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Castro‐Lima H, Passarelli V, Ribeiro ES, Adda CC, Preturlon‐Santos APP, Jorge CL, Valério R, Tzu WH, Boa‐Sorte N, Pipek LZ, Castro LHM. Bilateral ictal EEG is associated with better memory outcome after hippocampal sclerosis surgery. Epilepsia Open 2023; 8:1532-1540. [PMID: 37750472 PMCID: PMC10690677 DOI: 10.1002/epi4.12834] [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: 01/18/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To compare memory outcomes after surgery for unilateral hippocampal sclerosis (HS)-associated epilepsy in patients with unilateral and bilateral ictal electrographic involvement. METHODS We prospectively evaluated HS patients, aged 18-55 years and IQ ≥70. Left (L) and right (R) surgical groups underwent noninvasive video-EEG monitoring and Wada test. We classified patients as Ipsilateral if ictal EEG was restricted to the HS side, or Bilateral, if at least one seizure onset occurred contralaterally to the HS, or if ictal discharge evolved to the opposite temporal region. Patients who declined surgery served as controls. Memory was evaluated on two occasions with Rey Auditory-Verbal Learning Test and Rey Visual-Design Learning Test. Baseline neuropsychological test scores were compared between groups. Pre- and postoperative scores were compared within each group. Reliable change index Z-scores (RCI) were obtained using controls as references, and compared between surgical groups. RESULTS We evaluated 64 patients. Patients were classified as: L-Ipsilateral (9), L-Bilateral (15), L-Control (9), R-Ipsilateral (10), R-Bilateral (9), and R-Control (12). On preoperative evaluation, memory performance did not differ among surgical groups. Right HS patients did not present postoperative memory decline. L-Ipsilateral group presented postoperative decline on immediate (P = 0.036) and delayed verbal recall (P = 0.011), while L-Bilateral did not decline. L-Ipsilateral had lower RCI Z-scores, indicating delayed verbal memory decline compared to L-Bilateral (P = 0.012). SIGNIFICANCE Dominant HS patients with bilateral ictal involvement presented less pronounced postoperative verbal memory decline compared to patients with exclusive ipsilateral ictal activity. Surgery was indicated in these patients regardless of memory impairment on neuropsychological testing, since resection of the left sclerotic hippocampus could result in cessation of contralateral epileptiform activity, and, therefore, improved memory function.
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Affiliation(s)
| | - Valmir Passarelli
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Elyse S Ribeiro
- Division of Psychology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Carla C Adda
- Division of Psychology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Ana Paula P Preturlon‐Santos
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Carmen L Jorge
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Rosa Valério
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Wen Hung Tzu
- Department of Neurosurgery, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Ney Boa‐Sorte
- Bahiana School of Medicine and Public HealthSalvadorBrazil
| | - Leonardo Zumerkorn Pipek
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
| | - Luiz Henrique M Castro
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversity of Sao PauloSão PauloBrazil
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Lai N, Li Z, Xu C, Wang Y, Chen Z. Diverse nature of interictal oscillations: EEG-based biomarkers in epilepsy. Neurobiol Dis 2023; 177:105999. [PMID: 36638892 DOI: 10.1016/j.nbd.2023.105999] [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: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Interictal electroencephalogram (EEG) patterns, including high-frequency oscillations (HFOs), interictal spikes (ISs), and slow wave activities (SWAs), are defined as specific oscillations between seizure events. These interictal oscillations reflect specific dynamic changes in network excitability and play various roles in epilepsy. In this review, we briefly describe the electrographic characteristics of HFOs, ISs, and SWAs in the interictal state, and discuss the underlying cellular and network mechanisms. We also summarize representative evidence from experimental and clinical epilepsy to address their critical roles in ictogenesis and epileptogenesis, indicating their potential as electrophysiological biomarkers of epilepsy. Importantly, we put forwards some perspectives for further research in the field.
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Affiliation(s)
- Nanxi Lai
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhisheng Li
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Wang
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology & Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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3
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Aura Type and Outcome Following Anterior Temporal Lobectomy. World Neurosurg 2022; 161:e199-e209. [DOI: 10.1016/j.wneu.2022.01.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
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Mehvari Habibabadi J, Moein H, Jourahmad Z, Ahmadian M, Basiratnia R, Zare M, Hashemi Fesharaki SS, Badihian S, Barekatain M, Tabrizi N. Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country. Epilepsy Behav 2021; 122:108221. [PMID: 34352668 DOI: 10.1016/j.yebeh.2021.108221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. METHODS This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not-seizure free (NSF). RESULTS A total of 148 adult patients, with a mean age of 30.45 ± 9.23 years were included. The SF outcome was reported in 86.5% of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%. The mean follow-up duration was 26.7 ± 14.9 months. Temporal lobe lesions (76.3%) and mesial temporal sclerosis (MTS) (56.7%) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95% CI [1.08-2.87], p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI [1.03-1.35], p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI [1.06-2.81], p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI [1.18-1.70], p < 0.001) were positive predictors for a favorable outcome. CONCLUSION Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed.
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Affiliation(s)
| | - Houshang Moein
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Jourahmad
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | - Mana Ahmadian
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran.
| | - Reza Basiratnia
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | | | - Shervin Badihian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Majid Barekatain
- Psychosomatic Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Kang JY, Pickard AA, Bronder J, Yenokyan G, Chen M, Anderson WS, Sperling MR, Nei M. Magnetic resonance-guided laser interstitial thermal therapy: Correlations with seizure outcome. Epilepsia 2021; 62:1085-1091. [PMID: 33713425 DOI: 10.1111/epi.16872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to identify clinical factors associated with seizure freedom after magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) in temporal lobe epilepsy patients with unilateral mesial temporal sclerosis (MTS). METHODS We identified 56 patients with magnetic resonance imaging-defined MTS who underwent MRgLiTT with at least 1 year of follow-up. Primary outcome was seizure freedom at 1 year. We examined the association of seizure freedom and the following clinical factors: age at surgery, gender, history of febrile seizures, history of focal to bilateral tonic-clonic seizures, duration of epilepsy at the time of surgery, frequency of interictal epileptiform discharges (IEDs), seizure frequency, and presence of bilateral IEDs. RESULTS Thirty-five (62.5%) patients were seizure-free at 1 year. The presence of bilateral IEDs and age at surgery were associated with 1-year seizure freedom after MRgLiTT. The presence of bilateral IEDS was associated with lower odds of seizure freedom (odds ratio [OR] = .05, 95% confidence interval [CI] = .01-.46, p = .008), whereas increasing age at surgery was associated with increased odds of seizure freedom (OR = 1.10, 95% CI = 1.03-1.19, p = .009). SIGNIFICANCE This study demonstrates associations between presence of bilateral IEDs and age at surgery and seizure freedom at 1 year after MRgLiTT.
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Affiliation(s)
- Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Allyson A Pickard
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jay Bronder
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mo Chen
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - William S Anderson
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Maromi Nei
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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He X, Liu D, Yang Z, Zhang J, Li S, Yang Z. Side of Lesions Predicts Surgical Outcomes in Patients With Drug-Resistant Temporal Lobe Epilepsy Secondary to Focal Cortical Dysplasia Type IIIa. Front Neurol 2020; 11:580221. [PMID: 33362691 PMCID: PMC7758315 DOI: 10.3389/fneur.2020.580221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate the surgical outcomes and analyze the predictors of surgical outcomes in patients undergoing anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) secondary to focal cortical dysplasia (FCD) type IIIa. Methods: Data on patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL at Xiangya Hospital, Central South University from January 2014 to April 2018, were collected retrospectively. International League Against Epilepsy (ILAE) classification was used to evaluate postoperative seizure outcomes. Predictors of surgical outcomes were identified by using univariate and multivariate analyses. Results: A total of 43 patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL were included in this study. Twenty patients had right ATL, and 23 patients had left ATL. With a follow-up of 2-6 years, 76.7% (33 of 43) of patients were seizure-free. Univariate and multivariate analysis results indicated that lesions on the right side independently predict postoperative seizure freedom (OR, 0.08; 95% CI, 0.01-0.72; P = 0.024). Conclusion: ATL is an effective therapy for patients with drug-resistant TLE secondary to FCD type IIIa. Patients with lesions on the right side are more likely to achieve postoperative seizure freedom.
