Jorge G Burneo

London Health Sciences Centre, London, Ontario, Canada

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Publications (121)480.35 Total impact

  • Jorge G Burneo · Nathalie Jette

    No preview · Article · Jan 2016 · Neurology
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    ABSTRACT: Objective: To assess the use of epilepsy surgery in patients with medically intractable epilepsy in a publicly funded universal health care system. Methods: We performed a population-based retrospective cohort study using linked health care databases for Ontario, Canada, between 2001 and 2010. We identified all patients with medically intractable epilepsy, defined as those with seizures that did not respond to at least 2 adequate trials of seizure medications. We assessed the proportion of patients who had epilepsy surgery within the following 2 years. We further identified the characteristics associated with epilepsy surgery. Results: A total of 10,661 patients were identified with medically intractable epilepsy (mean age 47 years, 51% male); most (74%) did not have other comorbidities. Within 2 years of being defined as medically intractable, only 124 patients (1.2%) underwent epilepsy surgery. Death occurred in 12% of those with medically intractable epilepsy. Those who underwent the procedure were younger and had fewer comorbidities compared to those who did not. Conclusion: In our setting of publicly funded universal health care, more than 10% of patients died within 2 years of developing medically intractable epilepsy. Epilepsy surgery may be an effective treatment for some patients; however, fewer than 2% of patients who may have benefited from epilepsy surgery received it.
    No preview · Article · Dec 2015 · Neurology
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    ABSTRACT: Objectives: Our aim is to assess the subfield-specific histopathological correlates of hippocampal volume and intensity changes (T1, T2) as well as diff!usion MRI markers in TLE, and investigate the efficacy of quantitative MRI measures in predicting histopathology in vivo. Experimental design: We correlated in vivo volumetry, T2 signal, quantitative T1 mapping, as well as diffusion MRI parameters with histological features of hippocampal sclerosis in a subfield-specific manner. We made use of on an advanced co-registration pipeline that provided a seamless integration of preoperative 3 T MRI with postoperative histopathological data, on which metrics of cell loss and gliosis were quantitatively assessed in CA1, CA2/3, and CA4/DG. Principal observations: MRI volumes across all subfields were positively correlated with neuronal density and size. Higher T2 intensity related to increased GFAP fraction in CA1, while quantitative T1 and diffusion MRI parameters showed negative correlations with neuronal density in CA4 and DG. Multiple linear regression analysis revealed that in vivo multiparametric MRI can predict neuronal loss in all the analyzed subfields with up to 90% accuracy. Conclusion: Our results, based on an accurate co-registration pipeline and a subfield-specific analysis of MRI and histology, demonstrate the potential of MRI volumetry, diffusion, and quantitative T1 as accurate in vivo biomarkers of hippocampal pathology. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · Dec 2015 · Human Brain Mapping
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    ABSTRACT: Purpose: MRI-based diagnosis of temporal lobe epilepsy (TLE) can be challenging when pathology is not visually evident due to low image contrast or small lesion size. Computer-assisted analyses are able to detect lesions common in a specific patient population, but most techniques do not address clinically relevant individual pathologies resulting from the heterogeneous etiology of the disease. We propose a novel method to supplement the radiological inspection of TLE patients ([Formula: see text]) providing patient-specific quantitative assessment. Method: Regions of interest are defined across the brain and volume, relaxometry, and diffusion features are extracted from them. Statistical comparisons between individual patients and a healthy control group ([Formula: see text]) are performed on these features, identifying and visualizing significant differences through individual feature maps. Four maps are created per patient showing differences in intensity, asymmetry, and volume. Results: Detailed reports were generated per patient. Abnormal hippocampal intensity and volume differences were detected in all patients diagnosed with mesial temporal sclerosis (MTS). Abnormal intensities in the temporal cortex were identified in patients with no MTS. A laterality score correctly distinguished left from right TLE in 12 out of 15 patients. Conclusion: The proposed focus on subject-specific quantitative changes has the potential of improving the assessment of TLE patients using MRI techniques, possibly even redefining current imaging protocols for TLE.
    No preview · Article · Nov 2015 · International Journal of Computer Assisted Radiology and Surgery

