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Thompson SA. Kindling in humans: Does secondary epileptogenesis occur? Epilepsy Res 2023; 198:107155. [PMID: 37301727 DOI: 10.1016/j.eplepsyres.2023.107155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Abstract
The relevance of secondary epileptogenesis for human epilepsy remains a controversial subject decades after it was first described in animal models. Whether or not a previously normal brain region can become independently epileptogenic through a kindling-like process has not, and cannot, be definitely proven in humans. Rather than reliance on direct experimental evidence, attempts to answering this question must depend on observational data. In this review, observations based largely upon contemporary surgical series will advance the case for secondary epileptogenesis in humans. As will be argued, hypothalamic hamartoma-related epilepsy provides the strongest case for this process; all the stages of secondary epileptogenesis can be observed. Hippocampal sclerosis (HS) is another pathology where the question of secondary epileptogenesis frequently arises, and observations from bitemporal and dual pathology series are explored. The verdict here is far more difficult to reach, in large part because of the scarcity of longitudinal cohorts; moreover, recent experimental data have challenged the claim that HS is acquired consequent to recurrent seizures. Synaptic plasticity more than seizure-induced neuronal injury is the likely mechanism of secondary epileptogenesis. Postoperative running-down phenomenon provides the best evidence that a kindling-like process occurs in some patients, evidenced by its reversal. Finally, a network perspective of secondary epileptogenesis is considered, as well as the possible role for subcortical surgical interventions.
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Affiliation(s)
- Stephen A Thompson
- Department of Medicine (Neurology), McMaster University, Hamilton, ON, Canada.
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2
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Santos MV, Garcia CAB, Hamad APA, Costa UT, Sakamoto AC, Dos Santos AC, Machado HR. Clinical and Surgical Approach for Cerebral Cortical Dysplasia. Adv Tech Stand Neurosurg 2023; 48:327-354. [PMID: 37770690 DOI: 10.1007/978-3-031-36785-4_12] [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] [Indexed: 09/30/2023]
Abstract
The present article describes pathophysiological and clinical aspects of congenital malformations of the cerebral tissue (cortex and white matter) that cause epilepsy and very frequently require surgical treatment. A particular emphasis is given to focal cortical dysplasias, the most common pathology among these epilepsy-related malformations. Specific radiological and surgical features are also highlighted, so a thorough overview of cortical dysplasias is provided.
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Affiliation(s)
- Marcelo Volpon Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil.
- Department of Surgery and Anantomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil.
| | - Camila Araujo Bernardino Garcia
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Paula Andrade Hamad
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Ursula Thome Costa
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Americo Ceiki Sakamoto
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Carlos Dos Santos
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
| | - Helio Rubens Machado
- Center for Pediatric Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University Hospital, University of São Paulo, São Paulo, SP, Brazil
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3
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Gunnarsdottir KM, Li A, Smith RJ, Kang JY, Korzeniewska A, Crone NE, Rouse AG, Cheng JJ, Kinsman MJ, Landazuri P, Uysal U, Ulloa CM, Cameron N, Cajigas I, Jagid J, Kanner A, Elarjani T, Bicchi MM, Inati S, Zaghloul KA, Boerwinkle VL, Wyckoff S, Barot N, Gonzalez-Martinez J, Sarma SV. Source-sink connectivity: a novel interictal EEG marker for seizure localization. Brain 2022; 145:3901-3915. [PMID: 36412516 PMCID: PMC10200292 DOI: 10.1093/brain/awac300] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 07/26/2023] Open
Abstract
Over 15 million epilepsy patients worldwide have drug-resistant epilepsy. Successful surgery is a standard of care treatment but can only be achieved through complete resection or disconnection of the epileptogenic zone, the brain region(s) where seizures originate. Surgical success rates vary between 20% and 80%, because no clinically validated biological markers of the epileptogenic zone exist. Localizing the epileptogenic zone is a costly and time-consuming process, which often requires days to weeks of intracranial EEG (iEEG) monitoring. Clinicians visually inspect iEEG data to identify abnormal activity on individual channels occurring immediately before seizures or spikes that occur interictally (i.e. between seizures). In the end, the clinical standard mainly relies on a small proportion of the iEEG data captured to assist in epileptogenic zone localization (minutes of seizure data versus days of recordings), missing opportunities to leverage these largely ignored interictal data to better diagnose and treat patients. IEEG offers a unique opportunity to observe epileptic cortical network dynamics but waiting for seizures increases patient risks associated with invasive monitoring. In this study, we aimed to leverage interictal iEEG data by developing a new network-based interictal iEEG marker of the epileptogenic zone. We hypothesized that when a patient is not clinically seizing, it is because the epileptogenic zone is inhibited by other regions. We developed an algorithm that identifies two groups of nodes from the interictal iEEG network: those that are continuously inhibiting a set of neighbouring nodes ('sources') and the inhibited nodes themselves ('sinks'). Specifically, patient-specific dynamical network models were estimated from minutes of iEEG and their connectivity properties revealed top sources and sinks in the network, with each node being quantified by source-sink metrics. We validated the algorithm in a retrospective analysis of 65 patients. The source-sink metrics identified epileptogenic regions with 73% accuracy and clinicians agreed with the algorithm in 93% of seizure-free patients. The algorithm was further validated by using the metrics of the annotated epileptogenic zone to predict surgical outcomes. The source-sink metrics predicted outcomes with an accuracy of 79% compared to an accuracy of 43% for clinicians' predictions (surgical success rate of this dataset). In failed outcomes, we identified brain regions with high metrics that were untreated. When compared with high frequency oscillations, the most commonly proposed interictal iEEG feature for epileptogenic zone localization, source-sink metrics outperformed in predictive power (by a factor of 1.2), suggesting they may be an interictal iEEG fingerprint of the epileptogenic zone.