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Affiliation(s)
- Xinghui He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junmei Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Sushan Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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An image processing algorithm to aid diagnosis of mesial temporal sclerosis in children: a case-control study. Pediatr Radiol 2020; 50:98-106. [PMID: 31578627 DOI: 10.1007/s00247-019-04518-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/22/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mesial temporal sclerosis (MTS) is an important cause of intractable epilepsy. Early and accurate diagnosis of MTS is essential to providing curative and life-changing therapy but can be challenging in children in whom the impact of diagnosis is particularly high. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of MTS, and image processing of MRI is a recently studied strategy to improve its accuracy. OBJECTIVE In a retrospective case-control study, we assessed the performance of an image processing algorithm (Correlative Image Enhancement [CIE]) for detecting MTS-related hippocampal signal abnormality in children. MATERIALS AND METHODS Twenty-seven pediatric MTS cases (9 males, 18 females; mean age: 16±standard deviation [SD] 6.7 years) were identified from a pathology database of amygdylo-hippocampectomies performed in children with epilepsy. Twenty-seven children with no seizure history (9 males, 18 females; mean age: 13.8±SD 2.8 years), and with normal brain MRI, were identified for the control group. Blinded investigators processed the MRI coronal FLAIR (fluid-attenuated inversion recovery) images with CIE, saved the processed images as a separate series, and made equivalent region of interest measurements on the processed and unprocessed series to calculate contrast-to-noise ratio. Six blinded reviewers then rated the randomized series for hippocampal signal abnormality and MTS disease status. RESULTS CIE increased signal intensity and contrast-to-noise ratio in 26/27 hippocampi with pathologically confirmed MTS (96.3%) with the mean (SD) contrast-to-noise ratio of cases increasing from 14.9 (11.1) to 77.7 (58.7) after processing (P<0.001). Contrast-to-noise ratio increased in 1/54 normal control hippocampi (1.9%), with no significant change in the mean contrast-to-noise ratio of the control group after processing (P=0.57). Mean (SD) reader sensitivity for detecting abnormal signal intensity increased from 83.3% (14.2) to 94.8% (3.3) after processing. Mean specificity for abnormal signal intensity increased from 94.4% (7.3) to 96.3% (0). While sensitivity improved after processing for detection of MTS disease status in 4/6 readers, the mean reader sensitivity and specificity for MTS detection increased only minimally after processing, from 79.6% to 80.7% and from 95.7% to 96.3%, respectively. CONCLUSION The CIE image processing algorithm selectively increased the contrast-to-noise ratio of hippocampi affected by MTS, improved reader performance in detecting MTS-related hippocampal signal abnormality and could have high impact on pediatric patients undergoing work-up for seizures.
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Mithani K, Boutet A, Germann J, Elias GJB, Weil AG, Shah A, Guillen M, Bernal B, Achua JK, Ragheb J, Donner E, Lozano AM, Widjaja E, Ibrahim GM. Lesion Network Localization of Seizure Freedom following MR-guided Laser Interstitial Thermal Ablation. Sci Rep 2019; 9:18598. [PMID: 31819108 PMCID: PMC6901556 DOI: 10.1038/s41598-019-55015-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023] Open
Abstract
Treatment-resistant epilepsy is a common and debilitating neurological condition, for which neurosurgical cure is possible. Despite undergoing nearly identical ablation procedures however, individuals with treatment-resistant epilepsy frequently exhibit heterogeneous outcomes. We hypothesized that treatment response may be related to the brain regions to which MR-guided laser ablation volumes are functionally connected. To test this, we mapped the resting-state functional connectivity of surgical ablations that either resulted in seizure freedom (N = 11) or did not result in seizure freedom (N = 16) in over 1,000 normative connectomes. There was no difference seizure outcome with respect to the anatomical location of the ablations, and very little overlap between ablation areas was identified using the Dice Index. Ablations that did not result in seizure-freedom were preferentially connected to a number of cortical and subcortical regions, as well as multiple canonical resting-state networks. In contrast, ablations that led to seizure-freedom were more functionally connected to prefrontal cortices. Here, we demonstrate that underlying normative neural circuitry may in part explain heterogenous outcomes following ablation procedures in different brain regions. These findings may ultimately inform target selection for ablative epilepsy surgery based on normative intrinsic connectivity of the targeted volume.
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Affiliation(s)
- Karim Mithani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- University Health Network, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | | | - Alexander G Weil
- Division of Neurosurgery, CHU-Ste Justine, Université de Montréal, Montréal, Canada
| | - Ashish Shah
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - Magno Guillen
- Department of Radiology, Nicklaus Children's Hospital, Miami, USA
| | - Byron Bernal
- Department of Radiology, Nicklaus Children's Hospital, Miami, USA
| | - Justin K Achua
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - John Ragheb
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, USA
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - George M Ibrahim
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada. .,Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Canada.
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Wang YH, An Y, Fan XT, Lu J, Ren LK, Wei PH, Cui BX, Du JL, Lu C, Wang D, Zhang HQ, Shan YZ, Zhao GG. Comparison between simultaneously acquired arterial spin labeling and 18F-FDG PET in mesial temporal lobe epilepsy assisted by a PET/MR system and SEEG. NEUROIMAGE-CLINICAL 2018; 19:824-830. [PMID: 30013926 PMCID: PMC6024198 DOI: 10.1016/j.nicl.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
Objective In the detection of seizure onset zones, arterial spin labeling (ASL) can overcome the limitations of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG), which is invasive, expensive, and radioactive. PET/magnetic resonance (MR) systems have been introduced that allow simultaneous performance of ASL and PET, but comparisons of these techniques with stereoelectroencephalography (SEEG) and comparisons among the treatment outcomes of these techniques are still lacking. Here, we investigate the effectiveness of ASL compared with that of SEEG and their outcomes in localizing mesial temporal lobe epilepsy (MTLE) and assess the correlation between simultaneously acquired PET and ASL. Methods Between October 2016 and August 2017, we retrospectively studied 12 patients diagnosed with pure unilateral MTLE. We extracted and quantitatively computed values for ASL and PET in the bilateral hippocampus. SEEG findings and outcome were considered the gold standard of lateralization. Finally, the bilateral asymmetry index (AI) was calculated to assess the correlation between PET and ASL. Results Our results showed that hypoperfusion in the hippocampus detected using ASL matched the SEEG-defined epileptogenic zone in this series of patients. The mean normalized voxel value of ASL in the contralateral hippocampus was 0.97 ± 0.19, while in the ipsilateral hippocampus, it was 0.84 ± 0.14. Meanwhile, significantly decreased perfusion and metabolism were observed in these patients (Wilcoxon, p < 0.05), with a significant positive correlation between the AI values derived from PET and ASL (Pearson's correlation, r = 0.74, p < 0.05). Significance In our SEEG- and outcome-defined patients with MTLE, ASL could provide significant information during presurgical evaluation, with the hypoperfusion detected with ASL reliably lateralizing MTLE. This non-invasive technique may be used as an alternative diagnostic tool for MTLE lateralization. ASL has been increasingly used in presurgical evaluations in epilepsy recent years. Comparisons of ASL and PET with a PET/MR system using SEEG and treatment outcomes as gold-standard are still lacking. Decreased perfusion consistent with hypometabolism and SEEG was observed with ASL. ASL offers an effective non-invasive alternative to PET in evaluation of MTLE.
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Affiliation(s)
- Yi-He Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yang An
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lian-Kun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Bi-Xiao Cui
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia-Lin Du
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hua-Qiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Zhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorder, Beijing 100069, China.
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Delev D, Oehl B, Steinhoff BJ, Nakagawa J, Scheiwe C, Schulze-Bonhage A, Zentner J. Surgical Treatment of Extratemporal Epilepsy: Results and Prognostic Factors. Neurosurgery 2018; 84:242-252. [DOI: 10.1093/neuros/nyy099] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/04/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Daniel Delev
- Department of Neurosurgery, Medical Center—University of Freiburg, Frieburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernhard Oehl
- Department of Neurosurgery, Medical Center—University of Freiburg, Frieburg, Germany
| | | | - Julia Nakagawa
- Department of Neurosurgery, Medical Center—University of Freiburg, Frieburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center—University of Freiburg, Frieburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Freiburg Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center—University of Freiburg, Frieburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Taylor PN, Sinha N, Wang Y, Vos SB, de Tisi J, Miserocchi A, McEvoy AW, Winston GP, Duncan JS. The impact of epilepsy surgery on the structural connectome and its relation to outcome. Neuroimage Clin 2018; 18:202-214. [PMID: 29876245 PMCID: PMC5987798 DOI: 10.1016/j.nicl.2018.01.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/05/2017] [Accepted: 01/21/2018] [Indexed: 01/26/2023]
Abstract
Background Temporal lobe surgical resection brings seizure remission in up to 80% of patients, with long-term complete seizure freedom in 41%. However, it is unclear how surgery impacts on the structural white matter network, and how the network changes relate to seizure outcome. Methods We used white matter fibre tractography on preoperative diffusion MRI to generate a structural white matter network, and postoperative T1-weighted MRI to retrospectively infer the impact of surgical resection on this network. We then applied graph theory and machine learning to investigate the properties of change between the preoperative and predicted postoperative networks. Results Temporal lobe surgery had a modest impact on global network efficiency, despite the disruption caused. This was due to alternative shortest paths in the network leading to widespread increases in betweenness centrality post-surgery. Measurements of network change could retrospectively predict seizure outcomes with 79% accuracy and 65% specificity, which is twice as high as the empirical distribution. Fifteen connections which changed due to surgery were identified as useful for prediction of outcome, eight of which connected to the ipsilateral temporal pole. Conclusion Our results suggest that the use of network change metrics may have clinical value for predicting seizure outcome. This approach could be used to prospectively predict outcomes given a suggested resection mask using preoperative data only.
