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Rebsamen M, Jin BZ, Klail T, De Beukelaer S, Barth R, Rezny-Kasprzak B, Ahmadli U, Vulliemoz S, Seeck M, Schindler K, Wiest R, Radojewski P, Rummel C. Clinical Evaluation of a Quantitative Imaging Biomarker Supporting Radiological Assessment of Hippocampal Sclerosis. Clin Neuroradiol 2023; 33:1045-1053. [PMID: 37358608 PMCID: PMC10654177 DOI: 10.1007/s00062-023-01308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To evaluate the influence of quantitative reports (QReports) on the radiological assessment of hippocampal sclerosis (HS) from MRI of patients with epilepsy in a setting mimicking clinical reality. METHODS The study included 40 patients with epilepsy, among them 20 with structural abnormalities in the mesial temporal lobe (13 with HS). Six raters blinded to the diagnosis assessed the 3T MRI in two rounds, first using MRI only and later with both MRI and the QReport. Results were evaluated using inter-rater agreement (Fleiss' kappa [Formula: see text]) and comparison with a consensus of two radiological experts derived from clinical and imaging data, including 7T MRI. RESULTS For the primary outcome, diagnosis of HS, the mean accuracy of the raters improved from 77.5% with MRI only to 86.3% with the additional QReport (effect size [Formula: see text]). Inter-rater agreement increased from [Formula: see text] to [Formula: see text]. Five of the six raters reached higher accuracies, and all reported higher confidence when using the QReports. CONCLUSION In this pre-use clinical evaluation study, we demonstrated clinical feasibility and usefulness as well as the potential impact of a previously suggested imaging biomarker for radiological assessment of HS.
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Affiliation(s)
- Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Baudouin Zongxin Jin
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tomas Klail
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie De Beukelaer
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rike Barth
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beata Rezny-Kasprzak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uzeyir Ahmadli
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
- Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel, Bern, Switzerland.
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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Long-term follow-up of a large cohort with focal epilepsy of unknown cause: deciphering their clinical and prognostic characteristics. J Neurol 2019; 267:838-847. [DOI: 10.1007/s00415-019-09656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
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Blackmon K, Barr WB, Morrison C, MacAllister W, Kruse M, Pressl C, Wang X, Dugan P, Liu AA, Halgren E, Devinsky O, Thesen T. Cortical gray-white matter blurring and declarative memory impairment in MRI-negative temporal lobe epilepsy. Epilepsy Behav 2019; 97:34-43. [PMID: 31181427 PMCID: PMC8162756 DOI: 10.1016/j.yebeh.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) may be a distinct syndrome from TLE with mesial temporal sclerosis (TLE-MTS). Imaging and neuropsychological features of TLE-MTS are well-known; yet, these features are only beginning to be described in MRI-negative TLE. This study examined whether a quantitative measure of cortical gray and white matter blurring (GWB) was elevated in the temporal lobes ipsilateral to the seizure onset zone of individuals with MRI-negative TLE relative to TLE-MTS and healthy controls (HCs) and whether GWB elevations were associated with neuropsychological comorbidity. Gray-white matter blurring from 34 cortical regions and hippocampal volumes were quantified and compared across 28 people with MRI-negative TLE, 15 people with TLE-MTS, and 51 HCs. Declarative memory was assessed with standard neuropsychological tests and the intracarotid amobarbital procedure (IAP). In the group with MRI-negative TLE (left and right onsets combined), hippocampal volumes were within normal range but GWB was elevated, relative to HCs, across several mesial and lateral temporal lobe regions ipsilateral to the seizure onset zone. Gray-white matter blurring did not differ between the groups with TLE-MTS and HC or between the groups with TLE-MTS and MRI-negative TLE. The group with MRI-negative TLE could not be distinguished from the group with TLE-MTS on any of the standard neuropsychological tests; however, ipsilateral hippocampal volumes and IAP memory scores were lower in the group with TLE-MTS than in the group with MRI-negative TLE. The group with left MRI-negative TLE had lower general cognitive abilities and verbal fluency relative to the HC group, which adds to the characterization of neuropsychological comorbidities in left MRI-negative TLE. In addition, ipsilateral IAP memory performance was reduced relative to contralateral memory performance in MRI-negative TLE, indicating some degree of ipsilateral memory dysfunction. There was no relationship between hippocampal volume and IAP memory scores in MRI-negative TLE; however, decreased ipsilateral IAP memory scores were correlated with elevated GWB in the ipsilateral superior temporal sulcus of people with left MRI-negative TLE. In sum, GWB elevations in the ipsilateral temporal lobe of people with MRI-negative TLE suggest that GWB may serve as a marker for reduced structural integrity in regions in or near the seizure onset zone. Although mesial temporal abnormalities might be the major driver of memory dysfunction in TLE-MTS, a loss of structural integrity in lateral temporal lobe regions may contribute to IAP memory dysfunction in MRI-negative TLE.
