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Gales JM, Prayson RA. Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy. Hum Pathol 2016; 48:111-6. [DOI: 10.1016/j.humpath.2015.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
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Hutchings F, Han CE, Keller SS, Weber B, Taylor PN, Kaiser M. Predicting Surgery Targets in Temporal Lobe Epilepsy through Structural Connectome Based Simulations. PLoS Comput Biol 2015; 11:e1004642. [PMID: 26657566 PMCID: PMC4675531 DOI: 10.1371/journal.pcbi.1004642] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is a prevalent neurological disorder resulting in disruptive seizures. In the case of drug resistant epilepsy resective surgery is often considered. This is a procedure hampered by unpredictable success rates, with many patients continuing to have seizures even after surgery. In this study we apply a computational model of epilepsy to patient specific structural connectivity derived from diffusion tensor imaging (DTI) of 22 individuals with left TLE and 39 healthy controls. We validate the model by examining patient-control differences in simulated seizure onset time and network location. We then investigate the potential of the model for surgery prediction by performing in silico surgical resections, removing nodes from patient networks and comparing seizure likelihood post-surgery to pre-surgery simulations. We find that, first, patients tend to transit from non-epileptic to epileptic states more often than controls in the model. Second, regions in the left hemisphere (particularly within temporal and subcortical regions) that are known to be involved in TLE are the most frequent starting points for seizures in patients in the model. In addition, our analysis also implicates regions in the contralateral and frontal locations which may play a role in seizure spreading or surgery resistance. Finally, the model predicts that patient-specific surgery (resection areas chosen on an individual, model-prompted, basis and not following a predefined procedure) may lead to better outcomes than the currently used routine clinical procedure. Taken together this work provides a first step towards patient specific computational modelling of epilepsy surgery in order to inform treatment strategies in individuals. Temporal lobe epilepsy (TLE) is a disorder characterised by unpredictable seizures, where surgical removal of brain tissue is often the final treatment option. In roughly 30% of cases surgery procedures are unsuccessful at preventing future seizures. This paper shows the application of a computational model which uses patient derived brain connectivity to predict the success rates of surgery in people with TLE. We consider the brains of 22 patients as networks, with brain regions as nodes and the white matter connections between them as edges. The brain network is unique to each subject and produced from brain imaging scans of 22 patients and 39 controls. Seizures are simulated before and after surgery, where surgery in the model is the removal of nodes from the network. The model successfully identifies regions known to be involved in TLE, and its predicted success rates for surgery are close to the results found in reality. The model additionally provides patient specific recommendations for surgical procedures, which in simulations show improved results compared to standard surgery in every case. This is a first step towards designing personalised surgery procedures in order to improve surgery success rates.
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Affiliation(s)
- Frances Hutchings
- Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Cheol E. Han
- Department of Biomedical Engineering, Korea University, Seoul, Republic of Korea
- Department of Brain Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Simon S. Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Peter N. Taylor
- Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris) 2015; 171:315-25. [DOI: 10.1016/j.neurol.2015.01.561] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/01/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
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Mathon B, Bédos-Ulvin L, Baulac M, Dupont S, Navarro V, Carpentier A, Cornu P, Clemenceau S. Évolution des idées et des techniques, et perspectives d’avenir en chirurgie de l’épilepsie. Rev Neurol (Paris) 2015; 171:141-56. [DOI: 10.1016/j.neurol.2014.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/10/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Wasade VS, Elisevich K, Tahir R, Smith B, Schultz L, Schwalb J, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes after resective surgery for intractable epilepsy. Epilepsy Behav 2015; 43:122-7. [PMID: 25614128 DOI: 10.1016/j.yebeh.2014.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/06/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
