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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [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: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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2
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González Otárula KA, Tan YL, Hall JA, Chang EF, Correa JA, Dubeau F, Sziklas V, Soucy JP, Guiot MC, Knowlton RC, Kobayashi E. Postsurgical seizure outcome in temporal lobe epilepsy patients with normal or subtle, nonspecific MRI findings. J Neurosurg 2022; 137:442-448. [PMID: 34972090 DOI: 10.3171/2021.10.jns2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to report postsurgical seizure outcome of temporal lobe epilepsy (TLE) patients with normal or subtle, nonspecific MRI findings and to identify prognostic factors related to seizure control after surgery. METHODS This was a retrospective study of patients who underwent surgery from 1999 to 2014 at two comprehensive epilepsy centers. Patients with a clear MRI lesion according to team discussion and consensus were excluded. Presurgical information, surgery details, pathological data, and postsurgical outcomes were retrospectively collected from medical charts. Multiple logistic regression analysis was used to assess the effect of clinical, surgical, and neuroimaging factors on the probability of Engel class I (favorable) versus class II-IV (unfavorable) outcome at last follow-up. RESULTS The authors included 73 patients (59% were female; median age at surgery 35.9 years) who underwent operations after a median duration of epilepsy of 13 years. The median follow-up after surgery was 30.6 months. At latest follow-up, 44% of patients had Engel class I outcome. Favorable prognostic factors were focal nonmotor aware seizures and unilateral or no spikes on interictal scalp EEG. CONCLUSIONS Favorable outcome can be achieved in a good proportion of TLE patients with normal or subtle, nonspecific MRI findings, particularly when presurgical investigation suggests a rather circumscribed generator. Presurgical factors such as the presence of focal nonmotor aware seizures and unilateral or no spikes on interictal EEG may indicate a higher probability of seizure freedom.
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Affiliation(s)
- Karina A González Otárula
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Yee-Leng Tan
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 3Department of Neurology, National Neuroscience Institute, Singapore
| | - Jeffery A Hall
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Edward F Chang
- 2Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California
| | - José A Correa
- 4Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Viviane Sziklas
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- 6PET Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Marie-Christine Guiot
- 5Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and
| | - Robert C Knowlton
- 2Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California
| | - Eliane Kobayashi
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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3
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Hainc N, McAndrews MP, Valiante T, Andrade DM, Wennberg R, Krings T. Imaging in medically refractory epilepsy at 3 Tesla: a 13-year tertiary adult epilepsy center experience. Insights Imaging 2022; 13:99. [PMID: 35661273 PMCID: PMC9167324 DOI: 10.1186/s13244-022-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives MRI negative epilepsy has evolved through increased usage of 3 T and insights from surgically correlated studies. The goal of this study is to describe dedicated 3 T epilepsy MRI findings in medically refractory epilepsy (MRE) patients at a tertiary epilepsy center to familiarize radiologists with an updated spectrum and frequency of potential imaging findings in the adult MRE population. Methods Included were all patients with MRE admitted to the epilepsy monitoring unit who were discussed at weekly interdisciplinary imaging conferences at Toronto Western Hospital with MRI studies (3 T with dedicated epilepsy protocol) performed between January 2008 and January 2021. Lesion characterization was performed by two readers based on most likely imaging diagnosis in consensus. Lobes involved per case were recorded. Results A total of 738 patients (386 female; mean age 35 years, range 15–77) were included. A total of 262 patients (35.5%) were MRI negative. The most common imaging finding was mesial temporal sclerosis, seen in 132 patients (17.9%), followed by encephalomalacia and gliosis, either posttraumatic, postoperative, postischemic, or postinfectious in nature, in 79 patients (10.7%). The most common lobar involvement (either partially or uniquely) was temporal (341 cases, 58.6%). MRE patients not candidates for surgical resection were included in the study, as were newly described pathologies from surgically correlated studies revealing findings seen retrospectively on reported MRI negative exams (isolated enlargement of the amygdala, temporal pole white matter abnormality, temporal encephalocele). Conclusion This study provides an updated description of the spectrum of 3 T MRI findings in adult MRE patients from a tertiary epilepsy center.
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Affiliation(s)
- Nicolin Hainc
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. .,Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mary Pat McAndrews
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Danielle M Andrade
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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4
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Kassiri J, Elliott C, Liu N, Mailo J, Rajapakse T, Schmitt L, Wheatley M, Sinclair DB. Neuroimaging in pediatric temporal lobe epilepsy: Does neuroimaging accurately predict pathology and surgical outcome? Epilepsy Res 2021; 175:106680. [PMID: 34102391 DOI: 10.1016/j.eplepsyres.2021.106680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/17/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
Temporal lobe epilepsy (TLE) in children is considered different from that in adults. As such, characterizing the structural lesions present in pediatric patients with TLE and their association with long-term seizure control is important. Here, we aimed to assess the concordance between preoperative imaging and postoperative histopathological diagnoses and their associations with seizure outcomes in pediatric patients with TLE undergoing temporal lobe surgery. We retrospectively reviewed the charts of pediatric patients with TLE who underwent surgical treatment between 1988 and 2020 as a part of the Comprehensive Epilepsy Program at the University of Alberta. Demographic, age at seizure onset, age at surgery, preoperative electroencephalography (EEG), long-term video EEG, imaging (magnetic resonance imaging [MRI] and computed tomography), neuropathology, and long-term seizure outcome data were acquired and analyzed. One hundred and seventeen patients underwent surgery for refractory TLE; the preoperative MRI diagnosis was concordant with the histopathological diagnosis in 76 % of cases. Tumors were identified with high accuracy (91 %). Mesial temporal sclerosis (MTS) was strongly associated with an excellent outcome after surgery (94 %). Patients with normal imaging results or non-specific pathologies were more likely to experience poor seizure outcomes after surgery (50 %). The radiological identification of lesions was associated with good long-term seizure outcomes, whereas normal MRI results were associated with significantly poorer long-term seizure outcomes. An accurate preoperative MRI is essential to epilepsy surgery since it impacts all stages of management; these results will thereafter help inform practitioners' efforts to predict seizure outcome.