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Affiliation(s)
- Peter N Taylor
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, UK; Institute of Neuroscience, Faculty of Medical Science, Newcastle University, UK; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
| | - Nishant Sinha
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, UK; Institute of Neuroscience, Faculty of Medical Science, Newcastle University, UK
| | - Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, UK; Institute of Neuroscience, Faculty of Medical Science, Newcastle University, UK; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sjoerd B Vos
- Translational Imaging Group, Centre for Medical Image Computing, University College London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0LR, UK
| | - Jane de Tisi
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Anna Miserocchi
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Gavin P Winston
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0LR, UK
| | - John S Duncan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0LR, UK
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Dorfer C, Czech T, Aull-Watschinger S, Baumgartner C, Jung R, Kasprian G, Novak K, Pirker S, Seidl B, Stefanits H, Trimmel K, Pataraia E. Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy. J Neurosurg 2017; 129:174-181. [PMID: 29027855 DOI: 10.3171/2017.4.jns162699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to present long-term seizure outcome data in a consecutive series of patients with refractory mesial temporal lobe epilepsy primarily treated with transsylvian selective amygdalohippocampectomy (SAHE). METHODS The authors retrospectively analyzed prospectively collected data for all patients who had undergone resective surgery for medically refractory epilepsy at their institution between July 1994 and December 2014. Seizure outcome was assessed according to the International League Against Epilepsy (ILAE) and the Engel classifications. RESULTS The authors performed an SAHE in 158 patients (78 males, 80 females; 73 right side, 85 left side) with a mean age of 37.1 ± 10.0 years at surgery. Four patients lost to follow-up and 1 patient who committed suicide were excluded from analysis. The mean follow-up period was 9.7 years. At the last available follow-up (or before reoperation), 68 patients (44.4%) had achieved an outcome classified as ILAE Class 1a, 46 patients (30.1%) Class 1, 6 patients (3.9%) Class 2, 16 patients (10.4%) Class 3, 15 patients (9.8%) Class 4, and 2 patients (1.3%) Class 5. These outcomes correspond to Engel Class I in 78.4% of the patients, Engel Class II in 10.5%, Engel Class III in 8.5%, and Engel Class IV in 2.0%. Eleven patients underwent a second surgery (anterior temporal lobectomy) after a mean of 4.4 years from the SAHE (left side in 6 patients, right side in 5). Eight (72.7%) of these 11 patients achieved seizure freedom. The overall ILEA seizure outcome since (re)operation after a mean follow-up of 10.0 years was Class 1a in 72 patients (47.0%), Class 1 in 50 patients (32.6%), Class 2 in 7 patients (4.6%), Class 3 in 15 patients (9.8%), Class 4 in 8 patients (5.2%), and Class 5 in 1 patient (0.6%). These outcomes correspond to an Engel Class I outcome in 84.3% of the patients. CONCLUSIONS A satisfactory long-term seizure outcome following transsylvian SAHE was demonstrated in a selected group of patients with refractory temporal lobe epilepsy.
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Affiliation(s)
| | | | | | - Christoph Baumgartner
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gregor Kasprian
- 4Radiology and Nuclear Medicine, Medical University of Vienna; and
| | | | - Susanne Pirker
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
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Asadi-Pooya AA, Nei M, Rostami C, Sperling MR. Mesial temporal lobe epilepsy with childhood febrile seizure. Acta Neurol Scand 2017; 135:88-91. [PMID: 26861129 DOI: 10.1111/ane.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the demographic and clinical manifestations of patients with mesial temporal sclerosis and temporal lobe epilepsy (MTS-TLE) with childhood febrile seizure (FS) and establishing the potential differences as compared to those without FS. We also investigated the surgery outcome in these two groups of patients. MATERIALS AND METHODS In this retrospective study, all patients with a clinical diagnosis of drug-resistant TLE due to mesial temporal sclerosis, who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center, were recruited. Patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was classified into two groups; seizure-free or relapsed. Clinical manifestations and outcome were compared between patients with MTS-TLE with FS and those without FS. RESULTS Two hundred and sixty-two patients were eligible for this study. One hundred and seventy patients (64.9%) did not have FS in their childhood, while 92 patients (35.1%) reported experiencing FS in their childhood. Demographic and clinical characteristics of these two groups of patients were not different. Postoperative seizure outcome was not statistically different between these two groups of patients (P = 0.19). CONCLUSIONS When MTS is the pathological substrate of TLE, clinical manifestations and response to surgical treatment of patients are very similar in patients with history of febrile seizure in their childhood compared to those without such an experience. In other words, when the subgroup of patients with MTS-TLE and drug-resistant seizures is examined history of childhood febrile seizure loses its value as a distinguishing factor in characteristics or predictive factor for surgery outcome.
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Affiliation(s)
- A. A. Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - M. Nei
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - C. Rostami
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
| | - M. R. Sperling
- Jefferson Comprehensive Epilepsy Center; Department of Neurology; Thomas Jefferson University; Philadelphia PA USA
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14
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Keller SS, Glenn GR, Weber B, Kreilkamp BAK, Jensen JH, Helpern JA, Wagner J, Barker GJ, Richardson MP, Bonilha L. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain 2017; 140:68-82. [PMID: 28031219 PMCID: PMC5226062 DOI: 10.1093/brain/aww280] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/10/2016] [Accepted: 09/26/2016] [Indexed: 11/12/2022] Open
Abstract
Approximately one in every two patients with pharmacoresistant temporal lobe epilepsy will not be rendered completely seizure-free after temporal lobe surgery. The reasons for this are unknown and are likely to be multifactorial. Quantitative volumetric magnetic resonance imaging techniques have provided limited insight into the causes of persistent postoperative seizures in patients with temporal lobe epilepsy. The relationship between postoperative outcome and preoperative pathology of white matter tracts, which constitute crucial components of epileptogenic networks, is unknown. We investigated regional tissue characteristics of preoperative temporal lobe white matter tracts known to be important in the generation and propagation of temporal lobe seizures in temporal lobe epilepsy, using diffusion tensor imaging and automated fibre quantification. We studied 43 patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls. Patients underwent preoperative imaging, amygdalohippocampectomy and postoperative assessment using the International League Against Epilepsy seizure outcome scale. From preoperative imaging, the fimbria-fornix, parahippocampal white matter bundle and uncinate fasciculus were reconstructed, and scalar diffusion metrics were calculated along the length of each tract. Altogether, 51.2% of patients were rendered completely seizure-free and 48.8% continued to experience postoperative seizure symptoms. Relative to controls, both patient groups exhibited strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe. However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could classify individual patients according to outcome with 84% sensitivity and 89% specificity. Pathological changes in the dorsal fornix were beyond the margins of resection, and contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Furthermore, diffusion characteristics of the ipsilateral uncinate could classify patients from controls with a sensitivity of 98%; importantly, by co-registering the preoperative fibre maps to postoperative surgical lacuna maps, we observed that the extent of uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network. These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.