Resective surgery is considered an effective treatment for refractory localization-related epilepsy. Most studies have reported seizure and psychosocial outcomes of 2-5 years postsurgery and a few up to 10 years. Our study aimed to assess long-term (up to 15 years) postsurgical seizure and psychosocial outcomes at our epilepsy center. The Henry Ford Health System Corporate Data Store was accessed to identify patients who had undergone surgical resection for localization-related epilepsy from 1993 to 2011. Demographics including age at epilepsy onset and surgery, seizure frequency before surgery, and pathology were gathered from electronic medical records. Phone surveys were conducted from May 2012 to January 2013 to determine patients' current seizure frequency and psychosocial metrics including driving and employment status and use of antidepressants. Surgical outcomes were based on Engel's classification (classes I and II=favorable outcomes). McNemar's tests, chi-square tests, two sample t-tests, and Wilcoxon two sample tests were used to analyze the relationships of psychosocial and surgical outcomes with demographic and surgical characteristics. A total of 470 patients had resective epilepsy surgery, and of those, 50 (11%) had died since surgery. Of the remaining, 253 (60%) were contacted with mean follow-up of 10.6±5.0years (27% of patients had follow-up of 15 years or longer). Of the patients surveyed, 32% were seizure-free and 75% had a favorable outcome (classes I and II). Favorable outcomes had significant associations with temporal resection (78% temporal vs 58% extratemporal, p=0.01) and when surgery was performed after scalp EEG only (85% vs 65%, p<0.001). Most importantly, favorable and seizure-free outcome rates remained stable after surgery over long-term follow-up [i.e., <5 years (77%, 41%), 5-10 years (67%, 29%), 10-15 years (78%, 38%), and >15 years (78%, 26%)]. Compared to before surgery, patients at the time of the survey were more likely to be driving (51% vs 35%, p<0.001) and using antidepressants (30% vs 22%, p=0.013) but less likely to be working full-time (23% vs 42%, p<0.001). A large majority of patients (92%) considered epilepsy surgery worthwhile regardless of the resection site, and this was associated with favorable outcomes (favorable=98% vs unfavorable=74%, p<0.001). The findings suggest that resective epilepsy surgery yields favorable long-term postoperative seizure and psychosocial outcomes.
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Affiliation(s)
- Vibhangini S Wasade
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA.
| | - Kost Elisevich
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Rizwan Tahir
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Brien Smith
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Lonni Schultz
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Jason Schwalb
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Marianna Spanaki-Varelas
- Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Clinical Neurosciences, Division of Neurosurgery, Spectrum Health System, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
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Frigeri T, Rhoton A, Paglioli E, Azambuja N. Cortical projection of the inferior choroidal point as a reliable landmark to place the corticectomy and reach the temporal horn through a middle temporal gyrus approach. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:777-81. [PMID: 25337730 DOI: 10.1590/0004-282x20140165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/25/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To establish preoperatively the localization of the cortical projection of the inferior choroidal point (ICP) and use it as a reliable landmark when approaching the temporal horn through a middle temporal gyrus access. To review relevant anatomical features regarding selective amigdalohippocampectomy (AH) for treatment of mesial temporal lobe epilepsy (MTLE). METHOD The cortical projection of the inferior choroidal point was used in more than 300 surgeries by one authors as a reliable landmark to reach the temporal horn. In the laboratory, forty cerebral hemispheres were examined. CONCLUSION The cortical projection of the ICP is a reliable landmark for reaching the temporal horn.