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Affiliation(s)
- Janani Kassiri
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada.
| | - Cameron Elliott
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Natarie Liu
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Thilinie Rajapakse
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Schmitt
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Wheatley
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - D Barry Sinclair
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
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5
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Abstract
Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment-resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation-vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.
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Affiliation(s)
- Shahjehan Ahmad
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Arifin MT, Bakhtiar Y, Andar EBPS, Kurnia B H, Priambada D, Risdianto A, Kusnarto G, Tsaniadi K, Bunyamin J, Hanaya R, Arita K, Bintoro AC, Iida K, Kurisu K, Askoro R, Briliantika SP, Muttaqin Z. Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources. Sci Rep 2020; 10:8144. [PMID: 32424296 PMCID: PMC7235248 DOI: 10.1038/s41598-020-64968-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 11/08/2022] Open
Abstract
Approximately 26-30% of temporal lobe epilepsy (TLE) cases display a normal-appearing magnetic resonance image (MRI) leading to difficulty in determining the epileptogenic focus. This causes challenges in surgical management, especially in countries with limited resources. The medical records of 154 patients with normal-appearing MRI TLE who underwent epilepsy surgery between July 1999 and July 2019 in our epilepsy centre in Indonesia were examined. The primary outcome was the Engel classification of seizures. Anterior temporal lobectomy was performed in 85.1% of the 154 patients, followed by selective amygdalo-hippocampectomy and resection surgery. Of 82 patients (53.2%), Engel Class I result was reported in 69.5% and Class II in 25.6%. The median seizure-free period was 13 (95% CI,12.550-13.450) years, while the seizure-free rate at 5 and 12 years follow-up was 96.3% and 69.0%, respectively. Patients with a sensory aura had better seizure-free outcome 15 (11.575-18.425) years. Anterior temporal lobectomy and selective amygdala-hippocampectomy gave the same favourable outcome. Despite the challenges of surgical procedures for normal MRI TLE, our outcome has been favourable. This study suggests that epilepsy surgery in normal MRI TLE can be performed in centres with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia.
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Erie B P S Andar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Happy Kurnia B
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Dody Priambada
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ajid Risdianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Gunadi Kusnarto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Krisna Tsaniadi
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Surya P Briliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
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7
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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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8
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Kogias E, Altenmüller DM, Klingler JH, Schmeiser B, Urbach H, Doostkam S. Histopathology of 3 Tesla MRI-negative temporal lobe epilepsies. J Clin Neurosci 2017; 47:273-277. [PMID: 29042148 DOI: 10.1016/j.jocn.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Histopathology of MRI-negative temporal lobe epilepsies (TLE) shows heterogeneous findings. The use of either 1.5 or 3 Tesla MRI for the selection of MRI-negative cases and use of older classification systems instead of the current ILAE classification system may account for this heterogeneity. We focus on histopathology of 3 Tesla MRI-negative TLE according to ILAE criteria and investigate potential correlation to seizure outcome 1 year postoperatively. MATERIALS AND METHODS Twenty specimens (9 neocortical, 11 hippocampal) from eleven 3 Tesla MRI-negative patients with TLE were examined in two steps. Standard stains and immunohistochemical reactions as well as Palmini and Wyler criteria were used prospectively during the initial examination. Retrospectively, all specimens were re-examined and re-evaluated. Phospho-6 and calretinin stains and the ILAE criteria were used during the review examination. RESULTS Initial examination revealed 7 focal cortical dysplasias (FCDs) Palmini type 1, two cases of cortical gliosis, 4 cases of hippocampal sclerosis (HS) Wyler grade 1 and seven cases of hippocampal gliosis. The review examination according to ILAE criteria revealed 4 FCDs type I and 5 mild malformations of cortical development. All hippocampal specimens showed "no HS/gliosis only" after the review examination. Histopathology showed no correlation to seizure outcome. DISCUSSION This is the first histopathological study to include only 3 Tesla MRI-negative cases. The use of ILAE criteria lead to the diagnosis of "no HS/gliosis only" of all hippocampal specimens, a finding not in line with previously reported series. The spectrum of diagnoses within neocortical specimens showed accordingly more mild findings.
