surgery and were seizure free at 21 to 50 months follow up. The results from the literature review showed frequent hyperperfusion in structures outside insula and frequently over the contralateral hemisphere. Conclusions: This study highlights the technical limitations of SPECT when attempting to assess seizures arising from the insula. Our findings and the literature show ictal SPECT can be localising but falsely lateralising in seizures arising from the insula.

Research paper thumbnail of The yield and clinical utility of outpatient short-term video-electroencephalographic monitoring: A five-year retrospective study

Epilepsy & Behavior, 2012

Outpatient short-term video-electroencephalographic monitoring (OVEM) is recognized as a useful t... more Outpatient short-term video-electroencephalographic monitoring (OVEM) is recognized as a useful tool in the diagnosis of epilepsy and other paroxysmal disorders. The aim of this retrospective study was to determine the diagnostic yield of OVEM. We analyzed 175 OVEM records of adults (111 females and 64 males) referred over a period of 5 years. The mean length of recording was 3.8 h. The highest yield was found in psychogenic nonepileptic seizures (PNES) (37.1%), followed by interictal epileptiform discharges (17.2%), and epileptic seizures (6.9%). The provisional diagnosis was epilepsy in 77.7% and PNES in 22.3% before the test. Outpatient short-term video-electroencephalographic monitoring changed the pre-test diagnosis in 30.9% of patients. Outpatient short-term video-electroencephalographic monitoring is a useful diagnostic test for PNES. It has a higher yield for PNES than epilepsy.

Research paper thumbnail of Myoclonic status epilepticus as a presentation of caspr2 antibody‐associated autoimmune encephalitis

Epileptic Disorders International Epilepsy Journal With Videotape, Dec 1, 2014

We present a case of autoimmune encephalitis associated with antibodies targeting contactin-assoc... more We present a case of autoimmune encephalitis associated with antibodies targeting contactin-associated protein-like 2. This case is notable because of the presentation with myoclonic status epilepticus and the prolonged clinical course of refractory seizures, which are demonstrated in the accompanying videos, and not previously associated with this condition. Treatment with prednisone, intravenous immunoglobulin, plasma exchange, rituximab, cyclophosphamide, and mycophenolate mofetil resulted in significant functional improvement. Historically, myoclonic status epilepticus is associated with a grave prognosis and minimal chance of meaningful recovery. This case demonstrates that autoimmune encephalitis remains an important differential diagnosis in patients with such a presentation, and that early recognition and the appropriate institution of immunotherapy can result in seizure control and functional recovery.

Research paper thumbnail of Localisation and stimulation of the parietal eye field

Epileptic Disorders

Localisation of the human parietal eye fields (PEF) has not been as well studied as the human fro... more Localisation of the human parietal eye fields (PEF) has not been as well studied as the human frontal eye fields (FEF). Stimulation studies in rhesus monkeys have suggested the localisation of the PEF to be within the intraparietal sulcus. Functional MRI studies have demonstrated this region to be highly active and potentially connected in saccadic and gaze shifting tasks. Here, we present a case of a patient with left versive seizures evaluated with SEEG, in whom electrical stimulation within the right intraparietal sulcus resulted in horizontal and downward conjugate eye movements contralateral to stimulation. We illustrate clinical differences between the FEF and PEF on cortical stimulation. In addition to the frontal eye field, it is important to recognise other cortical regions involved in eye movement which can cause conjugate contralateral eye movement.

Research paper thumbnail of ‘The epileptology of primary brain tumours’: A study of the nature and impact of epilepsy, seizure outcome and the feasibility of using t ranscranial magnetic s timulation as a biomarker of treatment res po nse in patients with a primary brain tumour

University of Sydney, Aug 17, 2020

Research paper thumbnail of Investigating the Precise Localization of the Grasping Action in the Mid-Cingulate Cortex and Future Directions

Frontiers in Human Neuroscience, 2022

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the graspin... more ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients (n = 23) with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients (male: female 4:1; median age 31) exhibited contralateral grasping actions during electrical stimulation. All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure (VAC) line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex (MCC) di...

Research paper thumbnail of O-EG002. 8-Year experience of stereoelectroencephalography at Westmead Hospital and the Children’s Hospital at Westmead

Clinical Neurophysiology, 2021

Research paper thumbnail of Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit

Journal of Clinical Neuroscience, 2018

Background: Sudden Unexpected Death in Epilepsy Patients (SUDEP), a phenomenon in which postmorte... more Background: Sudden Unexpected Death in Epilepsy Patients (SUDEP), a phenomenon in which postmortem analysis does not reveal a structural or toxicological cause for death, is one of the leading causes of death in epilepsy patients. Regions of the brain that regulate autonomic functions have been thought to play a role in the onset of SUDEP.

Research paper thumbnail of Reduced complications from intracranial grid insertion by using a small grid size and a precise protocol during monitoring

Acta Neurochirurgica, 2015

A study of the risk factors associated with complications during intracranial EEG monitoring led ... more A study of the risk factors associated with complications during intracranial EEG monitoring led to a change in protocol for monitoring and implantation at our centres. We conducted a study to identify any reduction in complications following the changed protocols involving the use of smaller subdural electrode arrays, continuous ICP monitoring, use of a central line, and intake of prophylactic antibiotics and dexamethasone. We prospectively collected data on patient outcomes between 2005 and 2012 (group B) compared with patients between 1988 and 2004 (group A) before the protocol changes. Seventy-one patients in group A and 58 patients in group B underwent intracranial electrode implantation. Complications directly related to grids occurred in 25 % of group A vs. 8.6 % in group B (p < 0.05) and those indirectly related to grids were 11.2 % in group A vs. none in group B. The rate of transient complications requiring no treatment was 12.5 % in group A versus 1.7 % in group B. The rate of transient complications requiring treatment was 10 % in group A and 6.9 % in group B. There were two deaths in group A. The infection rate was higher in group B than group A (5.2 % vs. 2.8 %; p = 0.90). Since 2008 there have been no infective complications. Complications directly related to intracranial EEG monitoring were significantly reduced using the revised protocol (p < 0.05). Regression analysis identifying only the size of the grids (≤4 × 8 grid arrays) implanted was an independent predictor of more complications in group A (P < 0.05). Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol.