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Affiliation(s)
- Simon S Keller
- 1 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
- 2 Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- 3 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - G Russell Glenn
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
- 6 Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Bernd Weber
- 7 Department of Epileptology, University of Bonn, Germany
- 8 Department of Neurocognition / Imaging, Life and Brain Research Centre, Bonn, Germany
| | - Barbara A K Kreilkamp
- 1 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
- 2 Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jens H Jensen
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
| | - Joseph A Helpern
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
- 6 Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Jan Wagner
- 7 Department of Epileptology, University of Bonn, Germany
- 8 Department of Neurocognition / Imaging, Life and Brain Research Centre, Bonn, Germany
- 9 Department of Neurology, Epilepsy Centre Hessen-Marburg, University of Marburg Medical Centre, Germany
| | - Gareth J Barker
- 10 Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Mark P Richardson
- 3 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- 11 Engineering and Physical Sciences Research Council Centre for Predictive Modelling in Healthcare, University of Exeter, UK
| | - Leonardo Bonilha
- 12 Department of Neurology, Medical University of South Carolina, Charleston, USA
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15
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Tezer FI, Xasiyev F, Soylemezoglu F, Bilginer B, Oguz KK, Saygi S. Clinical and electrophysiological findings in mesial temporal lobe epilepsy with hippocampal sclerosis, based on the recent histopathological classifications. Epilepsy Res 2016; 127:50-54. [DOI: 10.1016/j.eplepsyres.2016.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/04/2016] [Accepted: 08/14/2016] [Indexed: 11/25/2022]
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Schmeiser B, Hammen T, Steinhoff B, Zentner J, Schulze-Bonhage A. Long-term outcome characteristics in mesial temporal lobe epilepsy with and without associated cortical dysplasia. Epilepsy Res 2016; 126:147-56. [DOI: 10.1016/j.eplepsyres.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Chen NC, Chuang YC, Huang CW, Lui CC, Lee CC, Hsu SW, Lin PH, Lu YT, Chang YT, Hsu CW, Chang CC. Interictal serum brain-derived neurotrophic factor level reflects white matter integrity, epilepsy severity, and cognitive dysfunction in chronic temporal lobe epilepsy. Epilepsy Behav 2016; 59:147-54. [PMID: 27152461 DOI: 10.1016/j.yebeh.2016.02.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/07/2016] [Accepted: 02/21/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Most patients with temporal lobe epilepsy (TLE) have epileptic foci originating from the medial temporal lobe, particularly the hippocampus. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin growth factor mainly expressed in the hippocampus, though it is not known whether the circulating level of BDNF reflects cognitive performance or white matter structural changes in chronic TLE. METHODS Thirty-four patients with TLE and 22 healthy controls were enrolled for standardized cognitive tests, diffusion tensor imaging, and serum BDNF measurement. The patients were further divided into a subgroup with unilateral TLE (n=23) and a subgroup with bilateral TLE (n=11) for clinical and neuroimaging comparisons. RESULTS There were significantly lower BDNF levels in the patients with TLE compared with the controls, with significance contributed mainly from the subgroup with bilateral TLE, which also had more frequent seizures. The BDNF levels correlated with epilepsy duration (σ=-0.355; p=0.040) and fractional anisotropy (FA) in the left temporal lobe, left thalamus, and right hippocampus. Using a regression model, BDNF level predicted verbal memory score. Further, design fluency scores were predicted by serum BDNF level via the interactions with left temporal FA. CONCLUSIONS Serum BDNF levels reflected longer epilepsy duration, impaired white matter integrity, and poor cognitive function in patients with chronic TLE.
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Affiliation(s)
- Nai-Ching Chen
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Health and Beauty, Shu-Zen College of Medicine and Management, Taiwan
| | - Yao-Chung Chuang
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Huang
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Health and Beauty, Shu-Zen College of Medicine and Management, Taiwan
| | - Chun-Chung Lui
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pin-Hsuan Lin
- Department of Health and Beauty, Shu-Zen College of Medicine and Management, Taiwan
| | - Yan-Ting Lu
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Health and Beauty, Shu-Zen College of Medicine and Management, Taiwan
| | - Che-Wei Hsu
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Chih Chang
- Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Mesial Temporal Lobe Epilepsy. World Neurosurg 2016; 89:78-83. [DOI: 10.1016/j.wneu.2016.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Patient Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Nonlesional Temporal Lobe Epilepsy. World Neurosurg 2016; 91:205-9. [PMID: 27086259 DOI: 10.1016/j.wneu.2016.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the possible influence of risk factors on seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy (TLE). METHODS This retrospective study recruited patients with drug-resistant nonlesional TLE who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center and were followed for a minimum of 1 year. Patients had been prospectively registered in a database from 1991 to 2014. Postsurgical outcome was classified into 2 groups: seizure free or relapsed. The possible risk factors influencing long-term seizure outcome after surgery were investigated. RESULTS Ninety-five patients (42 males and 53 females) were studied. Fifty-four (56.8%) patients were seizure free. Only a history of febrile seizure in childhood affected the risk of postoperative seizure recurrence (odds ratio, 0.22; 95% confidence interval, 0.06-0.83; P = 0.02). Gender, race, family history of epilepsy, history of status epilepticus, duration of disease before surgery, aura symptoms, IQ, and seizure type or frequency were not predictors of outcome. CONCLUSIONS Many patients with drug-resistant nonlesional TLE responded favorably to surgery. The only factor predictive of seizure outcome after surgery was a history of febrile seizure in childhood. It is critical to distinguish among different types of TLE when assessing outcome after surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Maromi Nei
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Elkommos S, Weber B, Niehusmann P, Volmering E, Richardson MP, Goh YY, Marson AG, Elger C, Keller SS. Hippocampal internal architecture and postoperative seizure outcome in temporal lobe epilepsy due to hippocampal sclerosis. Seizure 2016; 35:65-71. [PMID: 26803053 PMCID: PMC4773400 DOI: 10.1016/j.seizure.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Semi-quantitative analysis of hippocampal internal architecture (HIA) on MRI has been shown to be a reliable predictor of the side of seizure onset in patients with temporal lobe epilepsy (TLE). In the present study, we investigated the relationship between postoperative seizure outcome and preoperative semi-quantitative measures of HIA. METHODS We determined HIA on high in-plane resolution preoperative T2 short tau inversion recovery MR images in 79 patients with presumed unilateral mesial TLE (mTLE) due to hippocampal sclerosis (HS) who underwent amygdalohippocampectomy and postoperative follow up. HIA was investigated with respect to postoperative seizure freedom, neuronal density determined from resected hippocampal specimens, and conventionally acquired hippocampal volume. RESULTS HIA ratings were significantly related to some neuropathological features of the resected hippocampus (e.g. neuronal density of selective CA regions, Wyler grades), and bilaterally with preoperative hippocampal volume. However, there were no significant differences in HIA ratings of the to-be-resected or contralateral hippocampus between patients rendered seizure free (ILAE 1) compared to those continuing to experience seizures (ILAE 2-5). CONCLUSIONS This work indicates that semi-quantitative assessment of HIA on high-resolution MRI provides a surrogate marker of underlying histopathology, but cannot prospectively distinguish between patients who will continue to experience postoperative seizures and those who will be rendered seizure free. The predictive power of HIA for postoperative seizure outcome in non-lesional patients with TLE should be explored.
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Affiliation(s)
- Samia Elkommos
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | - Bernd Weber
- Department of Epileptology, University of Bonn, Germany; Department of Neurocognition/Imaging, Life&Brain Research Centre, Bonn, Germany
| | - Pitt Niehusmann
- Department of Neuropathology, University of Bonn, Germany; Department of Neuropathology, Oslo University Hospital, Norway
| | | | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Yen Y Goh
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | | | - Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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Bonilha L, Keller SS. Quantitative MRI in refractory temporal lobe epilepsy: relationship with surgical outcomes. Quant Imaging Med Surg 2015; 5:204-24. [PMID: 25853080 DOI: 10.3978/j.issn.2223-4292.2015.01.01] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/07/2015] [Indexed: 11/14/2022]
Abstract
Medically intractable temporal lobe epilepsy (TLE) remains a serious health problem. Across treatment centers, up to 40% of patients with TLE will continue to experience persistent postoperative seizures at 2-year follow-up. It is unknown why such a large number of patients continue to experience seizures despite being suitable candidates for resective surgery. Preoperative quantitative MRI techniques may provide useful information on why some patients continue to experience disabling seizures, and may have the potential to develop prognostic markers of surgical outcome. In this article, we provide an overview of how quantitative MRI morphometric and diffusion tensor imaging (DTI) data have improved the understanding of brain structural alterations in patients with refractory TLE. We subsequently review the studies that have applied quantitative structural imaging techniques to identify the neuroanatomical factors that are most strongly related to a poor postoperative prognosis. In summary, quantitative imaging studies strongly suggest that TLE is a disorder affecting a network of neurobiological systems, characterized by multiple and inter-related limbic and extra-limbic network abnormalities. The relationship between brain alterations and postoperative outcome are less consistent, but there is emerging evidence suggesting that seizures are less likely to remit with surgery when presurgical abnormalities are observed in the connectivity supporting brain regions serving as network nodes located outside the resected temporal lobe. Future work, possibly harnessing the potential from multimodal imaging approaches, may further elucidate the etiology of persistent postoperative seizures in patients with refractory TLE. Furthermore, quantitative imaging techniques may be explored to provide individualized measures of postoperative seizure freedom outcome.