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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
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center- University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center- University of Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center- University of Freiburg, Germany
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9
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Mehvari J, Zare M, Andami R, Ghadimi K, Tabrizi N. Ictal and Interictal Electroencephalography of Mesial and Lateral Temporal Lobe Epilepsy; A Comparative Study. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2017. [DOI: 10.29252/nirp.cjns.3.11.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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10
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Isler C, Ozkara C, Kucukyuruk B, Delil S, Oz B, Comunoglu N, Kizilkilic O, Kayhan A, Deniz K, Akkol S, Tanriverdi T, Uzan M. Seizure Outcome of Patients with Magnetic Resonance Imaging-Negative Epilepsies: Still An Ongoing Debate. World Neurosurg 2017; 106:638-644. [PMID: 28735141 DOI: 10.1016/j.wneu.2017.07.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical results regarding MRI-negative epilepsy were presented and related clinical and histopathological parameters were discussed. METHODS Thirty-six MRI-negative epilepsy patients were retrospectively analyzed. Histopathological specimens were re-reviewed by 2 blind neuropathologists and re-classified based on the current classifications. RESULTS The mean age at surgery and seizure onset was 24.5 years and 9.3 years, respectively. Eight patients were younger than 18 years. Mean duration of seizures was 15.3 years. All but 2 underwent invasive monitorization. Eighteen patients had hypometabolism on FDG-PET with temporal lobe involvement in majority (66.7%). Hypometabolism was found in all patients with hippocampal sclerosis (HS), which was present in 50% and 66.7% of focal cortical dysplasia (FCD) type I and II patients, respectively. The frontal lobe resection was the most frequent type of operation followed by resections in temporal, parietal and occipital lobes. In 7 patients, multilobar resection was performed. Histopathological diagnosis was FCD type I, II, III, HS, and gliosis in 14, 12, 2, 3 and 2 patients, respectively. The mean follow-up was 5.8 years. Seventeen patients were seizure free and favorable outcome (Engel's I and II) was found in 69.7%. FCD type I tend to have more favorable seizure outcome. Duration of epilepsy and hypometabolism on FDG-PET was significantly related to outcome, whereas involved lobe was not. CONCLUSIONS Our results suggest it is worth pursuing resective surgery in adults as well as in children with drug-resistant epilepsy with normal MRI.
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Affiliation(s)
- Cihan Isler
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sakir Delil
- Department of Neurology, Bati Bahat Hospital, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Kayhan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kaancan Deniz
- Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serdar Akkol
- Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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11
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Ivanovic J, Larsson PG, Østby Y, Hald J, Krossnes BK, Fjeld JG, Pripp AH, Alfstad KÅ, Egge A, Stanisic M. Seizure outcomes of temporal lobe epilepsy surgery in patients with normal MRI and without specific histopathology. Acta Neurochir (Wien) 2017; 159:757-766. [PMID: 28281007 PMCID: PMC5385196 DOI: 10.1007/s00701-017-3127-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/16/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Seizure outcome following surgery in pharmacoresistant temporal lobe epilepsy patients with normal magnetic resonance imaging and normal or non-specific histopathology is not sufficiently presented in the literature. METHODS In a retrospective design, we reviewed data of 263 patients who had undergone temporal lobe epilepsy surgery and identified 26 (9.9%) who met the inclusion criteria. Seizure outcomes were determined at 2-year follow-up. Potential predictors of Engel class I (satisfactory outcome) were identified by logistic regression analyses. RESULTS Engel class I outcome was achieved in 61.5% of patients, 50% being completely seizure free (Engel class IA outcome). The strongest predictors of satisfactory outcome were typical ictal seizure semiology (p = 0.048) and localised ictal discharges on scalp EEG (p = 0.036). CONCLUSION Surgery might be an effective treatment choice for the majority of these patients, although outcomes are less favourable than in patients with magnetic resonance imaging-defined lesional temporal lobe epilepsy. Typical ictal seizure semiology and localised ictal discharges on scalp EEG were predictors of Engel class I outcome.
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Affiliation(s)
- Jugoslav Ivanovic
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway.