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Affiliation(s)
| | - Adam Li
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Rachel J Smith
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Joon-Yi Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Adam G Rouse
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jennifer J Cheng
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Michael J Kinsman
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Patrick Landazuri
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Utku Uysal
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Carol M Ulloa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Nathaniel Cameron
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jonathan Jagid
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andres Kanner
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Turki Elarjani
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Manuel Melo Bicchi
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sara Inati
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Varina L Boerwinkle
- Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Sarah Wyckoff
- Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Niravkumar Barot
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | | | - Sridevi V Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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Hainc N, McAndrews MP, Valiante T, Andrade DM, Wennberg R, Krings T. Imaging in medically refractory epilepsy at 3 Tesla: a 13-year tertiary adult epilepsy center experience. Insights Imaging 2022; 13:99. [PMID: 35661273 PMCID: PMC9167324 DOI: 10.1186/s13244-022-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives MRI negative epilepsy has evolved through increased usage of 3 T and insights from surgically correlated studies. The goal of this study is to describe dedicated 3 T epilepsy MRI findings in medically refractory epilepsy (MRE) patients at a tertiary epilepsy center to familiarize radiologists with an updated spectrum and frequency of potential imaging findings in the adult MRE population. Methods Included were all patients with MRE admitted to the epilepsy monitoring unit who were discussed at weekly interdisciplinary imaging conferences at Toronto Western Hospital with MRI studies (3 T with dedicated epilepsy protocol) performed between January 2008 and January 2021. Lesion characterization was performed by two readers based on most likely imaging diagnosis in consensus. Lobes involved per case were recorded. Results A total of 738 patients (386 female; mean age 35 years, range 15–77) were included. A total of 262 patients (35.5%) were MRI negative. The most common imaging finding was mesial temporal sclerosis, seen in 132 patients (17.9%), followed by encephalomalacia and gliosis, either posttraumatic, postoperative, postischemic, or postinfectious in nature, in 79 patients (10.7%). The most common lobar involvement (either partially or uniquely) was temporal (341 cases, 58.6%). MRE patients not candidates for surgical resection were included in the study, as were newly described pathologies from surgically correlated studies revealing findings seen retrospectively on reported MRI negative exams (isolated enlargement of the amygdala, temporal pole white matter abnormality, temporal encephalocele). Conclusion This study provides an updated description of the spectrum of 3 T MRI findings in adult MRE patients from a tertiary epilepsy center.
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Affiliation(s)
- Nicolin Hainc
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. .,Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mary Pat McAndrews
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Danielle M Andrade
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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5
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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6
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Nowak A, Bala A. Occult focal cortical dysplasia may predict poor outcome of surgery for drug-resistant mesial temporal lobe epilepsy. PLoS One 2021; 16:e0257678. [PMID: 34591859 PMCID: PMC8483375 DOI: 10.1371/journal.pone.0257678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. METHODS We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005-2016, and correlated factors associated with seizure relapse. RESULTS At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. CONCLUSIONS The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.
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Affiliation(s)
- Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
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7
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Cossu M, d'Orio P, Barba C, Asioli S, Cardinale F, Casciato S, Caulo M, Colicchio G, Consales A, D'Aniello A, De Benedictis A, De Palma L, Didato G, Di Gennaro G, Di Giacomo R, Esposito V, Guerrini R, Nichelatti M, Revay M, Rizzi M, Vatti G, Villani F, Zamponi N, Tassi L, Marras CE. Focal Cortical Dysplasia IIIa in Hippocampal Sclerosis-Associated Epilepsy: Anatomo-Electro-Clinical Profile and Surgical Results From a Multicentric Retrospective Study. Neurosurgery 2021; 88:384-393. [PMID: 32860416 DOI: 10.1093/neuros/nyaa369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE). OBJECTIVE To investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa. METHODS A total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa). RESULTS At last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS. CONCLUSION Coexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.