Research paper thumbnail of Epilepsy in patients with primary brain tumors: The impact on mood, cognition, and HRQOL

Epilepsy & behavior : E&B, 2015

A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impa... more A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impact on health-related quality of life (HRQOL). Presence of epilepsy and adverse reactions from tumor and epilepsy treatments may cause additional decline in HRQOL. We aimed to study the impact of epileptic seizures on cognition, mood, and HRQOL in patients with brain tumor-related epilepsy. Patients were grouped on an ordinal scale according to epilepsy burden from none to severe based on the presence of epileptic seizures and seizure frequency: L1, no epilepsy; L2, with epilepsy, seizure-free in the last 6months with antiepileptic drugs; and L3, with epilepsy, at least one seizure in the last 6months with AEDs. Health-related quality of life was measured by Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Quality of Life in Epilepsy-31 (QOLIE-31) tools, cognition by the Montreal Cognitive Assessment (MoCA) tool and Frontal Assessment Battery (FAB), mood by the Hospital Anxiety...

Research paper thumbnail of A study of perfusion changes with Insula Epilepsy using SPECT

Seizure, 2019

The non-invasive localisation of insular lobe epilepsy is a challenge. We aimed to determine if i... more The non-invasive localisation of insular lobe epilepsy is a challenge. We aimed to determine if ictal SPECT is a reliable adjunctive test in insular cases and to explore its role in the tailoring of intracranial strategies. Method: From a dataset of patients who underwent SEEG between December 2012 and December 2016, we collected patients with focal insular onset epilepsy. We examined semiology, EEG, PET and SPECT hyperperfusion pattern with SISCOM. We also reviewed relevant literature. Results: 5 patients were identified, 4 females, from a dataset of 51 patients. Median age of seizure onset was 8 years old (8 months to 10 years). All patients had an ictal SPECT during pre-surgical work-up: median injection time was 7 s (3-17 sec) from clinical onset, and median seizure duration was 42 s (11-85 sec). Insula cortex showed focal hyperaemia in four patients, all bilateral, with the greatest hyperperfusion contralateral to the ictal onset in two cases, using SISCOM threshold at 1.5 standard deviation. Other sites with hyperaemia included basal ganglia and middle temporal gyrus. The SEEG confirmed insular onset seizures in all the cases. All patients had epilepsy surgery and were seizure free at 21 to 50 months follow up. The results from the literature review showed frequent hyperperfusion in structures outside insula and frequently over the contralateral hemisphere. Conclusions: This study highlights the technical limitations of SPECT when attempting to assess seizures arising from the insula. Our findings and the literature show ictal SPECT can be localising but falsely lateralising in seizures arising from the insula.

Research paper thumbnail of The yield and clinical utility of outpatient short-term video-electroencephalographic monitoring: A five-year retrospective study

Epilepsy & Behavior, 2012

Outpatient short-term video-electroencephalographic monitoring (OVEM) is recognized as a useful t... more Outpatient short-term video-electroencephalographic monitoring (OVEM) is recognized as a useful tool in the diagnosis of epilepsy and other paroxysmal disorders. The aim of this retrospective study was to determine the diagnostic yield of OVEM. We analyzed 175 OVEM records of adults (111 females and 64 males) referred over a period of 5 years. The mean length of recording was 3.8 h. The highest yield was found in psychogenic nonepileptic seizures (PNES) (37.1%), followed by interictal epileptiform discharges (17.2%), and epileptic seizures (6.9%). The provisional diagnosis was epilepsy in 77.7% and PNES in 22.3% before the test. Outpatient short-term video-electroencephalographic monitoring changed the pre-test diagnosis in 30.9% of patients. Outpatient short-term video-electroencephalographic monitoring is a useful diagnostic test for PNES. It has a higher yield for PNES than epilepsy.

Research paper thumbnail of Myoclonic status epilepticus as a presentation of caspr2 antibody‐associated autoimmune encephalitis

Epileptic Disorders International Epilepsy Journal With Videotape, Dec 1, 2014

We present a case of autoimmune encephalitis associated with antibodies targeting contactin-assoc... more We present a case of autoimmune encephalitis associated with antibodies targeting contactin-associated protein-like 2. This case is notable because of the presentation with myoclonic status epilepticus and the prolonged clinical course of refractory seizures, which are demonstrated in the accompanying videos, and not previously associated with this condition. Treatment with prednisone, intravenous immunoglobulin, plasma exchange, rituximab, cyclophosphamide, and mycophenolate mofetil resulted in significant functional improvement. Historically, myoclonic status epilepticus is associated with a grave prognosis and minimal chance of meaningful recovery. This case demonstrates that autoimmune encephalitis remains an important differential diagnosis in patients with such a presentation, and that early recognition and the appropriate institution of immunotherapy can result in seizure control and functional recovery.