  • No preview · Article · Nov 2015 · The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
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    A. Prasad · J. Burneo · B. Corbett

    Full-text · Article · Oct 2015
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    ABSTRACT: Malformations of cortical development are disturbances in brain formation that arise from abnormalities affecting the processes of cortical development. Surgical treatment of intractable epilepsy in patients with malformations of cortical development requires localization of both epileptogenic and eloquent cortices. Functional magnetic resonance imaging has been shown to detect the reorganization of activation patterns in such patients. The purpose of this study was to determine whether functional reorganization of the primary sensory and motor cortices occurs in patients with epileptogenic malformations of cortical development. Functional MRI data were obtained for 11 patients (four male, seven female) with a mean age of 36 years (range 18-55 years). The mean age at epilepsy onset was 23 years (range 3-55 years). Twelve healthy controls (six male, six female) with mean age of 33 years (range 28-51 years) were also recruited for comparison. High resolution anatomical MRI was used to confirm the presence and the location of the malformation. All imaging experiments were performed using a 3.0T Siemens Tim Trio whole body MRI. Each subject performed four block-paradigm fMRI experiments to study motor and sensory activation for each hand. A total of 132 image sets were collected for each paradigm over 5.5min (2.5s per image). Each paradigm consisted of seven stimulus periods lasting 30s (12 images) and stimulus onset of 30, 90, 150, 210 and 270s. Functional data were obtained from all eligible patients and compared to those of controls. Reorganization and reduction in function in the motor and sensory areas were observed in patients with cortical dysplasia. Patients with polymicrogyria did not present with significant functional reorganization and patients with heterotopias and coexisting polymicrogyria and/or cortical dysplasia had variable patterns of activation. In summary, this study showed evidence of functional reorganization of sensory and motor cortices in patients with cortical dysplasia development. Such information should be carefully considered in surgical planning and treatment.
    No preview · Article · Sep 2015 · Epilepsy research
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    ABSTRACT: To characterize the association between commonly used anti-epileptic drugs (AEDs) and plasma lipid levels in patients with epilepsy. We sought observational studies that reported association between commonly used AEDs and plasma lipid levels in patients. The primary outcome was low-density lipoprotein (LDL) cholesterol. High-density lipoprotein (HDL), total cholesterol and triglyceride were secondary outcomes. The control group included healthy controls, pre-treatment patients or patients treated with other AEDs. We conducted a systematic search of major bibliographic databases and review of reference lists of primary articles and reviews. Primary comparisons of interest were: AED monotherapy vs. no AED use, monotherapy with one AED vs. other AED, and AED polytherapy vs. no AED use. 31 studies in 4126 people were identified. Carbamazepine, phenytoin and valproic acid were the most commonly studied drugs and were also implicated in causing considerable changes in plasma lipid levels in treated patients. There was an increase in LDL and total cholesterol levels with use of these three drugs; however, carbamazepine and phenytoin were also associated with higher levels of HDL. We could not identify one particular AED which was worse than the other in head-to-head comparison. We were unable to identify a particular polytherapy regimen that was worse than others. We found evidence to suggest that some AEDs may negatively alter lipids levels in patients with epilepsy. Both treating physicians and people with epilepsy need to be vigilant in managing their vascular risk factors to avoid vascular disease. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Apr 2015 · Epilepsy Research
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    ABSTRACT: Advances in MRI have the potential to improve surgical treatment of epilepsy through improved identification and delineation of lesions. However, validation is currently needed to investigate histopathological correlates of these new imaging techniques. The purpose of this work is to develop and evaluate a protocol for deformable image registration of in-vivo to ex-vivo resected brain specimen MRI. This protocol, in conjunction with our previous work on ex-vivo to histology registration, completes a registration pipeline for histology to in-vivo MRI, enabling voxel-based validation of novel and existing MRI techniques with histopathology. A combination of image-based and landmark-based 3D registration was used to register in-vivo MRI and the ex-vivo MRI from patients (N=10) undergoing epilepsy surgery. Target registration error (TRE) was used to assess accuracy and the added benefit of deformable registration. A mean TRE of 1.35±0.11 and 1.41±0.33mm was found for neocortical and hippocampal specimens respectively. Statistical analysis confirmed that the deformable registration significantly improved the registration accuracy for both specimens. Image registration of surgically resected brain specimens is a unique application which presents numerous technical challenges and that have not been fully addressed in previous literature. Our computed TRE are comparable to previous attempts tackling similar applications, as registering in-vivo MRI to whole brain or serial histology. The presented registration pipeline finds dense and accurate spatial correspondence between in-vivo MRI and histology and allows for the spatially-local and quantitative assessment of pathological correlates in MRI. Copyright © 2014. Published by Elsevier B.V.
    Full-text · Article · Dec 2014 · Journal of Neuroscience Methods