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Affiliation(s)
- Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, National Research Council, Parma, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | | | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | | | - Luca De Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Giuseppe Didato
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Ikawa A, Fujimoto A, Arai Y, Otsuki Y, Nozaki T, Baba S, Sato K, Enoki H. Case Report: Late-Onset Temporal Lobe Epilepsy Following Subarachnoid Hemorrhage: An Interplay Between Pre-existing Cortical Development Abnormality and Tissue Damage. Front Neurol 2021; 12:599130. [PMID: 33633663 PMCID: PMC7901922 DOI: 10.3389/fneur.2021.599130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Epileptogenicity following brain insult depends on various factors including severity of the resulting lesion and extent of brain damage. We report a 54-year-old female patient who developed medically refractory epilepsy resulting from the interplay of pre-existing and post-insult pathologies. She presented with subarachnoid hemorrhage (SAH) due to a ruptured aneurysm and underwent clipping surgery. Seizures started 3 months post-operatively. MRI revealed cerebral ischemia and hemosiderin deposits in the left temporal lobes, and left hippocampal atrophy was suspected. As anti-seizure medications and vagus nerve stimulation failed to control her seizures, she underwent left temporal lobe resection and placement of a ventriculoperitoneal shunt for the post-operative complication of hydrocephalus. She remains seizure-free to date. Neuropathology revealed a previously undiagnosed focal cortical dysplasia (FCD) type 1a. Brain insult likely had a second hit effect in the late onset of epilepsy in this patient with pre-existing mild MCD, in whom secondary epilepsy can be attributed to the interplay of multiple underlying pathologies.
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Affiliation(s)
- Anna Ikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Toshiki Nozaki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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9
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Yu HY, Lin CF, Chou CC, Lu YJ, Hsu SPC, Lee CC, Chen C. Outcomes of hippocampus-sparing lesionectomy for temporal lobe epilepsy and the significance of intraoperative hippocampography. Clin Neurophysiol 2020; 132:746-755. [PMID: 33571882 DOI: 10.1016/j.clinph.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated hippocampal-sparing lesionectomy (HSL) outcomes in temporal lobe epilepsy (TLE) and the significance of high-frequency oscillations (HFOs) detected by hippocampography in HSL. METHODS We retrospectively reviewed data from patients who underwent HSL for lesional TLE. Patients were included when MRI confirmed (i) a lesion limited to the temporal lobe with normal hippocampi preoperatively and (ii) hippocampal integrity postoperatively. Factors possibly related to outcomes were collected. Intraoperative hippocampography was reviewed, and spikes, ripples, and fast ripples were marked. Seizure outcomes were tracked ≥ 2 years. Postoperative neuropsychological tests were performed and analyzed. RESULTS We included 67 patients (35 males/32 females, median age at surgery 28 years, 57 seizure-free). Complete resection was significantly associated with being seizure-free without aura, an outcome achieved by 32 (69.6%) patients with complete resection vs 1 (12.5%) with incomplete resection (p = 0.004). Spikes/ripples/fast ripples appeared frequently in the hippocampus, occurring in 86.4%/82.4%/75.0% of cases before resection and 76.7%/78.1%/63.0% after resection. The presence and rate were unconnected to seizure outcome. Postoperative neuropsychological outcomes in intelligence and visual memory improved overall. CONCLUSIONS HSL in lesional TLE can produce satisfactory seizure and cognitive outcomes. Intraoperative hippocampography-guided resection of apparently normal hippocampi should be performed cautiously and might not be necessary. SIGNIFICANCE This study provided evidence in decision making for patients with lesional TLE with a radiologically normal hippocampus.
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Affiliation(s)
- Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Chun-Fu Lin
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Jiun Lu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sanford P C Hsu
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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10
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Günbey C, Söylemezoğlu F, Bilginer B, Karlı Oğuz K, Akalan N, Topçu M, Turanlı G, Yalnızoğlu D. International consensus classification of hippocampal sclerosis and etiologic diversity in children with temporal lobectomy. Epilepsy Behav 2020; 112:107380. [PMID: 32882628 DOI: 10.1016/j.yebeh.2020.107380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood. METHODS Seventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification. RESULTS Neuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes. CONCLUSIONS Our study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.
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Affiliation(s)
- Ceren Günbey
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Söylemezoğlu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçak Bilginer
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kader Karlı Oğuz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nejat Akalan
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meral Topçu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzide Turanlı
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yalnızoğlu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Miyata H, Sudo S, Kuwashige H, Miyao S, Nakamoto H, Kubota Y, Yoshida Y. Dual pathology in a patient with temporal lobe epilepsy associated with neocortical glial scar after brain abscess and end folium sclerosis/hippocampal sclerosis type 3. Neuropathology 2020; 41:42-48. [PMID: 33094499 DOI: 10.1111/neup.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
End folium sclerosis or hippocampal sclerosis (HS) type 3 is often associated with another coexisting epileptogenic lesion (dual pathology); however, the pathogenesis of HS type 3 remains elusive. A 46-year-old man presented with medically intractable focal aware seizures and focal impaired awareness seizures (FIAS) with occasional focal to bilateral tonic-clonic seizures (FBTCS) two years after surgical treatment with extensive cranial reconstruction for a brain abscess in the right temporal lobe associated with intracranial extension of ipsilateral cholesteatoma. Head magnetic resonance imaging (MRI) at age 49 revealed atrophy of the right cerebral hemisphere including the hippocampus and amygdala. The patient's first epilepsy surgery was a lateral temporal lobectomy, in which the mesial temporal structures were preserved because no epileptiform discharge was detected on the intraoperative electrocorticogram. However, FIAS with FBTCS started 15 months after the operation. The second surgery, amygdalohippocampectomy, at age 52, resulted in the patient being seizure-free again for one year before seizures of the right lateral temporal origin recurred. He underwent a third surgery, resection of the Heschl's and supramarginal gyri, at age 53, but he continued to have drug-resistant epilepsy over two years after that. Histopathological examination revealed dual pathology consisting of glial scar in the lateral temporal lobe and ipsilateral HS type 3 with an unusually severe lesion in the subiculum. No significant inflammatory change was observed. The clinicopathological features in the present case indicate that HS developed secondarily in the context of neocortical epilepsy due to glial scar, suggesting a role of repetitive abnormal electrical input from neocortical epileptogenic lesions into the hippocampus finally via the perforant pathway in the pathogenesis of HS type 3. Severe hippocampal atrophy on preoperative MRI together with its silent electrocorticogram recording at initial epilepsy surgery may represent clinically pre-epileptogenic HS in a seizure-free "silent or latent period" before completion of hippocampal epileptogenesis to the extent that clinical epileptic seizures occur.
