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Qian Z, Lin J, Jiang R, Jean S, Dai Y, Deng D, Tagu PT, Shi L, Song S. Evaluation of MRI post-processing methods combined with PET in detecting focal cortical dysplasia lesions for patients with MRI-negative epilepsy. Seizure 2024; 117:275-283. [PMID: 38579502 DOI: 10.1016/j.seizure.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Accurate detection of focal cortical dysplasia (FCD) through magnetic resonance imaging (MRI) plays a pivotal role in the preoperative assessment of epilepsy. The integration of multimodal imaging has demonstrated substantial value in both diagnosing FCD and devising effective surgical strategies. This study aimed to enhance MRI post-processing by incorporating positron emission tomography (PET) analysis. We sought to compare the diagnostic efficacy of diverse image post-processing methodologies in patients presenting MRI-negative FCD. METHODS In this retrospective investigation, we assembled a cohort of patients with negative preoperative MRI results. T1-weighted volumetric sequences were subjected to morphometric analysis program (MAP) and composite parametric map (CPM) post-processing techniques. We independently co-registered images derived from various methods with PET scans. The alignment was subsequently evaluated, and its correlation was correlated with postoperative seizure outcomes. RESULTS A total of 41 patients were enrolled in the study. In the PET-MAP(p = 0.0189) and PET-CPM(p = 0.00041) groups, compared with the non-overlap group, the overlap group significantly associated with better postoperative outcomes. In PET(p = 0.234), CPM(p = 0.686) and MAP(p = 0.672), there is no statistical significance between overlap and seizure-free outcomes. The sensitivity of using the CPM alone outperformed the MAP (0.65 vs 0.46). The use of PET-CPM demonstrated superior sensitivity (0.96), positive predictive value (0.83), and negative predictive value (0.91), whereas the MAP displayed superior specificity (0.71). CONCLUSIONS Our findings suggested a superiority in sensitivity of CPM in detecting potential FCD lesions compared to MAP, especially when it is used in combination with PET for diagnosis of MRI-negative epilepsy patients. Moreover, we confirmed the superiority of synergizing metabolic imaging (PET) with quantitative maps derived from structural imaging (MAP or CPM) to enhance the identification of subtle epileptogenic zones (EZs). This study serves to illuminate the potential of integrated multimodal techniques in advancing our capability to pinpoint elusive pathological features in epilepsy cases.
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Affiliation(s)
- Zhe Qian
- Fujian Medical University, Fuzhou, China.
| | - Jiuluan Lin
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Fuzhou, China.
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Stéphane Jean
- Department of Neurosurgery, Fuzhou Children's Hospital, Fuzhou, China
| | - Yihai Dai
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Donghuo Deng
- Fujian Medical University Union Hospital, Fuzhou, China.
| | | | - Lin Shi
- BrainNow Research Institute, Guangdong, China.
| | - Shiwei Song
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Kogias E, Altenmüller DM, Karakolios K, Egger K, Coenen VA, Schulze-Bonhage A, Reinacher PC. Electrode placement for SEEG: Combining stereotactic technique with latest generation planning software for intraoperative visualization and postoperative evaluation of accuracy and accuracy predictors. Clin Neurol Neurosurg 2022; 213:107137. [DOI: 10.1016/j.clineuro.2022.107137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
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Sun Y, Ren G, Ren J, Wang Q. High-frequency oscillations detected by electroencephalography as biomarkers to evaluate treatment outcome, mirror pathological severity and predict susceptibility to epilepsy. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractHigh-frequency oscillations (HFOs) in the electroencephalography (EEG) have been extensively investigated as a potential biomarker of epileptogenic zones. The understanding of the role of HFOs in epilepsy has been advanced considerably over the past decade, and the use of scalp EEG facilitates recordings of HFOs. HFOs were initially applied in large scale in epilepsy surgery and are now being utilized in other applications. In this review, we summarize applications of HFOs in 3 subtopics: (1) HFOs as biomarkers to evaluate epilepsy treatment outcome; (2) HFOs as biomarkers to measure seizure propensity; (3) HFOs as biomarkers to reflect the pathological severity of epilepsy. Nevertheless, knowledge regarding the above clinical applications of HFOs remains limited at present. Further validation through prospective studies is required for its reliable application in the clinical management of individual epileptic patients.