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Affiliation(s)
- Thomas Frigeri
- Department Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Albert Rhoton
- Department Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Eliseu Paglioli
- Departmento de Neurocirurgia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ney Azambuja
- Departmento de Neurocirurgia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Na M, Ge H, Shi C, Shen H, Wang Y, Pu S, Liu L, Wang H, Xie C, Zhu M, Wang J, Shi C, Lin Z. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: a survival analysis. Seizure 2014; 25:141-6. [PMID: 25455728 DOI: 10.1016/j.seizure.2014.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy (MTLE) as a result of hippocampal sclerosis (HS). However, approximately one-third of patients with intractable epilepsy did not become seizure-free after tailored resection strategies. It would be compelling to identify predictive factors of postoperative seizure outcomes. Our aim was to assess the correlation between HS classification and long-term postoperative seizure outcome in patients with MTLE due to HS. METHODS To investigate HS classification, semi-quantitative analysis and immunohistochemical staining of neuronal nuclei (NeuN) were performed on 100 postoperative hippocampal specimens. All patients had a 1-7 year postoperative follow-up. The postoperative seizure outcome was evaluated using International League Against Epilepsy (ILAE) outcome classification. RESULTS Three types of HS were recognized. The highest incidence of initial precipitating injury (IPI) was noted in the HS ILAE type 1 group (53.1%). The most favorable long-term seizure outcome was also noted in the HS ILAE type 1 group. The shortest epilepsy duration was recorded in the HS ILAE type 2 group (mean epilepsy duration=6.64 ± 5.83 years). The completely seizure free rate of patients in all groups declined with an increase in time. CONCLUSIONS Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery.
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Affiliation(s)
- Meng Na
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haitao Ge
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chen Shi
- Department of Neurosurgery, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Song Pu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haiyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuncheng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minwei Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Changbin Shi
- Section of Neurosurgery/Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Zhiguo Lin
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
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Na M, Liu Y, Shi C, Gao W, Ge H, Wang Y, Wang H, Long Y, Shen H, Shi C, Lin Z. Prognostic value of CA4/DG volumetry with 3T magnetic resonance imaging on postoperative outcome of epilepsy patients with dentate gyrus pathology. Epilepsy Res 2014; 108:1315-25. [DOI: 10.1016/j.eplepsyres.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/21/2014] [Accepted: 06/13/2014] [Indexed: 02/04/2023]
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Di Gennaro G, Casciato S, D’Aniello A, De Risi M, Quarato PP, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Picardi A. Serial postoperative awake and sleep EEG and long-term seizure outcome after anterior temporal lobectomy for hippocampal sclerosis. Epilepsy Res 2014; 108:945-52. [DOI: 10.1016/j.eplepsyres.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/02/2014] [Accepted: 03/16/2014] [Indexed: 11/25/2022]
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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014; 340:183-90. [DOI: 10.1016/j.jns.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
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Management of antiepileptic drugs following epilepsy surgery: A meta-analysis. Epilepsy Res 2014; 108:765-74. [DOI: 10.1016/j.eplepsyres.2014.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/26/2014] [Indexed: 11/18/2022]
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Kanchanatawan B, Limothai C, Srikijvilaikul T, Maes M. Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study. BMJ Open 2014; 4:e004852. [PMID: 24755212 PMCID: PMC4010813 DOI: 10.1136/bmjopen-2014-004852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Resective epilepsy surgery is currently a standard treatment for intractable epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. This study was carried out to delineate (1) possible differences in the success rate of epilepsy surgery 6 and 24 months after surgery; and (2) the clinical predictors of a good response to surgery. SETTING This is a cohort study performed at a tertiary care unit of a university hospital. PARTICIPANTS In this cohort study, 189 adults with intractable epilepsy who underwent epilepsy surgery were included. We collected clinical data at three time points, that is, preoperative and 6 and 24 months after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES Engel class I-IV classification was the primary outcome measure of epilepsy surgery. The authors statistically adjusted Engel class I-IV classification for postoperative changes in antiepileptic drugs and used this new classification as a secondary outcome variable. RESULTS The success rate was 78.8% 6 months after surgery and increased to 88.3% 24 months after surgery. This success rate was reflected not only by the reduced number of seizures postsurgery, but also by a reduced dosage and use of antiepileptic drugs. Logistic regression analysis showed that a successful outcome of surgery is predicted by having temporal rather than extratemporal lobe epilepsy and less than nine presurgery seizures per month, while a positive familial history of epilepsy, younger age and dysphoric symptoms, the first 3 months after surgery, significantly worsened the outcome of surgery. Duration of illness, age at onset, epilepsy location, type of lesions and the presence of psychosis were not significant in predicting treatment outcome. CONCLUSIONS These findings have clinical relevance in that a better selection of patients based on the significant clinical predictors will increase the success rate of epilepsy surgery and treatment.
