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Orhan Varoglu A, Avarisli A, Keskin H, Garipbas N. Comparing neuropsychological functioning in Turkish patients with right and left temporal lobe epilepsy. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 38015648 DOI: 10.1080/23279095.2023.2286504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
We compared neuropsychiatric evaluations in temporal lobe epilepsy according to the lateralized hemisphere. Forty-one (68.3%) left-sided temporal lobe epilepsy (LTLE) were compared to 19 right-sided temporal lobe epilepsy (RTLE) (31.7%) (p < 0.001). RTLE mean age was 37 (22-46) years, and LTLE mean age 38 was (30-42). RTLE disease duration was 10 (6-20) years, and LTLE was 22 (10-33) (p < 0.013). Gender (man/woman) for RTLE was 7/12, and for LTLE was 18/23. LTLE scored poorer on the Wechsler Memory Scale (WMS)-III's Mental Control Months-error, WMS-V's "Forward Number Range" and "Backward Number Range" than RTLE (p < 0.017, p < 0.023, p < 0.004). There were differences between hemispheres for "Number of Items Remembered with a Hint" and "Total number of Recalled Items" (WMS-IV) (p < 0.038, p < 0.045). LTLE had lower scores in the Verbal Fluency -K-A-S letters words and WAIS (Wechsler Adult Intelligence Scale) similarity than RTLE (p < 0.019, p < 0.024, p < 0.033, p < 0.026). Oktem and Boston-number of Self-Named Items Tests were poorer in LTLE than RTLE (p < 0.05, p < 0.043). Mental Control Months-error (WMS-III), "Total Number of Recalled Items", "Number of Items Remembered with Hint" (WMS-IV), forward and backward number range (WMS-V), Oktem, Verbal Fluency -K,-A,-S letters words, WAIS similarity, and Boston-number of Self-Named Items tests, can help identify lateralization, particularly in LTLE.
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Affiliation(s)
- Asuman Orhan Varoglu
- Department of Neurology, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
| | - Aysenur Avarisli
- Department of Neurology, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
| | - Havva Keskin
- Department of Internal Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul,Turkey
| | - Nilay Garipbas
- Department of Psychiatry, Istanbul Medeniyet University, Goztepe Training, and Research Hospital, Istanbul,Turkey
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Wu Y, Zhang Z, Liang P, Li L, Zou B, Wang D, Dong X, Tang H, Qiu H, Zhai X. Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040785. [PMID: 37109743 PMCID: PMC10146799 DOI: 10.3390/medicina59040785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adjustment method can improve outcomes. Materials and Methods: Children who underwent failed epileptic resection surgery at the Department of Neurosurgery, Children's Hospital of Chongqing Medical University between January 2015 and December 2021 were included in this cohort, who were reviewed for whether they underwent adjustment of ASM with increased dose, alternative therapy, or combination therapy. The seizure outcome and quality of life (QoL) were assessed. Two-tailed Fisher exact test and Mann-Whitney U test were used for statistical analysis. Results: Sixty-three children with failed surgery were included for further analysis, with a median follow-up time of 53 months. The median seizure recurrence time was 4 months. At the last follow-up, 36.5% (n = 23) of patients achieved seizure freedom, 41.3% (n = 26) achieved seizure remission, and 61.9% (n = 39) had a good QoL. None of the three types of ASM adjustment improved children's outcomes, whether considered in terms of seizure-free rate, seizure remission rate, or QoL. Early recurrences were significantly associated with decreased probability of seizure freedom (p = 0.02), seizure remission (p = 0.02), and a good QoL (p = 0.01). Conclusions: Children who underwent failed epilepsy surgery remains some potential for late seizure remission from ASM. Yet adjusting ASM regimen does not increase the probability of seizure remission nor does it improve the QoL. Clinicians should complete evaluations and consider the need for other antiepileptic treatment as soon as possible after surgery failed, especially when dealing with children with an early recurrence.
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Affiliation(s)
- Yuxin Wu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Zaiyu Zhang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Ping Liang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Lusheng Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Bin Zou
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Difei Wang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Xinyu Dong
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Haotian Tang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Hanli Qiu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
| | - Xuan Zhai
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing 400015, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400015, China
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Shawarba J, Kaspar B, Rampp S, Winter F, Coras R, Blumcke I, Hamer H, Buchfelder M, Roessler K. Advantages of magnetoencephalography, neuronavigation and intraoperative MRI in epilepsy surgery re-operations. Neurol Res 2021; 43:434-439. [PMID: 33402062 DOI: 10.1080/01616412.2020.1866384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: Management of patients after failed epilepsy surgery is still challenging. Advanced diagnostic and intraoperative tools including magneto-encephalography (MEG) as well as neuronavigation and intraoperative magnetic resonance imaging (iopMRI) may contribute to a better postoperative seizure outcome in this patient group.Methods: We retrospectively analyzed consecutive patients after reoperation of failed epilepsy surgery for medically refractory epilepsy at the University of Erlangen between 1988 and 2017. Inclusion criteria for patients were available MEG, neuronavigation and iopMRI data. The Engel scale was used to categorize seizure outcome.Results: We report on 27 consecutive patients (13 female/14 male mean age at first surgery 29.4 years) who had operative revision of the first resection after failed epilepsy surgery. An improved seizure outcome postoperatively was observed in 78% of patients (p < 0.001) with 55% seizure free (Engel I) patients after a mean follow-up time of 4.9 years. In detail, 80% of lesional cases were seizure free compared to 59% of MRI negative patients. Localizing MEG spike activity in the vicinity of the first resection cavity was present in 12 of 27 patients (44%) corresponding to 83% (10/12) of MEG localizing spike patients having advanced seizure outcome after operative revision.Conclusion: Re-operation after failed surgery in refractory epilepsy may lead to a better seizure outcome in the majority of patients. Preoperative MEG may support the decision for surgery and may facilitate targeting epileptogenic tissue for re-resection by employing navigation and iopMR imaging.