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Surgical outcome and prognostic factors in epilepsy patients with MR-negative focal cortical dysplasia. PLoS One 2021; 16:e0249929. [PMID: 33852634 PMCID: PMC8046256 DOI: 10.1371/journal.pone.0249929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Focal cortical dysplasia (FCD) represents a heterogeneous group of disorders of the cortical formation and is one of the most common causes of epilepsy. Magnetic resonance imaging (MRI) is the modality of choice for detecting structural lesions, and the surgical prognosis in patients with MR lesions is favorable. However, the surgical prognosis of patients with MR-negative FCD is unknown. We aimed to evaluate the long-term surgical outcomes and prognostic factors in MR-negative FCD patients through comprehensive presurgical data. Methods We retrospectively reviewed data from 719 drug-resistant epilepsy patients who underwent resective surgery and selected cases in which surgical specimens were pathologically confirmed as FCD Type I or II. If the epileptogenic focus and surgical specimens were obtained from brain areas with a normal MRI appearance, they were classified as MR-negative FCD. Surgical outcomes were evaluated at 2 and 5 years, and clinical, neurophysiological, and neuroimaging data of MR-negative FCD were compared to those of MR-positive FCD. Results Finally, 47 MR-negative and 34 MR-positive FCD patients were enrolled in the study. The seizure-free rate after surgery (Engel classification I) at postoperative 2 year was 59.5% and 64.7% in the MR-negative and positive FCD groups, respectively (p = 0.81). This rate decreased to 57.5% and 44.4% in the MR-negative and positive FCD groups (p = 0.43) at postoperative 5 years. MR-negative FCD showed a higher proportion of FCD type I (87.2% vs. 50.0%, p = 0.001) than MR-positive FCD. Unilobar cerebral perfusion distribution (odds ratio, OR 5.41) and concordance of interictal epileptiform discharges (OR 5.10) were significantly associated with good surgical outcomes in MR-negative FCD. Conclusion In this study, MR-negative and positive FCD patients had a comparable surgical prognosis, suggesting that comprehensive presurgical evaluations, including multimodal neuroimaging studies, are crucial for obtaining excellent surgical outcomes even in epilepsy patients with MR-negative FCD.
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Middlebrooks EH, Lin C, Westerhold E, Okromelidze L, Vibhute P, Grewal SS, Gupta V. Improved detection of focal cortical dysplasia using a novel 3D imaging sequence: Edge-Enhancing Gradient Echo (3D-EDGE) MRI. NEUROIMAGE-CLINICAL 2020; 28:102449. [PMID: 33032066 PMCID: PMC7552096 DOI: 10.1016/j.nicl.2020.102449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
Detection of focal cortical dysplasia remains a substantial challenge in radiology. 3D-EDGE is a novel MR method to directly image abnormalities of gray-white boundary. 3D-EDGE had a significantly higher contrast for FCD than FLAIR and MP2RAGE.
Epilepsy is a common neurological disorder with focal cortical dysplasia (FCD) being one of the most common lesional causes. Detection of FCD by MRI is a major determinant of surgical outcome. Evolution of MRI sequences and hardware has greatly increased the detection rate of FCD, but these gains have largely been related to the more visible Type IIb FCD, with Type I and IIa remaining elusive. While most sequence improvements have relied on increasing contrast between gray and white matter, we propose a novel imaging approach, 3D Edge-Enhancing Gradient Echo (3D-EDGE), to directly image the gray-white boundary. By acquiring images at an inversion time where gray and white matter have equal signal but opposite phases, voxels with a mixture of gray and white matter (e.g., at the gray-white boundary) will have cancellation of longitudinal magnetization producing a thin area of signal void at the normal boundary. By creating greater sensitivity for minor changes in T1 relaxation, microarchitectural abnormalities present in FCD produce greater contrast than on other common MRI sequences. 3D-EDGE had a significantly greater contrast ratio between lesion and white matter for FCD compared to MP2RAGE (98% vs 17%; p = 0.0006) and FLAIR (98% vs 19%; p = 0.0006), which highlights its potential to improve outcomes in epilepsy. We present a discussion of the framework for 3D-EDGE, optimization strategies, and analysis of a series of FCDs to highlight the benefit of 3D-EDGE in FCD detection compared to commonly used sequences in epilepsy.