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Affiliation(s)
- Leonardo Bonilha
- 1 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 2 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ; 3 Department of Radiology, The Walton Centre NHS Foundation Trust, Liverpool, UK ; 4 Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon S Keller
- 1 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 2 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ; 3 Department of Radiology, The Walton Centre NHS Foundation Trust, Liverpool, UK ; 4 Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Keller SS, Richardson MP, Schoene-Bake JC, O'Muircheartaigh J, Elkommos S, Kreilkamp B, Goh YY, Marson AG, Elger C, Weber B. Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy. Ann Neurol 2015; 77:760-74. [PMID: 25627477 PMCID: PMC4832368 DOI: 10.1002/ana.24376] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 01/14/2015] [Accepted: 01/17/2015] [Indexed: 12/02/2022]
Abstract
Objective There are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI). Methods We performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy. Results Quantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI‐derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection. Interpretation Patients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group‐based findings to individualize prediction of patient outcomes. Ann Neurol 2015;77:760–774
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Affiliation(s)
- Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Radiology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom; Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, United Kingdom
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Burkholder DB, Sulc V, Hoffman EM, Cascino GD, Britton JW, So EL, Marsh WR, Meyer FB, Van Gompel JJ, Giannini C, Wass CT, Watson RE, Worrell GA. Interictal scalp electroencephalography and intraoperative electrocorticography in magnetic resonance imaging-negative temporal lobe epilepsy surgery. JAMA Neurol 2014; 71:702-9. [PMID: 24781216 DOI: 10.1001/jamaneurol.2014.585] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Scalp electroencephalography (EEG) and intraoperative electrocorticography (ECoG) are routinely used in the evaluation of magnetic resonance imaging-negative temporal lobe epilepsy (TLE) undergoing standard anterior temporal lobectomy with amygdalohippocampectomy (ATL), but the utility of interictal epileptiform discharge (IED) identification and its role in outcome are poorly defined. OBJECTIVES To determine whether the following are associated with surgical outcomes in patients with magnetic resonance imaging-negative TLE who underwent standard ATL: (1) unilateral-only IEDs on preoperative scalp EEG; (2) complete resection of tissue generating IEDs on ECoG; (3) complete resection of opioid-induced IEDs recorded on ECoG; and (4) location of IEDs recorded on ECoG. DESIGN, SETTING, AND PARTICIPANTS Data were gathered through retrospective medical record review at a tertiary referral center. Adult and pediatric patients with TLE who underwent standard ATL between January 1, 1990, and October 15, 2010, were considered for inclusion. Inclusion criteria were magnetic resonance imaging-negative TLE, standard ECoG performed at the time of surgery, and a minimum follow-up of 12 months. Univariate analysis was performed using log-rank time-to-event analysis. Variables reaching significance with log-rank testing were further analyzed using Cox proportional hazards. MAIN OUTCOMES AND MEASURES Excellent or nonexcellent outcome at time of last follow-up. An excellent outcome was defined as Engel class I and a nonexcellent outcome as Engel classes II through IV. RESULTS Eighty-seven patients met inclusion criteria, with 48 (55%) achieving an excellent outcome following ATL. Unilateral IEDs on scalp EEG (P = .001) and complete resection of brain regions generating IEDs on baseline intraoperative ECoG (P = .02) were associated with excellent outcomes in univariate analysis. Both were associated with excellent outcomes when analyzed with Cox proportional hazards (unilateral-only IEDs, relative risk = 0.31 [95% CI, 0.16-0.64]; complete resection of IEDs on baseline ECoG, relative risk = 0.39 [95% CI, 0.20-0.76]). Overall, 25 of 35 patients (71%) with both unilateral-only IEDs and complete resection of baseline ECoG IEDs had an excellent outcome. CONCLUSIONS AND RELEVANCE Unilateral-only IEDs on preoperative scalp EEG and complete resection of IEDs on baseline ECoG are associated with better outcomes following standard ATL in magnetic resonance imaging-negative TLE. Prospective evaluation is needed to clarify the use of ECoG in tailoring temporal lobectomy.
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Affiliation(s)
| | - Vlastimil Sulc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | | | | | | | - Elson L So
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - W Richard Marsh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - C Thomas Wass
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota7Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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Effect of partial drug withdrawal on the lateralization of interictal epileptiform discharges and its relationship to surgical outcome in patients with hippocampal sclerosis. Epilepsy Res 2014; 108:1406-16. [PMID: 25052709 DOI: 10.1016/j.eplepsyres.2014.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/20/2014] [Accepted: 06/13/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess changes in the relative lateralization of interictal epileptiform discharges (IEDs) and interictal EEG prognostic value in terms of surgical outcome between periods with full medication (FMP) and reduced medication (RMP) in patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS). METHODS Interictal scalp EEGs of 43 patients were evaluated for the presence of IEDs separately in a waking state (WS) and sleeping state (SS) during FMP and RMP. In each period, patients were categorized as having unitemporal or bitemporal IEDs. Surgical outcome was classified at year 1 after surgery and at last follow-up visit as Engel I or Engel II-IV; and alternatively as completely seizure-free or not seizure-free. RESULTS There were significant changes in relative IED lateralization between FMP and RMP during SS. The representation of patients with unitemporal IEDs declined from 37 (86%) in FMP during SS to 25 (58%) in RMP during SS (p=0.003). At year 1 after surgery, the relative IED lateralization is a predictive factor for surgical outcome defined as Engel I vs. Engel II-IV in both FMP during WS (p=0.037) and during SS (p=0.007), and for surgical outcome defined as completely seizure-free vs. not seizure-free in FMP during SS (p=0.042). At last follow up visit, the relative IED lateralization is a predictor for outcome defined as Engel I vs. Engel II-IV in FMP during SS (p=0.020), and for outcome defined as completely seizure-free vs. not seizure-free in both FMP during WS (p=0.043) and in FMP during SS (p=0.015). When stepwise logistic regression analysis was applied, only FMP during SS was found to be an independent predictor for surgical outcome at year 1 after surgery (completely seizure-free vs. not seizure-free p=0.032, Engel I vs. Engel II-IV p=0.006) and at last follow-up visit (completely seizure-free vs. not seizure-free p=0.024, Engel I vs. Engel II-IV p=0.017). Gender was found to be independent predictor for surgical efficacy at year 1 if the outcome was defined as completely seizure-free vs. not seizure-free (p=0.036). CONCLUSION The predictive value of relative IED lateralization with respect to surgical outcome in interictal EEG is present only during FMP; the predictive value decreases with the reduction of AEDs caused by the change of relative IED lateralization.
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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014; 340:183-90. [DOI: 10.1016/j.jns.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
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Yankam Njiwa J, Bouvard S, Catenoix H, Mauguiere F, Ryvlin P, Hammers A. Periventricular [(11)C]flumazenil binding for predicting postoperative outcome in individual patients with temporal lobe epilepsy and hippocampal sclerosis. NEUROIMAGE-CLINICAL 2013; 3:242-8. [PMID: 24273709 PMCID: PMC3814949 DOI: 10.1016/j.nicl.2013.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/05/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022]
Abstract
A third of patients with intractable temporal lobe epilepsy and hippocampal sclerosis (HS) are not seizure free (NSF) after surgery. Increased periventricular [11C]flumazenil (FMZ) binding, reflecting heterotopic neuron concentration, has been described as one predictor of NSF outcome at the group level. We aimed to replicate this finding in an independent larger cohort and investigated whether NSF outcome can be predicted in individuals. Preoperative [11C]FMZ summed radioactivity images were available for 16 patients with HS and 41 controls. Images were analyzed using SPM8, explicitly including the white matter, and correction for global radioactivity via group-specific ANCOVA. Periventricular increases were assessed with a mask and different cutoffs for distinguishing NSF and seizure free (SF) patients. NSF patients had increased [11C]FMZ binding around the posterior horn of the ventricles ipsilaterally (z = 2.53) and contralaterally (z = 4.44) to the seizure focus compared with SF patients. Compared with controls, SF patients had fewer periventricular increases (two clusters, total volume 0.87 cm3, zmax = 3.8) than NSF patients (two ipsilateral and three contralateral clusters, 6.15 cm3, zmax = 4.8). In individuals and at optimized cutoffs, five (63%) of eight NSF patients and one (13%) of eight SF patients showed periventricular increases compared with controls (accuracy 75%). Only one (2%) of the 41 controls had increases at the same cutoff. The association between periventricular [11C]FMZ increases and NSF outcome after temporal lobe resection for HS has been confirmed in an independent cohort on simple summed activity images. [11C]FMZ-PET may be useful for individual preoperative counseling with clinically relevant accuracy. [11C]FMZ periventricular WM binding for predicting surgery outcome in mTLE-HS. Summed radioactivity images allowed replicating a prior study at the group level. Blood sampling constraint removed in comparison to the previous study. Periventricular abnormalities may allow predicting surgery outcome in individuals.
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Elliott RE, Bollo RJ, Berliner JL, Silverberg A, Carlson C, Geller EB, Barr WB, Devinsky O, Doyle WK. Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control. J Neurosurg 2013; 119:261-72. [DOI: 10.3171/2013.4.jns121829] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH).
Methods
The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom.
Results
The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures.
Conclusions
Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.