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    ABSTRACT: Objective To investigate the histopathological correlates of quantitative relaxometry and DTI and determine their efficacy in epileptogenic lesion detection for pre-operative evaluation of focal epilepsy. Methods We correlated quantitative relaxometry and DTI with histological features of neuronal density and morphology in 55 regions of the temporal lobe neocortex, selected from 13 patients who underwent epilepsy surgery. We made use of a validated non-rigid image registration protocol to obtain accurate correspondences between in-vivo MRI and histology images. Results We found T1 to be a predictor of neuronal density in the neocortical GM using linear mixed effects models with random effects for subjects. FA was a predictor of neuronal density of large-caliber neurons only (pyramidal cells, layers 3/5). Comparing multivariate to univariate mixed effects models with nested univariate demonstrated that employing T1 and FA together provided a significantly better fit than T1 or FA alone in predicting density of large-caliber neurons. Correlations with clinical variables revealed significant positive correlations between neuronal density with age (rs = 0.726, pfwe = 0.021). This study is the first to relate in-vivo T1 and FA values to the proportion of neurons in GM. Interpretation Our results suggest that quantitative T1 mapping and DTI may have a role in pre-operative evaluation of focal epilepsy and can be extended to identify gray matter pathology in a variety of neurological disorders. This article is protected by copyright. All rights reserved. Copyright © 2014 American Neurological Association.
    Full-text · Article · Nov 2014 · Annals of Neurology
  • Asuri N. Prasad · Jorge G. Burneo · Bradley Corbett
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    ABSTRACT: Purpose The purpose of this study was to analyze national survey data to provide estimates of prevalence of epilepsy and associated developmental disabilities and comorbid conditions. Methods We analyzed data from Cycle 3 of Canada's National Longitudinal Survey of Children and Youth. The NLSCY captured, socio-demographic information, as well as age, sex, education, ethnicity, household income, chronic health related conditions from birth to 15 years old. The main survey question intended to identify “epilepsy”, “cerebral palsy”, “intellectual disability”, “learning disability”, and “emotional and nervous difficulties” in the population of children surveyed. Prevalence was based on the national cross-sectional sample and used 1000 bootstrap weights to account for survey design factors. Results Cycle 3 of the NLSCY had the largest number of patients with diagnosed epilepsy. Prevalence figures (n/1000) for epilepsy and cerebral palsy (EPI_CP), epilepsy and intellectual disability (EPI_ID), epilepsy and learning disability (EPI_LD), and epilepsy and emotional nervous difficulties (EPI_EMO_NERV) were 1.1, 1.17, 2.58 and 1.34 respectively. Amongst children with epilepsy, 43.17% reported the presence of one or more of the above comorbid conditions. Conclusion These results provide an initial prevalence estimate of comorbid conditions with epilepsy in Canadian children. In a high proportion of children with epilepsy, the PMK had reported at least one comorbid disorder. These findings carry implications for health care utilization and long-term outcomes. We discuss methodological aspects related to the ascertainment of epilepsy in both surveys, and to the validity and implications of our findings.
    No preview · Article · Nov 2014 · Seizure
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    ABSTRACT: Purpose To assess the mortality related to epilepsy in Latin America Methods We searched MEDLINE, EMBASE, and LILACS from inception to December 2013 for articles evaluating mortality in patients with epilepsy in Latin America. Studies were included if they evaluated any mortality outcome, included a population of subjects with recurrent seizures or epilepsy, and contained original data analysis. Results The search strategy yielded 177 publications in MEDLINE and EMBASE, and 59 publications in LILACS; of which 18 met inclusion criteria for our overall review of epilepsy and mortality in Latin America. Most excluded studies did not report the mortality or lacked original data. We also included two references obtained from 2 non-systematic reviews fulfilling our inclusion criteria, and able to provide data for our analyses. Five studies reported Standardized Mortality Ratio (SMR), and demonstrated that people with epilepsy had a higher risk of death than the general population. The SMRs reported in two community based studies were 1.34 and 2.45. Conclusion The information about mortality in epilepsy in Latin America is very scarce. Comparisons cannot be made among studies due to methodological differences. More studies are needed.
    Full-text · Article · Oct 2014 · Seizure
  • J.G. Burneo · R Bartha · J Gati · A Parrent · D.A. Steven
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    ABSTRACT: Objective: Malformations of cortical development (MCD) are an increasingly recognized cause of medically intractable epilepsy. We assessed the role of fMRI in evaluating the motor and somatosensory cortices, as well as if there is possible reorganization of these vital areas in patients with polymicrogyria. Methods: We included 2 patients with polymicrogyria and epilepsy. Somatosensory and motor cortices were assessed with a 4T fMRI. These findings were compared with direct cortical stimulation. Results: Localization of the sensorimotor cortices was adequately identified by fMRI. These vital areas did not reorganize outside the malformation of cortical development. Conclusion: fMRI is a tool that can allow identification of these vital areas of the brain in a non-invasive manner.
    No preview · Article · Jul 2014 · Clinical Neurology and Neurosurgery
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    ABSTRACT: Background: Epilepsy is a common medical condition for which physicians perform driver fitness assessments. The Canadian Medical Association (CMA) and the Canadian Council of Motor Transportation Administrators (CCMTA) publish documents to guide Canadian physicians' driver fitness assessments. Objectives: We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions. Methods: We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians' philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. Of the nine scenarios, CCMTA and CMA recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. Agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test. Results: Overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). For the two scenarios where CMA and CCMTA guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). A majority of specialists disagreed with CMA recommendations in three of seven discordant scenarios. The lack of consistency in respondents' agreement attained statistical significance (p<0.001). Conclusions: Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMA and CCMTA medical fitness guidelines. This study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada.
    Full-text · Article · Jul 2014 · The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
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    Jorge G Burneo · Jose E Cavazos