| | - Pål G Larsson
- Clinical Neurophysiologic Laboratory, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Ylva Østby
- Department of Clinical Psychology and Neuropsychology, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - John Hald
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Bård K Krossnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Jan G Fjeld
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Kristin Å Alfstad
- Department of Adult Epilepsy, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway
| | - Milo Stanisic
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway
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12
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Grau-López L, Jiménez M, Ciurans J, Cáceres C, Becerra JL. Importance of neuropsychological and clinical features to predict seizure control in medically treated patients with mesial temporal epilepsy and hippocampal sclerosis. Epilepsy Behav 2017; 69:121-125. [PMID: 28242475 DOI: 10.1016/j.yebeh.2017.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is not yet understood why seizures in certain patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) develop resistance to antiepileptic drugs (AEDs) while others achieve good seizure control with this treatment. We analyzed clinical and neuropsychological features associated with seizure control in patients with MTLE-HS who had not undergone resective surgery. METHODS We enrolled 40 patients with medically treated MTLE-HS and retrospectively collected the following data from prospective databases: sex, febrile seizures, central nervous system infection, history of head trauma, cognitive impairment, psychiatric disturbances, history of status epilepticus, age at onset of epilepsy, aura, seizure type and frequency, electroencephalography abnormalities, HS side, AEDs, global cognitive status, and neuropsychological functions such as cognitive processing speed, attention and executive functions, verbal and visual memory, language, and visuospatial ability. These factors were compared between patients who achieved seizure control (no seizures or a >50% reduction in seizure frequency) with AED treatment and those who continued with poor seizure control (increase or no change in frequency or <50% reduction) after starting treatment. RESULTS The factors associated with poor seizure control in the multivariate analysis were >2seizures per month before treatment (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.2-4.8, p=0.04), moderate or severe cognitive impairment (OR 2.1, 95% CI 1.8-7.6, p=0.02), and impairment of >2 neuropsychological functions (OR 2.88, 95% CI 2-6.6, p=0.04). No associations were observed between poor seizure control and specific neuropsychological function impairment. CONCLUSIONS Poor seizure control in MTLE-HS is associated with moderate-severe cognitive impairment but not with a specific profile of impairment. Recognizing poor prognostic features such as a high frequency of monthly seizures prior to starting AED treatment could help to identify patients with medically intractable MTLE-HS who may be good candidates for early epilepsy surgery.
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Affiliation(s)
- Laia Grau-López
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain.
| | - Marta Jiménez
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Jordi Ciurans
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
| | - Juan Luis Becerra
- Department of Neurosciences, Hospital Germans Trias i Pujol, C/ Canyet s/n, 08916 Badalona, Spain
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13
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Muhlhofer W, Tan Y, Mueller SG, Knowlton R. MRI
‐negative temporal lobe epilepsy—What do we know? Epilepsia 2017; 58:727-742. [DOI: 10.1111/epi.13699] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wolfgang Muhlhofer
- University of California San Francisco (UCSF) San Francisco California U.S.A
- University of Alabama Birmingham (UAB) Birmingham Alabama U.S.A
| | - Yee‐Leng Tan
- University of California San Francisco (UCSF) San Francisco California U.S.A
- National Neuroscience Institute Singapore Singapore
| | - Susanne G. Mueller
- University of California San Francisco (UCSF) San Francisco California U.S.A
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco California U.S.A
- Department of Radiology UCSF San Francisco CaliforniaU.S.A
| | - Robert Knowlton
- University of California San Francisco (UCSF) San Francisco California U.S.A
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14
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Adry RARDC, Meguins LC, da Silva Júnior SC, Pereira CU, de Araújo Filho GM, Marques LHN. Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis. Acta Neurochir (Wien) 2016; 158:2355-2363. [PMID: 27770263 DOI: 10.1007/s00701-016-2992-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS. OBJECTIVE The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL). METHODS Of 1,214 patients evaluated for surgery in the epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent ATL for MTS. Examinations and clinical data were analyzed and compared with the Engel Outcome Classification. RESULTS Of all the items analyzed, the MRI showed the greatest influence on patient outcome. As for the clinical evaluation and pathological antecedents, age at surgery, epilepsy duration, perinatal insults, family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure all had statistical significance. CONCLUSION In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with a favorable outcome for counseling patients in daily practice.
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Affiliation(s)
- Rodrigo Antonio Rocha da Cruz Adry
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
- Hospital Aliança, Salvador, Bahia, Brazil.
| | - Lucas Crociati Meguins
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Sebastião Carlos da Silva Júnior
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Gerardo Maria de Araújo Filho
- Psychiatry. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Lúcia Helena Neves Marques
- Neurology. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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15
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Corley JA, Nazari P, Rossi VJ, Kim NC, Fogg LF, Hoeppner TJ, Stoub TR, Byrne RW. Cortical stimulation parameters for functional mapping. Seizure 2016; 45:36-41. [PMID: 27914225 DOI: 10.1016/j.seizure.2016.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE There is significant variation in how patients respond to cortical electrical stimulation. It has been hypothesized that individual demographic and pathologic factors, such as age, sex, disease duration, and MRI findings, may explain this discrepancy. The purpose of our study is to identify specific patient characteristics and their effect on cortical stimulation, and discover the extent of variation in behavioral responses that exists among patients with epilepsy. METHOD We retrospectively analyzed data from 92 patients with medically intractable epilepsy who had extra-operative cortical electrical stimulation. Mapping records were evaluated and information gathered about demographic data, as well as the thresholds of stimulation for motor, sensory, speech, and other responses; typical seizure behavior; and the induction of afterdischarges. RESULTS Ninety-two patient cortical stimulation mapping reports were analyzed. The average of the minimum thresholds for motor response was 4.15mA±2.67. The average of the minimum thresholds for sensory response was 3.50mA±2.15. The average of the minimum thresholds for speech response was 4.48mA±2.42. The average of the minimum thresholds for afterdischarge was 4.33mA±2.37. Most striking were the degree of variability and wide range of thresholds seen between patients and within the different regions of the same patient. CONCLUSION Wide ranges of thresholds exist for the different responses between patients and within different regions of the same patient. With multivariate analysis in these series, no clinical or demographic factors predicted physiological response or afterdischarge threshold levels.