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Affiliation(s)
- Karen Blackmon
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America; St. George's University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada.
| | - William B. Barr
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Chris Morrison
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - William MacAllister
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Michelle Kruse
- St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
| | - Christina Pressl
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,The Rockefeller University, Laboratory of Neural Systems, New York, NY 10065, United States of America
| | - Xiuyuan Wang
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,New York University School of Medicine, Department of Radiology, New York, NY 10016, United States of America
| | - Patricia Dugan
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Anli A. Liu
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Eric Halgren
- University of California San Diego, Multimodal Imaging Laboratory, San Diego, CA 92093, United States of America
| | - Orrin Devinsky
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
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Mariani V, Revay M, D'Orio P, Rizzi M, Pelliccia V, Nichelatti M, Bottini G, Nobili L, Tassi L, Cossu M. Prognostic factors of postoperative seizure outcome in patients with temporal lobe epilepsy and normal magnetic resonance imaging. J Neurol 2019; 266:2144-2156. [PMID: 31127383 DOI: 10.1007/s00415-019-09394-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To retrospectively analyse a single-centre consecutive surgical series of patients with temporal lobe epilepsy (TLE) and negative MRI. To identify factors associated with postoperative seizure outcome among several presurgical, surgical and postsurgical variables. METHODS Clinical records of 866 patients who received temporal lobe resections and with a minimum follow-up of 12 months were retrospectively searched for MRI-negative cases. Anamnestic, clinical, neurophysiological, surgical, histopathological and postsurgical data were collected. Seizure outcome was categorised as favourable (Engel's class I) and unfavourable (Engel's classes II-IV). Uni- and multivariate statistical analysis was performed to identify variables having a significant association with seizure outcome. RESULTS Forty-eight patients matched the inclusion criteria. 26 (54.1%) patients required invasive EEG evaluation with Stereo-electro-encephalography (SEEG) before surgery. Histological evaluation was unremarkable in 34 cases (70.8%), revealed focal cortical dysplasias in 13 cases and hippocampal sclerosis in 2. 28 (58.3%) patients were in Engel's class I after a mean follow-up of 82 months (SD ± 74; range 12-252). Multivariate analysis indicated auditory aura, contralateral diffusion of the discharge at Video-EEG monitoring and use of 18F-FDG PET as variables independently associated with seizure outcome. CONCLUSION Carefully selected patients with MRI-negative TLE can be good candidates for surgery. Surgery should be considered with caution in patients with clinical features of neocortical seizure onset and contralateral propagation of the discharge. Use of 18F-FDG PET may be helpful to improve SEEG and surgical strategies. The presented data help in optimising the selection of patients with MRI-negative TLE with good chances to benefit from surgery.
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Affiliation(s)
- Valeria Mariani
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy. .,Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy. .,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan, Milan, Italy
| | - Piergiorgio D'Orio
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Michele Rizzi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Neuroscience, University of Parma, Parma, Italy
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriella Bottini
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, Istituto Giannina Gaslini, DINOGMI, University of Genova, Genoa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
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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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Effect of Temporal Neocortical Pathology on Seizure Freeness in Adult Patients with Temporal Lobe Epilepsy. World Neurosurg 2018; 116:e801-e805. [DOI: 10.1016/j.wneu.2018.05.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
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