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Affiliation(s)
- Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Saeko Sudo
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Haruka Kuwashige
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Satoru Miyao
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Saiseikai Kurihashi Hospital, Saitama, Japan
| | | | - Yuichi Kubota
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Yasuji Yoshida
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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Olszewska A, Schmidt MJ, Failing K, Nicpoń J, Podgórski P, Wrzosek MA. Interictal Single-Voxel Proton Magnetic Resonance Spectroscopy of the Temporal Lobe in Dogs With Idiopathic Epilepsy. Front Vet Sci 2020; 7:644. [PMID: 33195502 PMCID: PMC7541947 DOI: 10.3389/fvets.2020.00644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
Proton magnetic resonance spectroscopy (H1-MRS) could provide insight into the metabolic pathophysiology of the temporal lobe of canine brain after seizure. Currently, there is no evidence-based data available on MRS of temporal lobe in dogs with idiopathic epilepsy (IE). The aim of this prospective, cross-sectional study was to evaluate the interictal metabolic activity of the temporal lobe in IE dogs compared to a control group with the use of H1-MRS. Ten healthy dogs and 27 client-owned dogs with IE underwent 1.5-Tesla magnetic resonance imaging (MRI) and single-voxel H1-MRS. The MRS studies were acquired as spin echoes with a repetition time (TR) of 2,000 ms and an echo time (TE) of 144 ms. A cubic voxel (10 ×10 ×10 mm) was positioned bilaterally into the region of the left and right temporal lobe, including a middle part of the hippocampus and the amygdala. The N-acetylaspartate (NAA)-to-creatine (NAA/Cr), NAA-to-choline (NAA/Cho), choline-to-creatine (Cho/Cr), and choline-to-NAA (Cho/NAA) ratios were determined in both hemispheres and compared to controls. No significant differences in all metabolite ratios between epileptic dogs and the control group could be found. A time-dependent decrease in the NAA/Cho ratio as well as an increase in the Cho/NAA ratio was found with proximity in time to the last seizure. We found no correlation between metabolite ratios and age or sex in this animal group. Time span from the last seizure to the acquisition of MRS significantly correlated with NAA/Cho and Cho/NAA ratio. We conclude that without a time relation, metabolite ratios in dogs with IE do not differ from those of the control group.
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Affiliation(s)
- Agnieszka Olszewska
- Department of Veterinary Clinical Science, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Martin Jürgen Schmidt
- Department of Veterinary Clinical Science, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig-University Giessen, Giessen, Germany
| | - Józef Nicpoń
- Department of Internal Diseases With a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland.,Center of Experimental Diagnostics and Innovative Biomedical Technologies, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Przemysław Podgórski
- Department of General Radiology and Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Marcin Adam Wrzosek
- Department of Internal Diseases With a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
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Sheikh SR, Nair D, Gross RE, Gonzalez‐Martinez J. Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy. Epilepsia 2019; 60:1768-1793. [DOI: 10.1111/epi.16310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Shehryar R. Sheikh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
| | - Dileep Nair
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
- Epilepsy Center Cleveland Clinic Foundation Cleveland Ohio
| | | | - Jorge Gonzalez‐Martinez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland Ohio
- Epilepsy Center Cleveland Clinic Foundation Cleveland Ohio
- Department of Neurosurgery Cleveland Clinic Foundation Cleveland Ohio
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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15
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Mehvari Habibabadi J, Badihian S, Tabrizi N, Manouchehri N, Zare M, Basiratnia R, Barekatain M, Moein H, Mehvari Habibabadi A, Moein P, Gookizadeh P. Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis. Neurol Sci 2018; 40:495-502. [PMID: 30539344 DOI: 10.1007/s10072-018-3677-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/04/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS. METHODS This is a cross-sectional study conducted during 2007-2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS. RESULTS Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05). CONCLUSIONS We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.