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Affiliation(s)
- Jacquelyn A Corley
- Department of Neurosurgery, Duke University Hospital, DUMC Box 3807, Durham, NC 27710, United States.
| | - Pouya Nazari
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Vincent J Rossi
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC 28203, United States
| | - Nora C Kim
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Louis F Fogg
- College of Nursing, Rush University, Chicago, IL 60612, United States
| | - Thomas J Hoeppner
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, United States
| | - Travis R Stoub
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, United States
| | - Richard W Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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16
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Goldenholz DM, Jow A, Khan OI, Bagić A, Sato S, Auh S, Kufta C, Inati S, Theodore WH. Preoperative prediction of temporal lobe epilepsy surgery outcome. Epilepsy Res 2016; 127:331-338. [PMID: 27701046 DOI: 10.1016/j.eplepsyres.2016.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/29/2016] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE There is controversy about relative contributions of ictal scalp video EEG recording (vEEG), routine scalp outpatient interictal EEG (rEEG), intracranial EEG (iEEG) and MRI for predicting seizure-free outcomes after temporal lobectomy. We reviewed NIH experience to determine contributions at specific time points as well as long-term predictive value of standard pre-surgical investigations. METHODS Raw data was obtained via retrospective chart review of 151 patients. After exclusions, 118 remained (median 5 years follow-up). MRI-proven mesial temporal sclerosis (MTSr) was considered a separate category for analysis. Logistic regression estimated odds ratios at 6-months, 1-year, and 2 years; proportional hazard models estimated long-term comparisons. Subset analysis of the proportional hazard model was performed including only patients with commonly encountered situations in each of the modalities, to maximize statistical inference. RESULTS Any MRI finding, MRI proven MTS, rEEG, vEEG and iEEG did not predict two-year seizure-free outcome. MTSr was predictive at six months (OR=2.894, p=0. 0466), as were MRI and MTSr at one year (OR=10.4231, p=0. 0144 and OR=3.576, p=0. 0091). Correcting for rEEG and MRI, vEEG failed to predict outcome at 6 months, 1year and 2 years. Proportional hazard analysis including all available follow-up failed to achieve significance for any modality. In the subset analysis of 83 patients with commonly encountered results, vEEG modestly predicted long-term seizure-free outcomes with a proportional hazard ratio of 1.936 (p=0.0304). CONCLUSIONS In this study, presurgical tools did not provide unambiguous long-term outcome predictions. Multicenter prospective studies are needed to determine optimal presurgical epilepsy evaluation.
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Affiliation(s)
| | - Alexander Jow
- Clinical Epilepsy Section, NINDS, NIH, United States
| | - Omar I Khan
- Clinical Epilepsy Section, NINDS, NIH, United States; Office of the Clinical Director, NINDS, NIH, United States
| | - Anto Bagić
- Clinical Epilepsy Section, NINDS, NIH, United States
| | - Susumu Sato
- Electroencephalography Section, NINDS, NIH, United States
| | - Sungyoung Auh
- Clinical Neurosciences Program, NINDS, NIH, United States
| | - Conrad Kufta
- Neurosurgical Biology and Therapeutics Section, NINDS, NIH, United States
| | - Sara Inati
- Electroencephalography Section, NINDS, NIH, United States
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17
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Wang X, Zhang C, Wang Y, Hu W, Shao X, Zhang JG, Zhang K. Prognostic factors for seizure outcome in patients with MRI-negative temporal lobe epilepsy: A meta-analysis and systematic review. Seizure 2016; 38:54-62. [PMID: 27182689 DOI: 10.1016/j.seizure.2016.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to identify predictors of postoperative seizure freedom in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. METHOD Publications were screened from electronic databases (MEDLINE, EMBASE), epilepsy archives, and bibliographies of relevant articles that were written in English. We recorded all possible risk factors that might predict seizure outcome after surgery. We calculated odds ratio (OR) with corresponding 95% confidence intervals (95% CI) of predictors for postoperative seizure freedom. Heterogeneity was assessed with I(2). All meta-analyses were performed using Review Manager. RESULTS Epilepsy duration (OR=2.57, 95% CI=1.21-5.47, p<0.05, I(2)=1%) and ictal or interictal electroencephalographic anomalies precisely localized in the ipsilateral temporal lobe (OR=3.89, 95% CI=1.66-9.08, p<0.01, I(2)=0 and OR=3.38, 95% CI=1.57-7.25, p<0.05, I(2)=0, respectively) were significantly associated with a higher rate of seizure freedom after surgery. However, the positron emission tomography (PET) results were not predictive of postoperative seizure freedom (OR=2.11, 95% CI=0.95-4.65, p=0.06, I(2)=0). No significant difference in seizure freedom was observed between the positive and negative pathology groups (OR=1.36, 95% CI=0.70-2.63, p=0.36, I(2)=0). CONCLUSIONS A shorter epilepsy duration and scalp electroencephalogram (EEG) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy.
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Affiliation(s)
- Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China.