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Affiliation(s)
| | - Robert J. Bollo
- 2Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alyson Silverberg
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
| | | | - Eric B. Geller
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
| | - William B. Barr
- 4Neurology, Comprehensive Epilepsy Center, and
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Orrin Devinsky
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Werner K. Doyle
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
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Carone DA, Green P, Drane DL. Word Memory Test Profiles in Two Cases with Surgical Removal of the Left Anterior Hippocampus and Parahippocampal Gyrus. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:155-60. [DOI: 10.1080/09084282.2012.755533] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dominic A. Carone
- a Physical Medicine and Rehabilitation, SUNY Upstate Medical University , Syracuse , New York
| | - Paul Green
- b Private Practice , Edmonton , Alberta , Canada
| | - Daniel L. Drane
- c Department of Neurology , Emory University School of Medicine , Atlanta , Georgia
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Can status epilepticus sometimes just be a long seizure? Epilepsy Curr 2013; 13:150-1. [PMID: 23840180 DOI: 10.5698/1535-7511-13.3.150] [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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Junna MR, Buechler R, Cohen-Gadol AA, Mandrekar J, Christianson T, Marsh WR, Meyer FB, Cascino GD. Prognostic importance of risk factors for temporal lobe epilepsy in patients undergoing surgical treatment. Mayo Clin Proc 2013; 88:332-6. [PMID: 23541008 DOI: 10.1016/j.mayocp.2013.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/19/2012] [Accepted: 01/14/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the prognostic importance of an identified putative underlying risk factor in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). PATIENTS AND METHODS A retrospective study of 400 consecutive patients who underwent TLE surgery between December 21, 1987, and September 11, 1996, was performed. Demographic characteristics, history of remote symptomatic neurologic disease, preoperative evaluation, and postoperative outcome data were extracted. Individuals without any risk factors were considered controls. Magnetic resonance imaging findings were used to identify mesial temporal sclerosis (MTS) before surgery. Seizure outcome was classified by a modified Engel classification. RESULTS Two hundred eighty-one patients had a potential underlying etiology, and 143 patients had more than 1 risk factor. One hundred nineteen patients had no evidence of a putative symptomatic neurologic illness. There was a statistically significant association (P<.05) between the presence of MTS and a favorable operative outcome (odds ratio, 4.28; 95% CI, 2.67-6.87). A history of remote symptomatic neurologic disease was not of prognostic importance unless associated with the development of MTS. CONCLUSION These results indicate that the preoperative identification of MTS by neuroimaging is the most important predictor of a favorable operative outcome in patients with TLE. These findings may be useful in the identification and counseling of potential candidates for epilepsy surgery.
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Affiliation(s)
- Mithri R Junna
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Does the patient's hand hold the key to preventing secondary generalization in mesial temporal lobe epilepsy? Epilepsy Res 2013; 105:125-32. [PMID: 23490657 DOI: 10.1016/j.eplepsyres.2013.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/17/2012] [Accepted: 02/07/2013] [Indexed: 11/23/2022]
Abstract
This study aimed to analyze the impact of ictal dystonic posturing (DP) in postoperative seizure outcome and to assess the influence of DP in generalized tonic-clonic seizure (GTCS) occurrence during video-EEG monitoring of patients with temporal lobe epilepsy with mesial temporal sclerosis. The impact of DP on surgical outcome remains controversial. Moreover, DP has been recently associated with brain networks avoiding GTCS occurrence. Five hundred twenty-seven seizures of 171 patients who were submitted to standard anterior temporal lobectomy (ATL) between 2002 and 2010, with at least one year of post-surgical follow-up, were retrospectively analyzed and classified as with or without DP and as evolving or not to GTCS. The ictal semiologic correlates of DP, timing elapsed since precedent seizure and antiepileptic drug (AED) intake before each seizure were evaluated. Seizure outcome after ATL was assessed according to Engel's scale. Fifty-eight out of 171 patients (34%) exhibited ictal DP, of which 91.5% were always unilateral and contralateral to the operated side. DP was related to shorter seizures (p=0.007) and a much lower likelihood of the seizure evolving to GTCS (p=0.001), even during AED withdrawal (p=0.002). There was no association between DP and prognosis regarding seizure control as the result of the surgical resection, either in patients with shorter or in those with longer period of follow-up. Our data support the hypothesis that DP reflects a brain network activation that helps avoid GTCS, even during AED withdrawal.
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Hamad APA, Carrete H, Bianchin MM, Ferrari-Marinho T, Lin K, Yacubian EMT, Vilanova LCP, Garzon E, Caboclo LO, Sakamoto AC. Morphological variations of hippocampal formation in epilepsy: image, clinical and electrophysiological data. Epilepsy Behav 2013; 26:67-70. [PMID: 23220462 DOI: 10.1016/j.yebeh.2012.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 11/15/2022]
Abstract
Morphological variations of hippocampal formation (MVHF) are observed in patients with epilepsy but also in asymptomatic individuals. The precise role of these findings in epilepsy is not yet fully understood. This study analyzes the hippocampal formation (HF) morphology of asymptomatic individuals (n = 30) and of patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) (n = 68), patients with malformations of cortical development (MCD) (n = 34), or patients with pure morphological variations of hippocampal formation (pure MVHF) (n = 12). Main clinical and electrophysiological data of patients with MVHF were also analyzed. Morphological variations of hippocampal formation are more frequently observed in patients with MCD than in patients with MTLE-HS or in asymptomatic individuals. Patients with pure morphological variations of hippocampal formation showed higher incidence of extratemporal seizure onset. Refractoriness seems to be more associated with other abnormalities, like HS or MCD, than with the HF variation itself. Thus, although morphological HF abnormalities might play a role in epileptogenicity, they seem to contribute less to refractoriness.
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Affiliation(s)
- Ana Paula Andrade Hamad
- Departamento de Neurologia e Neurocirurgia, Hospital São Paulo, Universidade Federal de São Paulo, Rua Napoleão de Barros, 865, Vila Clementino, São Paulo/SP, Brazil.
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Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Epilepsy Behav 2013; 26:81-6. [PMID: 23247268 DOI: 10.1016/j.yebeh.2012.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/04/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
Abstract
Retrospective data analysis was performed in a sample of 45 consecutive patients who underwent epilepsy surgery for medically refractory mTLE-HS. Beck Depression Inventory (BDI) was used preoperatively to detect actual depressive symptoms and label patients into those "with depressive symptoms" or "without depressive symptoms". Postoperative seizure outcome one, two, and three years after surgery was classified into "complete seizure freedom" versus "presence of auras and/or seizures". Postoperative seizure outcomes were compared in patients with and without depressive symptoms, and no significant difference of postoperative seizure outcome was found. However, there was a non-significant trend for patients with preoperative depressive symptoms to experience a postoperative running down phenomenon more frequently than nondepressed patients. Depressive symptoms, identified by the BDI, do not seem to have a predictive value for postoperative seizure outcome in this highly selected patient population with mTLE-HS, but may be positive predictors for experiencing a postoperative running down phenomenon.
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Mueller CA, Scorzin J, von Lehe M, Fimmers R, Helmstaedter C, Zentner J, Lehmann TN, Meencke HJ, Schulze-Bonhage A, Schramm J. Seizure outcome 1 year after temporal lobe epilepsy: an analysis of MR volumetric and clinical parameters. Acta Neurochir (Wien) 2012; 154:1327-36. [PMID: 22722378 DOI: 10.1007/s00701-012-1407-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/24/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis. METHODS A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery. Prospectively collected data used for this analysis included the clinical and demographic data. Classic prognostic factors (e.g., gender, age at operation, age at epilepsy manifestation, duration of epilepsy, education, side of pathology, intracranial EEG recordings, secondarily generalized tonic-clonic seizures, etiological factors, histology) and a volumetric analysis of 12 temporal lobe subregions were used in a regression analysis to identify possible prognostic factors in surgery for TLE. Primary outcome measure was seizure freedom at 1 year and during the full first year expressed as class I in the ILAE outcome scale. RESULTS In the univariate analysis, we identified one negative predictor for a less favorable seizure outcome: intracranial EEG recordings (p = 0.010), hippocampal sclerosis as histological finding trended toward statistical significance (p = 0.054). No statistical outcome significance was found for preoperative temporal lobe compartment volume loss or postoperative lateral atrophy after mesial resection. CONCLUSIONS Necessity for intracranial EEG recording is an independent factor of not optimal seizure control in the 1-year follow-up. Preoperative temporal lobe volume differences including smaller mesial subcompartments did not correlate with poorer seizure outcome.
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Vale FL, Pollock G, Benbadis SR. Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology. Neurosurg Focus 2012; 32:E9. [DOI: 10.3171/2011.12.focus11318] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis.
Methods
A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates.
Results
Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings.
Conclusions
The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.
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Schulz R, Hoppe M, Boesebeck F, Gyimesi C, Pannek HW, Woermann FG, May T, Ebner A. Analysis of Reoperation in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis. Neurosurgery 2011; 68:89-97; discussion 97. [DOI: 10.1227/neu.0b013e3181fdf8f8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
BACKGROUND:
Most patients do well after epilepsy surgery for mesial temporal lobe sclerosis, and in only 8 to 12% of all operations, the outcome is classified as not improved.
OBJECTIVE:
To analyze the outcome of reoperation in cases of incomplete resection of mesial temporal lobe structures in patients with mesial temporal lobe sclerosis in temporal lobe epilepsy.