    Full-text · Article · Jun 2014 · Epilepsy Currents
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    ABSTRACT: We compared clinical characteristics of seizures at ischemic stroke presentation (SSP) to seizures during hospitalization post ischemic stroke (SDH), and their impacts on stroke outcome, using the Registry of the Canadian Stroke Network (RCSN) database. This cohort study included consecutive patients from the RCSN who had an acute ischemic stroke between July 2003 and March 2008. Outcome measures included morbidity, mortality, length of hospital stay, and discharge disposition. Clinical variables for either SSP or SDH were investigated and the stroke outcome was stratified by stroke severity. The study included 10,261 patients with ischemic strokes: 157 patients (1.53%) had SSP and 208 patients (2.03%) had SDH. Compared to stroke patients without seizures, patients with SSP and SDH were younger, had more severe strokes (p < 0.001), a higher admission rate to the intensive care unit (p < 0.001), higher morbidity, and higher mortality (p < 0.05). SSP was associated with female sex and less limb weakness, while SDH was associated with pneumonia and the presence of hemineglect. Importantly, patients with less severe strokes had higher morbidity and mortality (p < 0.005) if SDH occurred. Variables predicting overall mortality were SDH, older age, higher Charlson-Deyo index, more severe strokes, and nonalert status on arrival (all p < 0.001). SSP and SDH have different characteristics. SDH indicates a poorer prognosis in patients. Increased awareness of SSP and efforts to prevent SDH may be important in improving outcomes following clinical stroke care.
    Full-text · Article · Jan 2014 · Neurology
  • J.G. Burneo · R. Bartha · J. Gati · A. Parrent · D.A. Steven
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    ABSTRACT: Objective Malformations of cortical development (MCD) are an increasingly recognized cause of medically intractable epilepsy. We assessed the role of fMRI in evaluating the motor and somatosensory cortices, as well as if there is possible reorganization of these vital areas in patients with polymicrogyria. Methods We included 2 patients with polymicrogyria and epilepsy. Somatosensory and motor cortices were assessed with a 4 T fMRI. These findings were compared with direct cortical stimulation. Results Localization of the sensorimotor cortices was adequately identified by fMRI. These vital areas did not reorganize outside the malformation of cortical development. Conclusion fMRI is a tool that can allow identification of these vital areas of the brain in a non-invasive manner. Practice implications Adequate localization of the sensorimotor cortices is important for optimal patient selection, surgical strategy, and to determine the maximal extent of the resection. The clinical implications for such understanding are not limited to it; these findings should help researchers understand more of the neurobiology of MCDs and even possibly clues to the mechanisms of epileptogenesis associated with such malformations.
    No preview · Article · Jan 2014