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18
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Long-term surgical outcomes in patients with drug-resistant temporal lobe epilepsy and no histological abnormalities. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2013.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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Temporal lobe resective surgery for medically intractable epilepsy: a review of complications and side effects. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:752195. [PMID: 24288602 PMCID: PMC3833403 DOI: 10.1155/2013/752195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Object. It is widely accepted that temporal resective surgery represents an efficacious treatment option for patients with epilepsy of temporal origin. The meticulous knowledge of the potential complications, associated with temporal resective procedures, is of paramount importance. In our current study, we attempt to review the pertinent literature for summating the complications of temporal resective procedures for epilepsy. Method. A PubMed search was performed with the following terms: “behavioral,” “cognitive,” “complication,” “deficit,” “disorder,” “epilepsy,” “hemianopia,” “hemianopsia,” “hemorrhage,” “lobectomy,” “medial,” “memory,” “mesial,” “neurobehavioral,” “neurocognitive,” “neuropsychological,” “psychological,” “psychiatric,” “quadranopia,” “quadranopsia,” “resective,” “side effect,” “surgery,” “temporal,” “temporal lobe,” and “visual field.” Results. There were six pediatric, three mixed-population, and eleven adult surgical series examining the incidence rates of procedure-related complications. The reported mortality rates varied between 0% and 3.5%, although the vast majority of the published series reported no mortality. The cumulative morbidity rates ranged between 3.2% and 88%. Conclusions. Temporal resective surgery for epilepsy is a safe treatment modality. The reported morbidity rates demonstrate a wide variation. Accurate detection and frank reporting of any surgical, neurological, cognitive, and/or psychological complications are of paramount importance for maximizing the safety and improving the patients' overall outcome.
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20
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Ramey WL, Martirosyan NL, Lieu CM, Hasham HA, Lemole GM, Weinand ME. Current management and surgical outcomes of medically intractable epilepsy. Clin Neurol Neurosurg 2013; 115:2411-8. [PMID: 24169149 DOI: 10.1016/j.clineuro.2013.09.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/19/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022]
Abstract
Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life. Temporal lobe epilepsy (TLE) is the most common form of MIE and comprises about 80% of epilepsy surgeries with the majority of patients gaining complete seizure-freedom. As the number of procedures and different approaches continues to grow, temporal lobectomy remains consistently focused on resection of mesial structures such as the amygdala, hippocampus, and parahippocampal gyrus while preserving as much of the neocortex as possible resulting in optimum seizure control with minimal neurological deficits. MIE originating outside the temporal lobe is also effectively treated with resection. Though not as successful as TLE surgery because of their frequent proximity to eloquent brain structures and more diffuse pathology, epileptogenic foci located extratemporally also benefit from resection. Favorable seizure outcome in each of these procedures has heavily relied on pre-operative imaging, especially since the massive surge in MRI technology just over 20 years ago. However, in the absence of visible lesions on MRI, recent improvements in secondary imaging modalities such as fluorodeoxyglucose positron emission computed tomography (FDG-PET) and single-photon emission computed tomography (SPECT) have lead to progressively better long-term seizure outcomes by increasing the neurosurgeon's visualization of supposed non-lesional foci. Additionally, being historically viewed as a drastic surgical intervention for MIE, hemispherectomy has been extensively used quite successfully for diffuse epilepsies often found in pediatric patients. Although total anatomic hemispherectomy is not utilized as commonly today, it has given rise to current disconnective techniques such as hemispherotomy. Therefore, severe forms of hemispheric developmental epilepsy can now be surgically treated while substantially decreasing the amount of potential long-term complications resulting from cavitation of the brain following anatomical hemispherectomy. Despite the rapid pace at which we are gaining further knowledge about epilepsy and its surgical treatment, there remains a sizeable underutilization of such procedures. By reviewing the recent literature on resective treatment of MIE, we provide a recent up-date on epilepsy surgery while focusing on historical perspectives, techniques, prognostic indicators, outcomes, and complications associated with several different types of procedures.
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Affiliation(s)
- Wyatt L Ramey
- School of Medicine, Creighton University, Omaha, USA
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21
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Wang ZI, Alexopoulos AV, Jones SE, Jaisani Z, Najm IM, Prayson RA. The pathology of magnetic-resonance-imaging-negative epilepsy. Mod Pathol 2013; 26:1051-8. [PMID: 23558575 DOI: 10.1038/modpathol.2013.52] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/09/2022]
Abstract
Patients with magnetic-resonance-imaging (MRI)-negative (or 'nonlesional') pharmacoresistant focal epilepsy are the most challenging group undergoing presurgical evaluation. Few large-scale studies have systematically reviewed the pathological substrates underlying MRI-negative epilepsies. In the current study, histopathological specimens were retrospectively reviewed from MRI-negative epilepsy patients (n=95, mean age=30 years, 50% female subjects). Focal cortical dysplasia cases were classified according to the International League Against Epilepsy (ILAE) and Palmini et al classifications. The most common pathologies found in this MRI-negative cohort included: focal cortical dysplasia (n=43, 45%), gliosis (n=21, 22%), hamartia+gliosis (n=12, 13%), and hippocampal sclerosis (n=9, 9%). The majority of focal cortical dysplasia were ILAE type I (n=37) or Palmini type I (n=39). Seven patients had no identifiable pathological abnormalities. The existence of positive pathology was not significantly associated with age or temporal/extratemporal resection. Follow-up data post surgery was available in 90 patients; 63 (70%) and 57 (63%) attained seizure freedom at 6 and 12 months, respectively. The finding of positive pathology was significantly associated with seizure-free outcome at 6 months (P=0.035), but not at 12 months. In subgroup analysis, the focal cortical dysplasia group was not significantly correlated with seizure-free outcome, as compared with the negative-pathology groups at either 6 or 12 months. Of note, the finding of hippocampal sclerosis had a significant positive correlation with seizure-free outcome when compared with the negative-pathology group (P=0.009 and 0.004 for 6- and 12-month outcome, respectively). Absence of a significant histopathology in the resected surgical specimen did not preclude seizure freedom. In conclusion, our study highlights the heterogeneity of epileptic pathologies in MRI-negative epilepsies, with focal cortical dysplasia being the most common finding. The existence of positive pathology in surgical specimen may be a good indication for short-term good seizure outcome. There is a small subset of cases in which no pathological abnormalities are identified.
