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Gates S, Hackman DE, Agarwal N, Zhang W, Barnard P, White JR. Postoperative Neurologic Outcome in Patients Undergoing Resective Surgery for Parietal Lobe Epilepsy: A Systematic Review. Neurology 2024; 102:e209322. [PMID: 38815235 DOI: 10.1212/wnl.0000000000209322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parietal lobe epilepsy (PLE) surgery can be an effective treatment for selected patients with intractable epilepsy but can be associated with the risk of serious neurologic deficits. We performed a systematic review of the literature to obtain a comprehensive summary of the frequency and types of new postoperative neurologic deficits in patients undergoing PLE resective surgery. METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published between January 1, 1990, and April 28, 2022. We included studies that reported postoperative neurologic outcome following PLE resective surgery confined to the parietal lobe. We required that studies included ≥5 patients. The data collected included demographic information and specific details of postoperative neurologic deficits. When available, individual patient data were collected. We used the Risk of Bias in Nonrandomized Studies of Interventions tool to assess the risk of bias and Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence. RESULTS Of the 3,461 articles screened, 33 studies met the inclusion criteria. A total of 370 patients were included. One hundred patients (27.0%) had a new deficit noted postoperatively. Approximately half of the patients with deficits experienced only transient deficits. Motor deficits were the most commonly identified deficit. The rates of motor deficits noted after PLE surgery were 5.7%, 3.2%, and 2.2% for transient, long-term, and duration not specified, respectively. Sensory and visual field deficits were also commonly reported. Gerstmann syndrome was noted postoperatively in 4.9% of patients and was almost always transient. Individual patient data added information on parietal lobe subregion postoperative neurologic outcome. DISCUSSION Our systematic review provides a comprehensive summary of the frequency and types of neurologic deficits associated with PLE surgery. A significant percentage of postoperative deficits are transient. In addition to the expected sensory and visual deficits, PLE surgery is associated with a notable risk of motor deficits. The available literature has important deficiencies. Our study highlights gaps in the literature and provides recommendations for future directions. TRIAL REGISTRATION INFORMATION This systematic review was registered on PROSPERO (CRD42022313108, May 26, 2022).
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Affiliation(s)
- Stuart Gates
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Dawn E Hackman
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Nitin Agarwal
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Wenbo Zhang
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - Pamela Barnard
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
| | - James R White
- From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN
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Jiang S, Lang L, Sun B, Wu D, Feng R, He J, Chen L, Hu J, Mao Y. Surgery for Epilepsy Involving Rolandic and Perirolandic Cortex: A Case Series Assessing Complications and Efficacy. Oper Neurosurg (Hagerstown) 2022; 23:287-297. [PMID: 35973401 DOI: 10.1227/ons.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Surgical removal of lesions around the rolandic cortex remains a challenge for neurosurgeons owing to the high risk of neurological deficits. Evaluating the risk factors associated with motor deficits after surgery in this region may help reduce the occurrence of motor deficits. OBJECTIVE To report our surgical experience in treating epileptic lesions involving the rolandic and perirolandic cortices. METHODS We performed a single-center retrospective review of patients undergoing epilepsy surgeries with lesions located in the rolandic and perirolandic cortices. Patients with detailed follow-up information were included. The lesion locations, resected regions, and invasive exploration techniques were studied to assess their relationship with postoperative motor deficits. RESULTS Forty-one patients were included. Twenty-three patients suffered from a transient motor deficit, and 2 had permanent disabilities after surgery. Six patients with lesions at the posterior bank of the precentral sulcus underwent resection, and 5 experienced short-term motor deficits. Two patients with lesions adjacent to the anterior part of the precentral gyrus, in whom the adjacent precentral gyrus was removed, experienced permanent motor deficits. Lesions located at the bottom of the central sulcus and invading the anterior bank of the central sulcus were observed in 3 patients. The patients did not experience permanent motor deficits after surgery. CONCLUSION The anterior bank of the central sulcus is indispensable for motor function, and destruction of this region would inevitably cause motor deficits. The anterior bank of the precentral gyrus can also be removed without motor impairment if there is a preexisting epileptogenic lesion.
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Affiliation(s)
- Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Liqin Lang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bing Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongyan Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui Feng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Juanjuan He
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, China
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Balogun S, Winzenberg T, Wills K, Scott D, Jones G, Callisaya ML, Aitken D. Prospective associations of low muscle mass and strength with health-related quality of life over 10-year in community-dwelling older adults. Exp Gerontol 2019; 118:65-71. [PMID: 30641106 DOI: 10.1016/j.exger.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
AIMS This study aims to describe the associations of low muscle mass, handgrip (HGS) and lower-limb muscle strength (LMS) with health-related quality of life (HRQoL) over 10 years in community-dwelling older adults. METHODS Participants (N = 1002; 51% women; mean age 63 ± 7.4 years) were prospectively followed for 10 years. HRQoL was measured using the validated assessment of quality of life (AQoL) instrument. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry and normalized to body mass index (BMI). HGS and LMS were assessed using dynamometers. Low ALM/BMI (ALM/BMILOW), LMS (LMSLOW) and HGS (HGSLOW) at baseline were defined as the lowest 20% of the sex-specific distribution for each measure. Linear mixed effect regression models, adjusting for confounders, were used to estimate the association between ALM/BMILOW, LMSLOW, and HGSLOW at baseline and HRQoL over 10 years. RESULTS Participants with LMSLOW (β = -0.061, 95% CI: -0.089, -0.033) and women (β = -0.089, 95% CI: -0.129, -0.049) but not men (β = -0.023, 95% CI: -0.064, 0.019) with HGSLOW had clinically meaningful reductions in HRQoL over 10 years compared to those with normal strength. There was a weaker but statistically significant association between ALM/BMILOW and 10-year HRQoL (β = -0.038, 95% CI: -0.068, -0.008). CONCLUSIONS Lower-limb muscle strength and handgrip strength (in women only), which can be easily measured in clinical practice, appear more important than muscle mass for HRQoL.
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Affiliation(s)
- Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Australia; Faculty of Health, University of Tasmania, Australia.
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - David Scott
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia; Australian Institute for Musculoskeletal Science, Melbourne Medical School (Western Campus), The University of Melbourne, St Albans, Victoria 3021, Australia.
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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