METHODS:
We analyzed 22 consecutive patients who underwent reoperation for mesial temporal lobe sclerosis (follow-up, 23-112 months; mean, 43.18 months) by evaluating noninvasive electroencephalographic/video monitoring before the first and second surgeries (semiology, interictal epileptiform discharges, ictal electroencephalography with special attention to the secondary contralateral evolution of the electroencephalographic seizure pattern after the initial regionalization), and magnetic resonance imaging (resection indices after the first and second surgeries on the amygdala, hippocampus, lateral temporal lobe). In 18 of 22 patients T2 relaxometry of the contralateral hippocampus was performed.
RESULTS:
Nine of 22 patients became seizure free; another 4 patients had a decrease in seizures and eventually became seizure free (range, 16-51 months; mean, 30.3). Recurrence of seizures is associated with (1) ictal electroencephalography with later evolution of an independent pattern over the contralateral temporal lobe (0 of 5 patients seizure free vs 5 of 7 patients non–seizure free; P = .046) and (2) a smaller amount of lateral temporal lobe resection in the second surgery (1.06 ± 0.59 cm vs 2.18 ± 1.37 cm; P = .019). No significant correlation with outcome was found for lateralization of interictal epileptiform discharges, change in semiology, other resection indices, T2 relaxometry, onset and duration of epilepsy, duration of follow-up, and side of surgery.
CONCLUSION:
Patients have a less favorable outcome with a reoperation if they show ictal scalp electroencephalography with secondary contralateral propagation and if only a small second resection of the lateral temporal lobe is performed.
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Affiliation(s)
| | | | | | | | | | | | - Theodor. May
- Gesellschaft für Epilepsieforschung, Bielefeld, Germany
| | - Alois. Ebner
- Bethel Epilepsy Center, Mara, Bielefeld, Germany
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Vale FL, Ahmadian A, Youssef AS, Tatum WO, Benbadis SR. Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. Seizure 2010; 20:244-8. [PMID: 21196125 DOI: 10.1016/j.seizure.2010.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/27/2010] [Accepted: 12/03/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. METHODS All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. RESULTS Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). CONCLUSION VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.
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Affiliation(s)
- Fernando L Vale
- University of South Florida, Department of Neurosurgery, Tampa, FL 33606, United States.
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Napolitano CE, Orriols MA. Graduated and Sequential Propagation in Mesial Temporal Epilepsy: Analysis With Scalp Ictal EEG. J Clin Neurophysiol 2010; 27:285-91. [DOI: 10.1097/wnp.0b013e3181eaaa0e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Association between temporal lobe P-glycoprotein expression and seizure recurrence after surgery for pharmacoresistant temporal lobe epilepsy. Neurobiol Dis 2010; 39:192-7. [PMID: 20403441 DOI: 10.1016/j.nbd.2010.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/29/2010] [Accepted: 04/07/2010] [Indexed: 01/16/2023] Open
Abstract
Surgery is recommended for pharmacoresistant temporal lobe epilepsy (TLE), but seizures recur in approximately one third of patients postsurgery. P-glycoprotein is an efflux multidrug transporter that is overexpressed in a range of epileptogenic pathologies. We hypothesized that increased expression of P-glycoprotein in the epileptogenic temporal lobe might be a marker for recurrence of pharmacoresistant seizures postsurgery. We performed immunohistochemistry on temporal lobe tissues resected from 69 patients who underwent anterior temporal lobectomy for pharmacoresistant TLE with histopathological proven hippocampal sclerosis. P-glycoprotein expression was rated by three pathologists independently. Patients with seizure recurrence (n=22) had greater number of positively stained capillaries (p=0.001) and higher P-glycoprotein immunoreactive score in capillaries (p=0.002) in the white matter of resected temporal lobe. The differences remained significant in multivariate analysis (p=0.002 and 0.006, respectively). The results suggest that P-glycoprotein expression in temporal lobe may be associated with seizure recurrence after surgery for pharmacoresistant TLE.
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Jing X, Liu X, Wen T, Xie S, Yao D, Liu X, Wang G, Xie L. Combined effects of epileptic seizure and phenobarbital induced overexpression of P-glycoprotein in brain of chemically kindled rats. Br J Pharmacol 2010; 159:1511-22. [PMID: 20233212 DOI: 10.1111/j.1476-5381.2009.00634.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The multidrug resistance of epilepsy may result from the overexpression of P-glycoprotein, but the mechanisms are unclear. We investigated whether the overexpression of P-glycoprotein in the brains of subjects with pharmacoresistant epilepsy resulted from both drug effects and seizure activity. EXPERIMENTAL APPROACH Kindled rats were developed by injecting a subconvulsive dose of pentylenetetrazole (33 mg.kg(-1).day(-1), i.p.) for 28 days. Groups were then treated with an oral dose of phenobarbital (45 mg x kg(-1) x day(-1)) for 40 days. In accord with behavioural observations, P-glycoprotein activity in brain was assessed using brain-to-plasma concentration ratios of rhodamine 123. P-glycoprotein levels in the brain regions were further evaluated using RT-PCR and Western blot analysis. The distribution of phenobarbital in the brain was assessed by measuring phenobarbital concentrations 1 h following its oral administration. KEY RESULTS The kindling significantly increased P-glycoprotein activity and expression. Good associations were found among P-glycoprotein activity, expression and phenobarbital concentration in the hippocampus. Short-term treatment with phenobarbital showed good anti-epileptic effect; the maximum effect occurred on day 14 when overexpression of P-glycoprotein was reversed. Continuous treatment with phenobarbital had a gradually reduced anti-epileptic effect and on day 40, phenobarbital exhibited no anti-epileptic effect; this was accompanied by both a re-enhancement of P-glycoprotein expression and decreased phenobarbital concentration in the hippocampus. P-glycoprotein function and expression were also increased in age-matched normal rats treated with phenobarbital. CONCLUSIONS AND IMPLICATIONS The overexpression of P-glycoprotein in the brain of subjects with pharmacoresistant epilepsy is due to a combination of drug effects and epileptic seizures.
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Affiliation(s)
- Xinyue Jing
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
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Kwan P, Sperling MR. Refractory seizures: Try additional antiepileptic drugs (after two have failed) or go directly to early surgery evaluation? Epilepsia 2009; 50 Suppl 8:57-62. [DOI: 10.1111/j.1528-1167.2009.02237.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramos E, Benbadis S, Vale FL. Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis: results and treatment options. J Neurosurg 2009; 110:1127-34. [PMID: 19249930 DOI: 10.3171/2009.1.jns08638] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control. METHODS This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24-84 months). Surgeries were all performed by the senior author (F.L.V.). RESULTS Following initial surgical intervention, 97 patients (92%) improved to Engel Class I or II (Group A), and 8 (8%) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5%) with contralateral temporal EEG findings. Five patients (62.5%) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5%) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I. CONCLUSIONS Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.
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Affiliation(s)
- Edwin Ramos
- Department of Neurological Surgery, University of South Florida College of Medicine, Tampa, Florida, USA
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Souza-Oliveira C, Escorsi-Rosset S, Bianchin MM, Terra VC, Wichert-Ana L, Machado HR, Sakamoto AC. Comparative role of neuropsychological testing in the presurgical evaluation of children with medically intractable epilepsies. Childs Nerv Syst 2009; 25:875-80. [PMID: 19252915 DOI: 10.1007/s00381-009-0839-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 01/09/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE In the present study, we evaluated the preoperative demographic, clinical, and neuropsychological variables that could predict postoperative seizure outcome in a group of pediatric epileptic patients. MATERIALS AND METHODS We studied 40 consecutive pediatric patients, ages ranging from 6 to 16 years, that underwent resective surgery for the treatment of medically intractable epilepsy at the Clinical Hospital of Ribeirão Preto School of Medicine. We performed ictal electroencephalography (EEG), interictal EEG, magnetic resonance imaging (MRI), and a preoperative neuropsychological assessment in the presurgical workup. RESULTS The following factors were correlated with seizure outcome: (1) duration of epilepsy, (2) surgery localization, (3) localized Neuropsychological (NPS) Evaluation, (4) ictal EEG, (5) interictal EEG, and (6) MRI. Mental retardation, NPS tests, and the other demographic variables failed to correlate with seizure reduction. CONCLUSIONS The identification of predictor variables of epilepsy surgery outcome could improve the epileptic prognosis and guarantee the children's full potential development.