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Affiliation(s)
- Z Irene Wang
- Cleveland Clinic Epilepsy Center, Cleveland, OH, USA
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22
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Maccotta L, He BJ, Snyder AZ, Eisenman LN, Benzinger TL, Ances BM, Corbetta M, Hogan RE. Impaired and facilitated functional networks in temporal lobe epilepsy. NEUROIMAGE-CLINICAL 2013; 2:862-72. [PMID: 24073391 PMCID: PMC3777845 DOI: 10.1016/j.nicl.2013.06.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 12/13/2022]
Abstract
How epilepsy affects brain functional networks remains poorly understood. Here we investigated resting state functional connectivity of the temporal region in temporal lobe epilepsy. Thirty-two patients with unilateral temporal lobe epilepsy underwent resting state blood-oxygenation level dependent functional magnetic resonance imaging. We defined regions of interest a priori focusing on structures involved, either structurally or metabolically, in temporal lobe epilepsy. These structures were identified in each patient based on their individual anatomy. Our principal findings are decreased local and inter-hemispheric functional connectivity and increased intra-hemispheric functional connectivity ipsilateral to the seizure focus compared to normal controls. Specifically, several regions in the affected temporal lobe showed increased functional coupling with the ipsilateral insula and immediately neighboring subcortical regions. Additionally there was significantly decreased functional connectivity between regions in the affected temporal lobe and their contralateral homologous counterparts. Intriguingly, decreased local and inter-hemispheric connectivity was not limited or even maximal for the hippocampus or medial temporal region, which is the typical seizure onset region. Rather it also involved several regions in temporal neo-cortex, while also retaining specificity, with neighboring regions such as the amygdala remaining unaffected. These findings support a view of temporal lobe epilepsy as a disease of a complex functional network, with alterations that extend well beyond the seizure onset area, and the specificity of the observed connectivity changes suggests the possibility of a functional imaging biomarker for temporal lobe epilepsy. We studied functional connectivity changes in patients with temporal lobe epilepsy. Patients had decreased local and inter-hemispheric functional connectivity. Patients had increased intra-hemispheric connectivity, ipsilateral to seizure focus. Functional changes involved several neocortical sites, including the insula. This pattern may have usefulness as a non-invasive method for presurgical planning.
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Affiliation(s)
- Luigi Maccotta
- Department of Neurology, Washington University, St. Louis, MO, USA
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Abstract
PURPOSE To evaluate the prevalence of nonlesional focal epilepsy in an adult epilepsy clinic and its refractoriness to antiepileptic drug therapy. BACKGROUND Focal epilepsy is frequently, but not always, associated with structural epileptogenic lesions identifiable on magnetic resonance imaging (MRI). METHODS We analyzed the data from all patients evaluated at an adult epilepsy clinic from January 2002 to December 2011. Clinical and paraclinical findings were used to diagnose focal epilepsy. Magnetic resonance imaging were reviewed and classified as normal, with an epileptogenic lesion, or with a lesion of unclear epileptogenicity. Epileptogenic lesions were further categorized as tumours, vascular malformations, gliosis (including hippocampal atrophy/sclerosis), and malformations of cortical development. Our study group included patients with no lesions on MRI. Pharmacoresistance of patients with nonlesional focal epilepsy was assessed using the ILAE and Perucca's criterias. RESULTS Out of 1521 patients evaluated (mean age 44 years; range 14-93 years), 843 had focal epilepsy. Magnetic resonance imaging data, available for 806 (96%) subjects, showed epileptogenic lesions in 65%, no obvious epileptogenic lesions in 31% and lesions of unclear epileptogenicity in 4%. Magnetic resonance imaging-identified lesions included gliosis due to an acquired insult (52% including 17% of hippocampal atrophy or sclerosis), tumours (29%), vascular malformations (16%) and malformations of cortical development (10%). Fifty-two percent of nonlesional focal epileptic patients were drug-refractory. CONCLUSION In a tertiary epilepsy clinic, close to a third of patients with focal epilepsy were found to be nonlesional, half of which were drug-resistant.