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Affiliation(s)
| | - Shervin Badihian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Neurology Department, Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Navid Manouchehri
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Basiratnia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Houshang Moein
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Payam Moein
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peyman Gookizadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Students' Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. .,, Isfahan, Iran.
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16
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Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy. PLoS One 2018; 13:e0206095. [PMID: 30339697 PMCID: PMC6195284 DOI: 10.1371/journal.pone.0206095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/06/2018] [Indexed: 01/12/2023] Open
Abstract
Objectives To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE). Materials and methods We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up. Results The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0–21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053). Conclusion This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.
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Luan L, Sun Y, Yang K. Surgical strategy for temporal lobe epilepsy with dual pathology and incomplete evidence from EEG and neuroimaging. Exp Ther Med 2018; 16:4886-4892. [PMID: 30546403 DOI: 10.3892/etm.2018.6774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 11/06/2022] Open
Abstract
Coexistence of hippocampal sclerosis (HS) and a temporal neocortical lesion, including focal cortical dysplasia, vascular malformations or benign primary brain tumors, is defined as dual pathology. In the majority of cases, the complete evidence based on electroencephalogram (EEG) and magnetic resonance imaging (MRI) for each of the dual pathological lesions is difficult to obtain. As a result, patients with dual pathology are poor surgical candidates due to potential incomplete resection of the epileptogenic zone. The current study retrospectively reviewed 24 patients with potential dual pathology and incomplete EEG and MRI evidence, aiming to provide novel surgical strategies. The results revealed a significantly worse seizure-free outcome for patients with incomplete EEG and MRI data compared with patients who received a clear diagnosis of dual pathology based on complete test results (11.1 vs. 60.0%; P<0.05). Notably, satisfying surgical (seizure-free) outcomes were still achieved in 60% of patients with unclear EEGs to locate the onset zone and clear MRI scans identifying the sclerotic hippocampus and nearby neocortical lesions, which could be resected together. In patients with multiple epileptogenic onsets or with widespread epileptic discharges, the hippocampus should be spared from resection due to concern for potential postsurgical mood or memory disorders. In conclusion, patients with resection of the sclerotic hippocampus and neocortical lesion had improved seizure-free outcomes compared with patients who received individual lesion resection. The current study aimed to provide a novel surgical strategy for neurosurgeons treating epileptic patients with dual pathology.
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Affiliation(s)
- Lan Luan
- Department of Neurosurgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Yuqiang Sun
- Department of Neurosurgery, The Central Hospital of Harbin, Harbin, Heilongjiang 150000, P.R. China
| | - Kang Yang
- Department of Neurosurgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
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Effect of Temporal Neocortical Pathology on Seizure Freeness in Adult Patients with Temporal Lobe Epilepsy. World Neurosurg 2018; 116:e801-e805. [DOI: 10.1016/j.wneu.2018.05.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
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Reed CM, Dewar S, Fried I, Engel J, Eliashiv D. Failed epilepsy surgery deserves a second chance. Clin Neurol Neurosurg 2017; 163:110-115. [DOI: 10.1016/j.clineuro.2017.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/12/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
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Kim H, Oh A, Olson L, Chern JJ. Use of an intraventricular strip electrode for mesial temporal monitoring in children with medically intractable epilepsy. J Neurosurg Pediatr 2017; 19:495-501. [PMID: 28156216 DOI: 10.3171/2016.10.peds16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate mesial temporal electroencephalographic (EEG) monitoring, using an intraventricular strip electrode (IVSE) along the ventricular surface of the hippocampus, in children with medically intractable epilepsy. METHODS The authors reviewed 10 consecutive cases in which subdural electrode placements and mesial temporal monitoring were recommended. The median age of the patients was 12.7 years (range 4.5-19.3 years). Both grids and IVSE were placed in all patients. The 4-contact IVSE was used in 5 cases, and the 6-contact IVSE in the other 5 cases. The median number of contacts, including IVSE contacts, was 122 (range 66-181). A total of 182 seizures were analyzed. RESULTS The IVSE localized seizure-onset zones in 8 patients. The seizure-onset zone was identified exclusively by IVSE in 3 patients and was simultaneous in IVSE and subdural electrodes in 5 patients. Among the 5 patients with simultaneous onset on both IVSE and subdural electrodes, 4 had basal temporal onset and one had orbitofrontal and lateral midtemporal onset. In the remaining 2 patients, the absence of IVSE seizure onset permitted sparing of mesial temporal structures. An Engel Class Ia outcome was achieved in 9 of 10 cases. No complication was associated with IVSE placement. CONCLUSIONS Intracranial monitoring using IVSE offers an alternative in terms of quality of EEG recording. IVSE was useful in children who already required open craniotomy for intracranial monitoring over an extensive network of hyper-excitability.
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Affiliation(s)
- Hyunmi Kim
- Departments of Pediatrics and
- Division of Pediatric Neurology and
| | | | - Larry Olson
- Departments of Pediatrics and
- Division of Pediatric Neurology and
| | - Joshua J. Chern
- Neurosurgery, Emory University School of Medicine; and
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Georgia
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Nagae LM, Lall N, Dahmoush H, Nyberg E, Mirsky D, Drees C, Honce JM. Diagnostic, treatment, and surgical imaging in epilepsy. Clin Imaging 2016; 40:624-36. [DOI: 10.1016/j.clinimag.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Abstract
Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.