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Affiliation(s)
- B Kanchanatawan
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - C Limothai
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Srikijvilaikul
- Department of Surgery, Prasat Neurological Institute, Bangkok, Thailand
| | - M Maes
- Faculty of Medicine, Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Hinde S, Soares M, Burch J, Marson A, Woolacott N, Palmer S. The added clinical and economic value of diagnostic testing for epilepsy surgery. Epilepsy Res 2014; 108:775-81. [PMID: 24630045 PMCID: PMC4000270 DOI: 10.1016/j.eplepsyres.2014.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 01/22/2014] [Accepted: 02/02/2014] [Indexed: 12/20/2022]
Abstract
We assess the added value of diagnostic imaging for epilepsy surgery. A cost-effectiveness evaluation is conducted considering a range of strategies. We find that additional PET and invasive EEG investigations are most cost-effective. The long-term effectiveness of surgery has a large impact on the optimal strategy.
The costs, benefits and risks associated with diagnostic imaging investigations for epilepsy surgery necessitate the identification of an optimal pathway in the pre-surgical workup. In order to assess the added value of additional investigations a full cost-effectiveness evaluation should be conducted, taking into account all of the life-time costs and benefits associated with undertaking additional investigations. This paper considers and applies the appropriate framework against which a full evaluation should be assessed. We conducted a systematic review to evaluate the progression of the literature through this framework, finding that only isolated elements of added value have been appropriately evaluated. The results from applying the full added value framework are also presented, identifying an optimal strategy for pre-surgical evaluation for temporal lobe epilepsy surgery. Our results suggest that additional FDG–PET and invasive EEG investigations after an initially discordant MRI and video-EEG appears cost-effective, and that the value of subsequent invasive-EEGs is closely linked to the maintenance of longer-term benefits after surgery. It is integral to the evaluation of imaging technologies in the work-up for epilepsy surgery that the impact of the use of these technologies on clinical decision-making, and on further treatment decisions, is considered fully when informing cost-effectiveness.
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Affiliation(s)
- Sebastian Hinde
- Centre for Health Economics, University of York, York, United Kingdom.
| | - Marta Soares
- Centre for Health Economics, University of York, York, United Kingdom
| | - Jane Burch
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, United Kingdom
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Palmini A, Paglioli E, Silva VD. Developmental tumors and adjacent cortical dysplasia: single or dual pathology? Epilepsia 2014; 54 Suppl 9:18-24. [PMID: 24328867 DOI: 10.1111/epi.12438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Developmental tumors often lead to refractory partial seizures and constitute a well-defined, surgically remediable epilepsy syndrome. Dysplastic features are often associated with these tumors, and their significance carries both practical and conceptual relevance. If associated focal cortical dysplasia (FCD) relates to the extent of the epileptogenic tissue, then presurgical evaluation and surgical strategies should target both the tumor and the surrounding dyslaminated cortex. Furthermore, the association has been included in the recently revised classification of FCD and the epileptogenicity of this associated dysplastic tissue is crucial to validate such revision. In addition to the possibility of representing dual pathology, the association of developmental tumors and adjacent dysplasia may instead represent a single developmental lesion with distinct parts distributed along a histopathologic continuum. Moreover, the possibility that this adjacent dyslamination is of minor epileptogenic relevance should also be entertained. Surgical data show that complete resection of the solid tumors and immediately adjacent tissue harboring satellites may disrupt epileptogenic networks and lead to high rates of seizure freedom, challenging the epileptogenic relevance of more extensive adjacent dyslaminated cortex. Whether the latter is a primary or secondary abnormality and whether dyslaminated cortex in the context of a second lesion may produce seizures after complete resection of the main lesion is still to be proven.
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Affiliation(s)
- André Palmini
- Porto Alegre Epilepsy Surgery Program, Services of Neurology and Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil; Department ofInternal Medicine, Faculty of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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