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Affiliation(s)
- Cecília Souza-Oliveira
- Department of Neurology, Psychiatry and Psychology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Lim YM, Cho YW, Shamim S, Solomon J, Birn R, Luh WM, Gaillard WD, Ritzl EK, Theodore WH. Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy. Epilepsy Res 2009; 82:183-9. [PMID: 19041041 DOI: 10.1016/j.eplepsyres.2008.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 06/06/2008] [Accepted: 08/11/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) is a developing magnetic resonance imaging (MRI) method for noninvasive measurement of cerebral blood flow (CBF). The purpose of this study was to evaluate the usefulness of ASL for detecting interictal temporal hypoperfusion in temporal lobe epilepsy (TLE). ASL-derived CBF measurements were compared with those derived from H(2)(15)O positron emission tomography (PET). METHODS 11 normal controls and 10 patients with medically intractable TLE were studied. Pulsed ASL (PASL) with quantitative imaging of perfusion using a single subtraction, second version (QUIPSS II) was performed in all subjects and H(2)(15)O PET was performed in patients. Regional CBF values in the mesial and lateral temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region. RESULTS In patients, mean CBF in the mesial temporal lobe was not significantly different between PASL and H(2)(15)O PET, and ipsilateral mesial temporal CBF was lower than contralateral CBF with both techniques. PASL detected significant mesial temporal perfusion asymmetry agreeing with EEG laterality in four patients. H(2)(15)O PET found ipsilateral interictal hypoperfusion in three. Both scans found unilateral hypoperfusion in one patient with bilateral EEG discharges. CONCLUSIONS Pulsed ASL may be a promising approach to detecting interictal hypoperfusion in TLE. This method has potential as a clinical alternative to H(2)(15)O PET due to noninvasiveness and easy accessibility.
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Affiliation(s)
- Young-Min Lim
- Clinical Epilepsy Section, NINDS, NIH, Bethesda, MD 20892, USA.
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The mortality and morbidity of febrile seizures. ACTA ACUST UNITED AC 2009; 4:610-21. [PMID: 18978801 DOI: 10.1038/ncpneuro0922] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 09/04/2008] [Indexed: 11/08/2022]
Abstract
Approaches to the treatment and investigation of febrile seizures have changed since the main reference studies on outcomes were conducted in the 1960s and 1970s. We have, therefore, conducted a systematic review of literature from the past 15 years to see whether outcomes have also changed. We found that simple febrile seizures do not carry a risk of death, but there is a very small risk of death after complex febrile seizures (CFSs), particularly febrile status epilepticus. There is no evidence that SUDEP (sudden unexpected death in epilepsy) occurs in association with febrile seizures. The risk of later epilepsy after a febrile seizure lies between 2.0% and 7.5%, and the risk of developing epilepsy after CFSs is estimated at around 10-20%. There is no evidence of any risk of hippocampal or mesial temporal sclerosis (HS/MTS) in association with simple febrile seizures. Serial imaging has shown that HS/MTS develops in 0-25% of patients over time after prolonged febrile seizures; the range in prevalence reflects selection bias in different studies. The overall risk of HS/MTS associated with CFSs is around 3%. Approximately 40% of patients with medically refractory temporal lobe epilepsy and HS/MTS on neuroimaging have a history of febrile seizures.
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Sakamoto S, Takami T, Tsuyuguchi N, Morino M, Ohata K, Inoue Y, Ide W, Hashimoto I, Kamada H, Tanaka H, Hara M. Prediction of seizure outcome following epilepsy surgery: Asymmetry of thalamic glucose metabolism and cerebral neural activity in temporal lobe epilepsy. Seizure 2009; 18:1-6. [DOI: 10.1016/j.seizure.2008.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 04/03/2008] [Accepted: 05/09/2008] [Indexed: 12/01/2022] Open
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Aull-Watschinger S, Pataraia E, Czech T, Baumgartner C. Outcome predictors for surgical treatment of temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 2008; 49:1308-16. [DOI: 10.1111/j.1528-1167.2008.01732.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Castro LH, Serpa MH, Valério RM, Jorge CL, Ono CR, Arantes PR, Rosemberg S, Wen HT. Good surgical outcome in discordant ictal EEG-MRI unilateral mesial temporal sclerosis patients. Epilepsia 2008; 49:1324-32. [PMID: 18627415 DOI: 10.1111/j.1528-1167.2008.01714.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Video electroencephalography (vEEG) monitoring of patients with unilateral mesial temporal sclerosis (uMTS) may show concordant or discordant seizure onset in relation to magnetic resonance imaging (MRI) evidence of MTS. Contralateral seizure usually leads to an indication of invasive monitoring. Contralateral seizure onset on invasive monitoring may contraindicate surgery. We evaluated long-term outcome after anteromesial temporal lobectomy (AMTL) in a consecutive series of uMTS patients with concordant and discordant vEEG findings, uniformly submitted to AMTL on the MRI evidence of MTS side without invasive monitoring. METHODS We compared surgical outcome of all uMTS patients undergoing vEEG monitoring between January 1999 and April 2005 in our service. Discordant cases were defined by at least one seizure onset contralateral to the MRI evidence of MTS. Good surgical outcome was considered as Engel's class I. We also evaluated ictal SPECT concordance to ictal EEG and surgical outcome. RESULTS Fifty-four patients had concordant (C) and 22 had discordant (D) scalp EEG and MRI. Surgical outcome was similar in both groups (C = 74% versus D = 86%). Duration of follow-up was comparable in both groups: C = 56.1 +/- 20.7 months versus D = 59.8 +/- 21.2 months (p = 0.83, nonsignificant). Discordant single-photon emission computed tomography (SPECT) results did not influence surgical outcome. DISCUSSION Surgical outcome was not influenced by contralateral vEEG seizure onset or contralateral increased flow on ictal SPECT. Although vEEG monitoring should still be performed in these patients, to rule out psychogenic seizures and extratemporal seizure onset, a potentially risky procedure such as invasive monitoring may not only not be indicated in this patient population, but may also lead to patients erroneously being denied surgery.
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Affiliation(s)
- Luiz H Castro
- Department of Neurology, Hospital das Clínicas Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
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Tezer FI, Akalan N, Oguz KK, Karabulut E, Dericioglu N, Ciger A, Saygi S. Predictive factors for postoperative outcome in temporal lobe epilepsy according to two different classifications. Seizure 2008; 17:549-60. [PMID: 18403220 DOI: 10.1016/j.seizure.2008.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 01/25/2008] [Accepted: 02/29/2008] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The determination of prognostic factors is important for predicting outcome after epilepsy surgery. We investigated the factors related to surgical outcome within a homogeneous group of patients suffering from pathologically proven mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), and compared Engel's outcome classification system with the latest one proposed by the ILAE. METHOD We included 109 patients with MTLE-HS who were followed-up for at least 1 year after epilepsy surgery. A retrospective chart review was performed to extract patients' demographic details, and potential pre-postoperative risk factors. Outcome of surgery was defined by the Engel's and ILAE classifications. In addition, the course of prognosis was determined according to the changes in ILAE classifications on an annual basis. Univariate and multivariate logistic regression analyses were used for the latest available outcomes and two different courses of prognosis. RESULTS The average duration of follow up was 4.78+/-2.55 years in the 109 patients with MTLE-HS. The univariate and multiple logistic regression analyses showed that the occurrence of seizures during the first month after surgery was a significant risk factor for a poor outcome. A history of trauma was also significant for patients with late recurrence of postsurgical seizures after at least 1-year seizure remission. CONCLUSION The occurrence of seizures during the first month after surgery is a significant prognostic factor in patients with MTLE-HS. Ignoring early postoperative seizures in classification systems may result in difficulty in identifying the course of epilepsy after surgery.
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Affiliation(s)
- F Irsel Tezer
- Institute of Neurological Sciences and Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey.
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Bartolomei F, Hayashi M, Tamura M, Rey M, Fischer C, Chauvel P, Régis J. Long-term efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy. Neurology 2008; 70:1658-63. [DOI: 10.1212/01.wnl.0000294326.05118.d8] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Gamma knife (GK) radiosurgery has been proposed as an alternative to classic microsurgery in mesial temporal lobe epilepsy (MTLE). Short-term follow-up studies have reported encouraging results, but long-term efficacy is not known.Objective: To report the efficacy and tolerance of GK radiosurgery in MTLE after a follow-up > 5 years.Methods: Patients with a follow-up > 5 years presenting with MTLE and treated with a marginal dose of 24 Gy were included in the study.Results: Fifteen patients were included. Eight were treated on the left side, and 7 were treated on the right. The mean follow-up was 8 years (range 6–10 years). At the last follow-up, 9 of 16 patients (60%) were considered seizure free (Engel Class I) (4/16 in Class IA, 5/16 in Class IB). Seizure cessation occurred with a mean delay of 12 months (± 3) after GK radiosurgery, often preceded by a period of increasing aura or seizure occurrence (6/15 patients). The mean delay of appearance of the first neuroradiologic changes was 12 months (± 4). Nine patients (60%) experienced mild headache and were placed on corticosteroid treatment for a short period. All patients who were initially seizure free experienced a relapse of isolated aura (10/15, 66%) or complex partial seizures (10/15, 66%) during antiepileptic drug tapering. Restoration of treatment resulted in good control of seizures.Conclusion: Gamma knife radiosurgery is an effective and safe treatment for mesial temporal lobe epilepsy. Results are maintained over time with no additional side effects. Long-term results compare well with those of conventional surgery.
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