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Affiliation(s)
- Julia Shawarba
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany
| | - Burkhard Kaspar
- Neurological Department, Erlangen University Clinic, Erlangen, Germany
| | - Stefan Rampp
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany
| | - Fabian Winter
- Neurosurgical Clinic, Vienna Medical University, Vienna, Austria
| | - Roland Coras
- Neuropathological Institute, Erlangen University Clinic, Erlangen, Germany
| | - Ingmar Blumcke
- Neuropathological Institute, Erlangen University Clinic, Erlangen, Germany
| | - Hajo Hamer
- Neurological Department, Erlangen University Clinic, Erlangen, Germany
| | | | - Karl Roessler
- Neurosurgical Department, Erlangen University Clinic, Erlangen, Germany.,Neurosurgical Clinic, Vienna Medical University, Vienna, Austria
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Posttraumatic epilepsy may be a state in which underlying epileptogenicity involves focal cortical dysplasia. Epilepsy Behav 2021; 114:107352. [PMID: 32843304 DOI: 10.1016/j.yebeh.2020.107352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The occurrence rate of posttrauma epilepsy ranges widely from 1% to 30%. Little is known about the underlying epileptogenesis of traumatic brain injury (TBI)-related epilepsy (TRE), because no comparison between TRE and TBI without epilepsy has been performed in terms of neuropathology. Therefore, we postulated that different neuropathological factors may be present between TRE and TBI without epilepsy. The purpose of this study was to clarify differences between TRE and TBI without epilepsy. METHODS We studied patients who experienced severe head trauma and underwent brain surgery. The age range of the patients was 9-71 years old. Patients with medically resistant epilepsy were included in the Epilepsy group, and patients without epilepsy were included in the nonepilepsy group. Pathological findings, age, sex, and cause of head trauma were statistically compared between these two groups. RESULTS This study involved 10 patients, nine of whom met the inclusion criteria. Pathological findings for all patients in the Epilepsy group included focal cortical dysplasia (FCD) (p = 0.012). CONCLUSION The difference between TRE and TBI without epilepsy was underlying FCD in patients with TRE.
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg 2018; 32:663-670. [PMID: 30317876 DOI: 10.1080/02688697.2018.1506095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
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Integration of 24 Feature Types to Accurately Detect and Predict Seizures Using Scalp EEG Signals. SENSORS 2018; 18:s18051372. [PMID: 29710763 PMCID: PMC5982573 DOI: 10.3390/s18051372] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 01/22/2023]
Abstract
The neurological disorder epilepsy causes substantial problems to the patients with uncontrolled seizures or even sudden deaths. Accurate detection and prediction of epileptic seizures will significantly improve the life quality of epileptic patients. Various feature extraction algorithms were proposed to describe the EEG signals in frequency or time domains. Both invasive intracranial and non-invasive scalp EEG signals have been screened for the epileptic seizure patterns. This study extracted a comprehensive list of 24 feature types from the scalp EEG signals and found 170 out of the 2794 features for an accurate classification of epileptic seizures. An accuracy (Acc) of 99.40% was optimized for detecting epileptic seizures from the scalp EEG signals. A balanced accuracy (bAcc) was calculated as the average of sensitivity and specificity and our seizure detection model achieved 99.61% in bAcc. The same experimental procedure was applied to predict epileptic seizures in advance, and the model achieved Acc = 99.17% for predicting epileptic seizures 10 s before happening.
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Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ. Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia 2017; 58:2133-2142. [PMID: 28994113 DOI: 10.1111/epi.13920] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series and reviews. Therefore, our group performed the first quantitative meta-analysis of the literature from the past 30 years to assess for rates and predictors of successful reoperations. METHODS A PubMed search was conducted for studies reporting outcomes of repeat epilepsy surgery. Studies were excluded if they reported fewer than five eligible patients or had average follow-ups < 1 year, and patients were excluded from analysis if they received a nonresective intervention. Outcomes were stratified by each variable of interest, and quantitative meta-analysis was performed to generate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Seven hundred eighty-two patients who received repeat resective epilepsy surgery from 36 studies were included. Engel I outcome was observed in 47% (n = 369) of patients. Significant predictors of seizure freedom included congruent over noncongruent electrophysiology data (OR = 3.6, 95% CI = 1.6-8.2), lesional over nonlesional epilepsy (OR = 3.2, 95% CI = 1.9-5.3), and surgical limitations over disease-related factors associated with failure of the first surgery (OR = 2.6, 95% CI = 1.3-5.3). Among patients with at least one of these predictors, seizure freedom was achieved in 58%. Conversely, the use of invasive monitoring was associated with worse outcome (OR = 0.4, 95% CI = 0.2-0.9). Temporal lobe over extratemporal/multilobe resection (OR = 1.5, 95% CI = 0.8-3.0) and abnormal over normal preoperative magnetic resonance imaging (OR = 1.9, 95% CI = 0.6-5.4) showed nonsignificant trends toward seizure freedom. SIGNIFICANCE This analysis supports considering further resection in patients with intractable epilepsy who continue to have debilitating seizures after an initial surgery, especially in the context of factors predictive of a favorable outcome.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Alvin Y Chan
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Stephen C Harward
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Carrie Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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