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Affiliation(s)
- Jian Guan
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Michael Karsy
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Katrina Ducis
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
| | - Robert J Bollo
- 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, Vermont, USA
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Functional Connectome before and following Temporal Lobectomy in Mesial Temporal Lobe Epilepsy. Sci Rep 2016; 6:23153. [PMID: 27001417 PMCID: PMC4802388 DOI: 10.1038/srep23153] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/29/2016] [Indexed: 01/05/2023] Open
Abstract
As mesial temporal lobe epilepsy (mTLE) has been recognized as a network disorder, a longitudinal connectome investigation may shed new light on the understanding of the underlying pathophysiology related to distinct surgical outcomes. Resting-state functional MRI data was acquired from mTLE patients before (n = 37) and after (n = 24) anterior temporal lobectomy. According to surgical outcome, patients were classified as seizure-free (SF, n = 14) or non-seizure-free (NSF, n = 10). First, we found higher network resilience to targeted attack on topologically central nodes in the SF group compared to the NSF group, preoperatively. Next, a two-way mixed analysis of variance with between-subject factor ‘outcome’ (SF vs. NSF) and within-subject factor ‘treatment’ (pre-operation vs. post-operation) revealed divergent dynamic reorganization in nodal topological characteristics between groups, in the temporoparietal junction and its connection with the ventral prefrontal cortex. We also correlated the network damage score (caused by surgical resection) with postsurgical brain function, and found that the damage score negatively correlated with postoperative global and local parallel information processing. Taken together, dynamic connectomic architecture provides vital information for selecting surgical candidates and for understanding brain recovery mechanisms following epilepsy surgery.
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Coexistent arteriovenous malformation and hippocampal sclerosis. J Clin Neurosci 2016; 28:180-2. [PMID: 26899356 DOI: 10.1016/j.jocn.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/17/2015] [Indexed: 11/24/2022]
Abstract
Cavernous angiomas or cavernomas have been occasionally described in patients presenting with medically intractable epilepsy. Reports of cavernomas associated with a second pathology potentially causative of seizures have rarely been documented; most commonly, the second pathology is focal cortical dysplasia or less frequently, hippocampal sclerosis. To our knowledge, cases of arteriovenous malformation arising in this clinical setting and associated with hippocampal sclerosis have not been previously described. We report a 56-year-old woman who initially presented at age 24years with staring spells. Imaging studies revealed an arteriovenous malformation in the right parietal lobe. At age 51years, she represented with signs and symptoms related to a hemorrhage from the malformation. The patient underwent Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden) of the lesion. She subsequently developed seizures, refractory to medical management. MRI studies showed atrophy in the right hippocampus. She underwent resection of the right parietal lobe and hippocampus. Histopathologic examination of the right parietal lesion revealed an arteriovenous malformation marked by focally prominent vascular sclerosis, calcification and adjacent hemosiderin deposition. The hippocampus was marked by prominent neuronal loss and gliosis in the CA1 region, consistent with CA1 sclerosis or hippocampal sclerosis International League Against Epilepsy type 2.
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Gales JM, Prayson RA. Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy. Hum Pathol 2016; 48:111-6. [DOI: 10.1016/j.humpath.2015.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
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Barba C, Rheims S, Minotti L, Guénot M, Hoffmann D, Chabardès S, Isnard J, Kahane P, Ryvlin P. Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain 2015; 139:444-51. [DOI: 10.1093/brain/awv372] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Abstract
See Engel (doi:10.1093/awv374) for a scientific commentary on this article.
Reasons for failed temporal lobe epilepsy surgery remain unclear. Temporal plus epilepsy, characterized by a primary temporal lobe epileptogenic zone extending to neighboured regions, might account for a yet unknown proportion of these failures. In this study all patients from two epilepsy surgery programmes who fulfilled the following criteria were included: (i) operated from an anterior temporal lobectomy or disconnection between January 1990 and December 2001; (ii) magnetic resonance imaging normal or showing signs of hippocampal sclerosis; and (iii) postoperative follow-up ≥ 24 months for seizure-free patients. Patients were classified as suffering from unilateral temporal lobe epilepsy, bitemporal epilepsy or temporal plus epilepsy based on available presurgical data. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom over time. Predictors of seizure recurrence were investigated using Cox proportional hazards model. Of 168 patients included, 108 (63.7%) underwent stereoelectroencephalography, 131 (78%) had hippocampal sclerosis, 149 suffered from unilateral temporal lobe epilepsy (88.7%), one from bitemporal epilepsy (0.6%) and 18 (10.7%) from temporal plus epilepsy. The probability of Engel class I outcome at 10 years of follow-up was 67.3% (95% CI: 63.4–71.2) for the entire cohort, 74.5% (95% CI: 70.6–78.4) for unilateral temporal lobe epilepsy, and 14.8% (95% CI: 5.9–23.7) for temporal plus epilepsy. Multivariate analyses demonstrated four predictors of seizure relapse: temporal plus epilepsy (P < 0.001), postoperative hippocampal remnant (P = 0.001), past history of traumatic or infectious brain insult (P = 0.022), and secondary generalized tonic-clonic seizures (P = 0.023). Risk of temporal lobe surgery failure was 5.06 (95% CI: 2.36–10.382) greater in patients with temporal plus epilepsy than in those with unilateral temporal lobe epilepsy. Temporal plus epilepsy represents a hitherto unrecognized prominent cause of temporal lobe surgery failures. In patients with temporal plus epilepsy, anterior temporal lobectomy appears very unlikely to control seizures and should not be advised. Whether larger resection of temporal plus epileptogenic zones offers greater chance of seizure freedom remains to be investigated.