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Benedetti-Isaac JC, Torres-Zambrano M, Fandiño-Franky J, Dussán-Ordóñez J, Herrera-Trujillo A, Guerra-Olivares R, Alcalá-Cerra G. Long-term surgical outcomes in patients with drug-resistant temporal lobe epilepsy and no histological abnormalities. Neurologia 2013; 28:543-9. [PMID: 23623700 DOI: 10.1016/j.nrl.2013.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/30/2012] [Accepted: 01/22/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Reports on surgical outcomes in patients with drug-resistant temporal lobe epilepsy without histological abnormalities are scarce. METHODS Retrospective review of data from patients with drug-resistant temporal lobe epilepsy and no histopathological alterations who underwent anterior mesial temporal lobectomy. We analysed the following variables: age, sex, age at seizure onset, age at surgery, time elapsed between diagnosis and the date of the surgery, follow-up time, and classification according to the Engel rating scale. RESULTS From a database of 256 temporal lobectomies, 21 were identified as meeting the inclusion criteria. The average age upon diagnosis of epilepsy was 8.3 years and average age at time of surgery was 28.6 years. The mean time elapsed between diagnosis and surgery was 20.2 years. After a mean follow-up of 6.5 years, 90.5% of the patients showed favourable outcomes (classes i and ii) and 42.9% were seizure-free (class IA). Comparative analysis of the variables revealed that average age at seizure onset was the only statistically significant difference between groups, with age at onset being lower in patients with favourable outcomes. CONCLUSION Although long-term surgical outcomes were favourable for a large majority of patients, the percentage of seizure-free patients is lower than in patients with lesional epilepsy and comparable to that previously reported in the literature.
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Affiliation(s)
- J C Benedetti-Isaac
- Departamento de Investigación, Centro Latinoamericano de Investigación en Epilepsia (CLIE), Cartagena de Indias, Colombia.
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Pediatric temporal lobe epilepsy surgery: resection based on etiology and anatomical location. Adv Tech Stand Neurosurg 2012. [PMID: 23250838 DOI: 10.1007/978-3-7091-1360-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Advances in electrophysiological assessment with improved structural and functional neuroimaging have been very helpful in the use of surgery as a tool for drug-resistant epilepsy. Increasing interest in epilepsy surgery has had a major impact on adult patients; a refined evaluation process and new criteria for drug resistance combined with refined surgical techniques resulted in large surgical series in many centers. Pediatric surgery has lagged behind this evolution, possibly because of the diverse semiology and electrophysiology of pediatric epilepsy obscuring the focal nature of the seizures and frustrating the treatment of catastrophic epileptic syndromes specific to children. Unfortunately, refractory -epilepsy is more -devastating in children than in adults as it interferes with all aspects of neural development. Nevertheless, during the last few decades, the efforts of a small number of centers with encouraging results in pediatric epilepsy surgery have motivated pediatric neurologists to gain interest. Although well behind in the number of patients compared with that of adults, pediatric series are increasing exponentially. While temporal lobe epilepsy is the focus of interest in adults, with almost 70 % of resections in the temporal lobe, the pediatric epilepsy spectrum is different. Resective or functional surgery techniques devoted to resistant extratemporal epilepsy are the major improvements in pediatric epilepsy surgery. Temporal lobe epilepsy in adults has been studied extensively but only recently has begun to receive attention in children. Several aspects of temporal lobe epilepsy in childhood remain unclear or controversial in terms of seizure semiology and its pathology. This is reflected in the surgical treatment. Information on the major contributors to a favorable outcome, such as type or extent of resection, in terms of seizure control and morbidity is not available as in adult temporal lobe epilepsy. This chapter discusses the major discrepancies between adult and pediatric temporal lobe epilepsy and outlines the current concepts in surgical treatment. The resection strategy based on the different substrates at different locations in the temporal lobe causing seizures is emphasized with respect to available literature.
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Falowski SM, Wallace D, Kanner A, Smith M, Rossi M, Balabanov A, Ouyang B, Byrne RW. Tailored Temporal Lobectomy for Medically Intractable Epilepsy. Neurosurgery 2012; 71:703-9; discussion 709. [DOI: 10.1227/neu.0b013e318262161d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
There have been only a few large series that have used a tailored temporal lobectomy.
OBJECTIVE:
To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections.
METHODS:
Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated.
RESULTS:
Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections.
CONCLUSION:
Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.
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Affiliation(s)
| | - David Wallace
- Department of Neurosurgery, Rush University, Chicago, Illinois
| | - Andres Kanner
- Department of Neurology, Rush University, Chicago, Illinois
| | - Michael Smith
- Department of Neurology, Rush University, Chicago, Illinois
| | - Michael Rossi
- Department of Neurology, Rush University, Chicago, Illinois
| | | | - Bichun Ouyang
- Department of Neurology, Rush University, Chicago, Illinois
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Which Hippocampal Sclerosis is Imaged with 7-T MRI? Epilepsy Curr 2012; 12:99-100. [DOI: 10.5698/1535-7511-12.3.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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