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Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Surgical outcomes related to invasive EEG monitoring with subdural grids or depth electrodes in adults: A systematic review and meta-analysis. Seizure 2019; 70:12-19. [DOI: 10.1016/j.seizure.2019.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
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Lagarde S, Scholly J, Popa I, Valenti-Hirsch MP, Trebuchon A, McGonigal A, Milh M, Staack AM, Lannes B, Lhermitte B, Proust F, Benmekhbi M, Scavarda D, Carron R, Figarella-Branger D, Hirsch E, Bartolomei F. Can histologically normal epileptogenic zone share common electrophysiological phenotypes with focal cortical dysplasia? SEEG-based study in MRI-negative epileptic patients. J Neurol 2019; 266:1907-1918. [DOI: 10.1007/s00415-019-09339-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
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Thom M, Boldrini M, Bundock E, Sheppard MN, Devinsky O. Review: The past, present and future challenges in epilepsy-related and sudden deaths and biobanking. Neuropathol Appl Neurobiol 2019; 44:32-55. [PMID: 29178443 PMCID: PMC5820128 DOI: 10.1111/nan.12453] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
Awareness and research on epilepsy-related deaths (ERD), in particular Sudden Unexpected Death in Epilepsy (SUDEP), have exponentially increased over the last two decades. Most publications have focused on guidelines that inform clinicians dealing with these deaths, educating patients, potential risk factors and mechanisms. There is a relative paucity of information available for pathologists who conduct these autopsies regarding appropriate post mortem practice and investigations. As we move from recognizing SUDEP as the most common form of ERD toward in-depth investigations into its causes and prevention, health professionals involved with these autopsies and post mortem procedure must remain fully informed. Systematizing a more comprehensive and consistent practice of examining these cases will facilitate (i) more precise determination of cause of death, (ii) identification of SUDEP for improved epidemiological surveillance (the first step for an intervention study), and (iii) biobanking and cell-based research. This article reviews how pathologists and healthcare professionals have approached ERD, current practices, logistical problems and areas to improve and harmonize. The main neuropathology, cardiac and genetic findings in SUDEP are outlined, providing a framework for best practices, integration of clinical, pathological and molecular genetic investigations in SUDEP, and ultimately prevention.
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Affiliation(s)
- M Thom
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - M Boldrini
- Department of Psychiatry, Columbia University Medical Centre, Divisions of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - E Bundock
- Office of the Chief Medical Examiner, Burlington, VT, USA
| | - M N Sheppard
- Department of Pathology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - O Devinsky
- Department of Neurology, NYU Epilepsy Center, New York, NY, USA
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Chauvel P, Gonzalez-Martinez J, Bulacio J. Presurgical intracranial investigations in epilepsy surgery. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:45-71. [PMID: 31307620 DOI: 10.1016/b978-0-444-64142-7.00040-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Identification and localization of the "epileptogenic process" in the brain of patients with drug-resistant epilepsy for surgical cure is the goal of presurgical investigations. Intracranial recordings are required when conflicting data between seizure clinical semiology and EEG prevent precise localization within one hemisphere or lateralization, when a visible lesion on MRI seems unrelated to the electroclinical data, or in MRI-negative cases. Two methods are currently used. The objective of the subdural grid electrocorticography with or without depth electrodes (SDG/DE) is the best possible identification of the area of onset of spontaneous seizures and localization of the eloquent cortex. The objective of stereoelectroencephalography (SEEG) is to define the epileptogenic zone (configured as a network) and its relation to an unmasked lesion. Two-dimensional (SDG) and three-dimensional (SEEG) brain sampling dictate different strategies for noninvasive presurgical phase I goals as well as for data analysis. SEEG must resolve several potential localization hypotheses in a manner that cannot be achieved with SDG. SDG operates through brain surface coverage, unlike SEEG, which samples networks. SDG estimates the extent of cortical resection through a lobar or sublobar localization of ictal onset and constraints from functional mapping. SEEG defines a tailored resection according to the results of anatomo-electro-clinical correlations in stereotaxic space that will guide the ablation of the epileptogenic zone. SEEG is currently expanding faster than SDG. The prerequisites (especially in the preimplantation hypothetical strategy) and technical tools (especially stimulation and functional mapping) in the two methods are very different. This chapter presents a comparative review of the rationale, indications, electrode implantation strategies, interpretation, and surgical decision making of these two approaches of presurgical evaluation for epilepsy surgery.