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Affiliation(s)
- Carmen Barba
- 1 Paediatric Neurology Unit, Children’s Hospital A. Meyer-University of Florence, 50139, Florence, Italy
| | - Sylvain Rheims
- 2 Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, 69500, Lyon and Lyon 1 University, France
- 3 Lyon’s Research Neuroscience Centre, INSERM U1028/CNRS UMR5292, Lyon, France
- 4 Epilepsy Institute (IDEE), Lyon, France
| | - Lorella Minotti
- 5 Epilepsy Unit, Neurology Department, 38043, Michallon Hospital, Grenoble, France
| | - Marc Guénot
- 6 Department of Functional Neurosurgery, Hospices Civils de Lyon, 69003 Lyon, and Lyon 1 University, France
| | | | - Stephan Chabardès
- 7 Neurosurgery Department, Michallon Hospital, 38043, Grenoble, France
| | - Jean Isnard
- 2 Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, 69500, Lyon and Lyon 1 University, France
| | - Philippe Kahane
- 5 Epilepsy Unit, Neurology Department, 38043, Michallon Hospital, Grenoble, France
- 8 GIN, Inserm U836, University Grenoble-Alpes, Grenoble, France
| | - Philippe Ryvlin
- 3 Lyon’s Research Neuroscience Centre, INSERM U1028/CNRS UMR5292, Lyon, France
- 4 Epilepsy Institute (IDEE), Lyon, France
- 9 Department of Clinical Neurosciences, Centre Hospitalo-Universitaire Vaudois, 1011, Lausanne, Switzerland
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Prayson RA, Gales JM. Coexistent ganglioglioma, focal cortical dysplasia, and hippocampal sclerosis (triple pathology) in chronic epilepsy. Ann Diagn Pathol 2015; 19:310-3. [DOI: 10.1016/j.anndiagpath.2015.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
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Tong F, Jewells V, Trembath DG, Hadar E, Shin HW. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 4:52-5. [PMID: 26288757 PMCID: PMC4536300 DOI: 10.1016/j.ebcr.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 11/18/2022]
Abstract
Mesial temporal sclerosis (MTS) is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD) is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.
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Affiliation(s)
- Fumin Tong
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
- Corresponding author at: Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA. Tel.: + 1 919 966 8162.
| | - Valerie Jewells
- Department of Radiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Dimitri G. Trembath
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Hae Won Shin
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
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Abstract
BACKGROUND Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to the age of the participants and which focal epilepsies are included, but have been reported as at least 20% and in some studies up to 70%. If the epileptogenic zone can be located surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.The secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence and to identify the factors that correlate to remission of seizures postoperatively. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 to 4 July 2013), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for relevant trials up to 4 July 2013. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), cohort studies or case series, with either a prospective and/or retrospective design, including at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportion of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RR) and 95% confidence intervals. MAIN RESULTS We identified 177 studies (16,253 participants) investigating the outcome of surgery for epilepsy. Four studies were RCTs (including one that randomised participants to surgery or medical treatment). The risk of bias in the RCTs was unclear or high, limiting our confidence in the evidence that addressed the primary review objective. Most of the remaining 173 non-randomised studies had a retrospective design; they were of variable size, were conducted in a range of countries, recruited a wide demographic range of participants, used a wide range of surgical techniques and used different scales used to measure outcomes. We performed quality assessment using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across the domains.In terms of freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy. We judged the evidence from the four RCTs to be of moderate to very low quality due to the lack of information reported about the randomised trial design and the restricted study populations.Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to the recording of adverse events to be very poor.In total, 118 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: an abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation or presence of postoperative discharges were prognostic factors of outcome. We observed variability between studies for many of our analyses, likely due to the small study sizes with unbalanced group sizes, variation in the definition of seizure outcome, definition of the prognostic factor and the influence of the site of surgery, all of which we observed to be related to postoperative seizure outcome. Twenty-nine studies reported multivariable models of prognostic factors and the direction of association of factors with outcome was generally the same as found in the univariate analyses. However, due to the different multivariable analysis approaches and selective reporting of results, meaningful comparison of multivariate analysis with univariate meta-analysis is difficult. AUTHORS' CONCLUSIONS The study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcome. Future research should be of high quality, have a prospective design, be appropriately powered and focus on specific issues related to diagnostic tools, the site-specific surgical approach and other issues such as the extent of resection. Prognostic factors related to the outcome of surgery should be investigated via multivariable statistical regression modelling, where variables are selected for modelling according to clinical relevance and all numerical results of the prognostic models are fully reported. Protocols should include pre- and postoperative measures of speech and language function, cognition and social functioning along with a mental state assessment. Journal editors should not accept papers where adverse events from a medical intervention are not recorded. Improvements in the development of cancer care over the past three to four decades have been achieved by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH
