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Bottan JS, Alshahrani A, Gilmore G, Steven DA, Burneo JG, Lau JC, McLachlan RS, Parrent AG, MacDougall KW, Diosy DC, Mirsattari SM, Suller Marti A. Lack of spontaneous typical seizures during intracranial monitoring with stereo-electroencephalography. Epileptic Disord 2023; 25:833-844. [PMID: 37792454 DOI: 10.1002/epd2.20165] [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: 11/27/2022] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE In the presurgical evaluation of patients with drug-resistant epilepsy (DRE), occasionally, patients do not experience spontaneous typical seizures (STS) during a stereo-electroencephalography (SEEG) study, which limits its effectiveness. We sought to identify risk factors for patients who did not have STS during SEEG and to analyze the clinical outcomes for this particular set of patients. METHODS We conducted a retrospective analysis of all patients with DRE who underwent depth electrode implantation and SEEG recordings between January 2013 and December 2018. RESULTS SEEG was performed in 155 cases during this period. 11 (7.2%) did not experience any clinical seizures (non-STS group), while 143 experienced at least one patient-typical seizure during admission (STS group). No significant differences were found between STS and non-STS groups in terms of patient demographics, lesional/non-lesional epilepsy ratio, pre-SEEG seizure frequency, number of ASMs used, electrographic seizures or postoperative seizure outcome in those who underwent resective surgery. Statistically significant differences were found in the average number of electrodes implanted (7.0 in the non-STS group vs. 10.2 in STS), days in Epilepsy Monitoring Unit (21.8 vs. 12.8 days) and the number of cases that underwent resective surgery following SEEG (27.3% vs. 60.8%), respectively. The three non-STS patients (30%) who underwent surgery, all had their typical seizures triggered during ECS studies. Three cases were found to have psychogenic non-epileptic seizures. None of the patients in the non-STS group were offered neurostimulation devices. Five of the non-STS patients experienced transient seizure improvement following SEEG. SIGNIFICANCE We were unable to identify any factors that predicted lack of seizures during SEEG recordings. Resective surgery was only offered in cases where ECS studies replicated patient-typical seizures. Larger datasets are required to be able to identify factors that predict which patients will fail to develop seizures during SEEG.
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Affiliation(s)
- Juan S Bottan
- Section of Neurosurgery, Hospital General de Niños "Pedro De Elizalde", Ciudad Autónoma de Buenos Aires, Argentina
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashwaq Alshahrani
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Greydon Gilmore
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan C Lau
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard S McLachlan
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David C Diosy
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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McIntosh AM, Wynd AW, Berkovic SF. Extended follow-up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery. Epilepsia 2023; 64:92-102. [PMID: 36268808 PMCID: PMC10098858 DOI: 10.1111/epi.17440] [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: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up. METHODS Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly. Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98). RESULTS Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizure-free after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74). SIGNIFICANCE Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.
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Affiliation(s)
- Anne M McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.,Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex W Wynd
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
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Sivaraju A, Hirsch L, Gaspard N, Farooque P, Gerrard J, Xu Y, Deng Y, Damisah E, Blumenfeld H, Spencer DD. Factors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy. Neurology 2022; 99:e1-e10. [PMID: 35508395 PMCID: PMC9259091 DOI: 10.1212/wnl.0000000000200569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to identify predictors of a resective surgery and subsequent seizure freedom following intracranial EEG (ICEEG) for seizure-onset localization. METHODS This is a retrospective chart review of 178 consecutive patients with medically refractory epilepsy who underwent ICEEG monitoring from 2002 to 2015. Univariable and multivariable regression analysis identified independent predictors of resection vs other options. Stepwise Akaike information criteria with the aid of clinical consideration were used to select the best multivariable model for predicting resection and outcome. Discrete time survival analysis was used to analyze the factors predicting seizure-free outcome. Cumulative probability of seizure freedom was analyzed using Kaplan-Meier curves and compared between resection and nonresection groups. Additional univariate analysis was performed on 8 select clinical scenarios commonly encountered during epilepsy surgical evaluations. RESULTS Multivariable analysis identified the presence of a lesional MRI, presurgical hypothesis suggesting temporal lobe onset, and a nondominant hemisphere implant as independent predictors of resection (p < 0.0001, area under the receiver operating characteristic curve 0.80, 95% CI 0.73-0.87). Focal ICEEG onset and undergoing a resective surgery predicted absolute seizure freedom at the 5-year follow-up. Patients who underwent resective surgery were more likely to be seizure-free at 5 years compared with continued medical treatment or neuromodulation (60% vs 7%; p < 0.0001, hazard ratio 0.16, 95% CI 0.09-0.28). Even patients thought to have unfavorable predictors (nonlesional MRI or extratemporal lobe hypothesis or dominant hemisphere implant) had ≥50% chance of seizure freedom at 5 years if they underwent resection. DISCUSSION Unfavorable predictors, including having nonlesional extratemporal epilepsy, should not deter a thorough presurgical evaluation, including with invasive recordings in many cases. Resective surgery without functional impairment offers the best chance for sustained seizure freedom and should always be considered first. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the presence of a lesional MRI, presurgical hypothesis suggesting temporal lobe onset, and a nondominant hemisphere implant are independent predictors of resection. Focal ICEEG onset and undergoing resection are independent predictors of 5-year seizure freedom.
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Affiliation(s)
- Adithya Sivaraju
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT.
| | - Lawrence Hirsch
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Nicolas Gaspard
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Pue Farooque
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Jason Gerrard
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Yunshan Xu
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Yanhong Deng
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Eyiyemisi Damisah
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Hal Blumenfeld
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
| | - Dennis D Spencer
- From the Comprehensive Epilepsy Center (A.S., L.H., N.G., P.F., H.B.), Department of Neurology, Yale University School of Medicine, New Haven, CT; Service de Neurologie (N.G.), Université Libre de Bruxelles-Hôpital Erasme, Belgium; Comprehensive Epilepsy Center (J.G., E.D., D.D.S.), Department of Neurosurgery, Yale University School of Medicine, New Haven; and Yale Center for Analytical Sciences (Y.X., Y.D.), Yale School of Public Health, New Haven, CT
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