  • No preview · Article · Dec 2013 · Epilepsy Currents
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    ABSTRACT: Seizure recurrence after epilepsy surgery has been classified as either early or late depending on the recurrence time after operation. However, time of recurrence is variable and has been arbitrarily defined in the literature. We established a mathematical model for discriminating patients with early or late seizure recurrence, and examined differences between these two groups. A historical cohort of 247 consecutive patients treated surgically for temporal lobe epilepsy was identified. In patients who recurred, postoperative time until seizure recurrence was examined using an receiver-operating characteristic (ROC) curve to determine the best cutoff for predicting long-term prognosis, dividing patients in those with early and those with late seizure recurrence. We then compared the groups in terms of a number of clinical, electrophysiologic, and radiologic variables. Seizures recurred in 107 patients (48.9%). The ROC curve demonstrated that 6 months was the ideal time for predicting long-term surgical outcome with best accuracy, (area under the curve [AUC] = 0.761; sensitivity = 78.8%; specificity = 72.1%). We observed that patients with seizure recurrence during the first 6 months started having seizures at younger age (odds ratio [OR] = 6.03; 95% confidence interval [CI] = 1.06-11.01; p = 0.018), had a worse outcome (OR = 6.85; 95% CI = 2.54-18.52; p = 0.001), needed a higher number of antiepileptic medications (OR = 2.07; 95% CI = 1.16-9.34; p = 0.013), and more frequently had repeat surgery (OR = 9.59; 95% CI = 1.18-77.88; p = 0.021). Patients with late relapse more frequently had seizures associated with trigger events (OR = 9.61; 95% CI = 3.52-26.31; p < 0.01). Patients with early or late recurrence of seizures have different characteristics that might reflect diversity in the epileptogenic zone and epileptogenicity itself. These disparities might help explain variable patterns of seizure recurrence after epilepsy surgery.
    No preview · Article · Nov 2013 · Epilepsia
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    ABSTRACT: OBJECTIVE: To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. METHOD: A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. RESULTS: The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. RECOMMENDATIONS: Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U).
    Full-text · Article · Oct 2013 · Neurology

Publication Stats

2k Citations
480.35 Total Impact Points


  • 2013-2015
    • London Health Sciences Centre
      • Department of Clinical Neurological Sciences
      London, Ontario, Canada
  • 2012-2015
    • Western University
      London, Ontario, Canada
  • 2004-2015
    • The University of Western Ontario
      • • Department of Clinical Neurological Sciences
      • • Department of Epidemiology and Biostatistics
      London, Ontario, Canada
  • 2001-2009
    • University of Alabama at Birmingham
      • • Department of Pediatrics
      • • Department of Neurology
      Birmingham, Alabama, United States
  • 2007
    • NYU Langone Medical Center
      New York, New York, United States
  • 2006
    • Government of Ontario, Canada
      Guelph, Ontario, Canada
  • 2002-2004
    • University of Alabama
      Tuscaloosa, Alabama, United States