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Affiliation(s)
- Patrick Chauvel
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | | | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Kogias E, Schmeiser B, Doostkam S, Brandt A, Hammen T, Zentner J, Ramantani G. Multilobar Resections for 3T MRI-Negative Epilepsy: Worth the Trouble? World Neurosurg 2018; 123:e338-e347. [PMID: 30502474 DOI: 10.1016/j.wneu.2018.11.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Multilobar resection in magnetic resonance imaging (MRI)-negative drug-resistant epilepsy warrants attention because they account for up to one third of MRI-negative epilepsy surgery. Despite their high prevalence, data are sparse, and the risk/benefit ratio continues to be debated. The present study investigated the postoperative seizure outcomes in this especially challenging subgroup. METHODS We retrospectively analyzed the data of 4 consecutive patients with 3T MRI-negative findings and drug-resistant focal epilepsy who had undergone multilobar epilepsy surgery at our institution. RESULTS The mean age at first surgery was 28.5 years (range, 14-48); 1 patient required 2 consecutive reoperations. The final resection was in the frontotemporal and temporo-parieto-occipital regions in 2 patients each. Histopathological examination revealed mild malformations of cortical development in 2 patients and focal cortical dysplasia type Ia and type IIa in 1 patient each. At the last follow-up examination (median, 3.3 years; range, 1-11), 2 patients were completely seizure free (Engel class Ia), 1 patient had experienced some disabling seizures after surgery but had been free of disabling seizures for 2 years at the last follow-up examination (Engel class Ic), and 1 patient had experienced worthwhile improvement (Engel class IIb) and had been seizure free for 1 year at the last follow-up examination. No surgical complications developed. CONCLUSIONS Our results have demonstrated that multilobar epilepsy surgery is effective for lasting seizure control for selected 3T MRI-negative candidates, leading to favorable outcomes for all 4 of our patients. Comprehensive multimodal preoperative evaluation is a prerequisite for postoperative success. Reevaluation should be considered for patients with seizure recurrence, because reoperation could be especially beneficial for selected patients who have not responded to an initially limited resection.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Thilo Hammen
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Georgia Ramantani
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland.
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Shi J, Gao Z, Gao J, Li G, Chen Y. Predictors and outcome surgery for posterior cortex epilepsies. Clin Neurol Neurosurg 2018; 171:124-128. [DOI: 10.1016/j.clineuro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/29/2023]
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Hu WH, Wang X, Liu LN, Shao XQ, Zhang K, Ma YS, Ai L, Li JJ, Zhang JG. Multimodality Image Post-processing in Detection of Extratemporal MRI-Negative Cortical Dysplasia. Front Neurol 2018; 9:450. [PMID: 29963006 PMCID: PMC6010529 DOI: 10.3389/fneur.2018.00450] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/28/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: To determine the diagnostic value of individual image post-processing techniques in a series of patients who underwent extratemporal operations for histologically proven, MRI-negative focal cortical dysplasia (FCD). Methods: The morphometric analysis program (MAP), PET/MRI co-registration and statistical parametric mapping (SPM) analysis of PET (SPM-PET) techniques were analyzed in 33 consecutive patients. The epileptogenic zone (EZ) assumed by MAP, PET/MRI, and SPM-PET was compared with the location of the FCD lesions determined by stereoelectroencephalography (SEEG) and histopathological study. The detection rate of each modality was statistically compared. Results: Three lesions were simultaneously detected by the three post-processing methods, while two lesions were only MAP positive, and 8 were only PET/MRI positive. The detection rate of MAP, PET/MRI, SPM-PET and the combination of the three modalities was 24.2, 90.9, 57.6, and 97.0%, respectively. Taking the pathological subtype into account, no type I lesions were detected by MAP, and PET/MRI was the most sensitive method for detecting FCD types II and IIA. During a mean follow-up period of 22.94 months, seizure freedom was attained in 26/33 patients (78.8%) after focal corticectomy. Conclusions: MAP, PET/MRI, and SPM-PET provide complementary information for FCD detection, intracranial electrode design, and lesion resection. PET/MRI was particularly useful, with the highest detection rate of extratemporal MRI-negative FCD.
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Affiliation(s)
- Wen-Han Hu
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Na Liu
- Department of Pathology, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan-Shan Ma
- Department of Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Lin Ai
- Department of Neuroimage, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ju Li
- Department of Neurosurgery, Hainan General Hospital, Haikou, China
| | - Jian-Guo Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Kogias E, Klingler JH, Urbach H, Scheiwe C, Schmeiser B, Doostkam S, Zentner J, Altenmüller DM. 3 Tesla MRI-negative focal epilepsies: Presurgical evaluation, postoperative outcome and predictive factors. Clin Neurol Neurosurg 2017; 163:116-120. [PMID: 29101859 DOI: 10.1016/j.clineuro.2017.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate presurgical diagnostic modalities, clinical and seizure outcome as well as predictive factors after resective epilepsy surgery in 3 Tesla MRI-negative focal epilepsies. PATIENTS AND METHODS This retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated. RESULTS All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome. CONCLUSIONS In almost two thirds of temporal and extratemporal epilepsies defined as "non-lesional" by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center-University of Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
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