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Osawa SI, Iwasaki M, Suzuki H, Nakasato N, Tominaga T. Occult dual pathology in mesial temporal lobe epilepsy. Neurol Sci 2015; 36:1743-5. [PMID: 26024729 DOI: 10.1007/s10072-015-2268-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Shin-Ichiro Osawa
- Departments of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Evaluation of Posterior Hippocampal Epileptogenicity During Epilepsy Surgery For Temporal Lobe Cavernoma by the Occipital Approach. World Neurosurg 2015; 84:1494.e1-6. [PMID: 25936905 DOI: 10.1016/j.wneu.2015.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cavernomas frequently are associated with intractable epilepsy. When cavernomas located in the temporal lobe are associated with intractable epilepsy, the hippocampus also may have an epileptic focus. The objective in the present study was to clarify the importance of evaluation of the posterior hippocampal epileptogenicity during epilepsy surgery for posteromedial temporal lobe cavernoma. CASE DESCRIPTIONS In this study, we describe 2 rare cases of medically intractable epilepsy in patients with posteromedial temporal lobe cavernomas who underwent surgery via the occipital approach. Using longitudinal insertion of depth electrodes into the hippocampus, we evaluated epileptogenicity in both patients from the cavernoma cavity and its surrounding hemosiderin, as well as from the posterior hippocampus near the cavernoma. We show that the transoccipital approach to the posteromedial temporal lobe is compatible with depth electrode insertion and subdural electrode placement on the temporal lobe, enabling an accurate evaluation of potential epileptogenic zones in the posterior part of the hippocampus. Both patients did not experience any seizures and had no postoperative neurologic deficits, and their cognitive functions were intact. CONCLUSIONS The transoccipital approach enables the optimization of the extent of posterior hippocampectomy while avoiding unnecessary resection for seizure control. We suggest resecting the posterior part of the hippocampus in addition to the cavernoma and surrounding areas in patients with medically refractory epilepsy due to a posteromedial temporal cavernoma. Tailored systematic resection guided by intraoperative electrocorticography and electroencephalography with a depth electrode was important and necessary in the present cases.
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Kahane P, Barba C, Rheims S, Job-Chapron A, Minotti L, Ryvlin P. The concept of temporal ‘plus’ epilepsy. Rev Neurol (Paris) 2015; 171:267-72. [DOI: 10.1016/j.neurol.2015.01.562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/27/2015] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE The purpose of this article is to describe an MRI protocol optimized for epilepsy evaluation, common causes of epilepsy visualized on MR images of patients evaluated for medically intractable partial epilepsy, and the basic concepts of advanced imaging techniques in the evaluation of epilepsy. CONCLUSION Epilepsy is one of the most common neurologic disorders in the United States. The long-term seizure-free success of epilepsy surgery is related to the ability to define and completely resect the epileptogenic zone. Detection of structural lesions at preoperative imaging requires not only a dedicated epilepsy protocol but also meticulous examination of the images by the interpreting radiologist with particular attention to subtle abnormalities that might otherwise go unreported.
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Johnson AM, Sugo E, Barreto D, Cunningham AM, Hiew CC, Lawson JA, Somerville ER, Connolly AM, Bye AM. Clinicopathological associations in temporal lobe epilepsy patients utilising the current ILAE focal cortical dysplasia classification. Epilepsy Res 2014; 108:1345-51. [DOI: 10.1016/j.eplepsyres.2014.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 11/16/2022]
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Liu X, Yang Z, Yin Y, Deng X. Increased expression of Notch1 in temporal lobe epilepsy: animal models and clinical evidence. Neural Regen Res 2014; 9:526-33. [PMID: 25206850 PMCID: PMC4153506 DOI: 10.4103/1673-5374.130083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 11/04/2022] Open
Abstract
Temporal lobe epilepsy is associated with astrogliosis. Notch1 signaling can induce astrogliosis in glioma. However, it remains unknown whether Notch1 signaling is involved in the pathogenesis of epilepsy. This study investigated the presence of Notch1, hairy and enhancer of split-1, and glial fibrillary acidic protein in the temporal neocortex and hippocampus of lithium-pilocarpine-treated rats. The presence of Notch1 and hairy and enhancer of split-1 was also explored in brain tissues of patients with intractable temporal lobe epilepsy. Quantitative electroencephalogram analysis and behavioral observations were used as auxiliary measures. Results revealed that the presence of Notch1, hairy and enhancer of split-1, and glial fibrillary acidic protein were enhanced in status epilepticus and vehicle-treated spontaneous recurrent seizures rats, but remain unchanged in the following groups: control, absence of either status epilepticus or spontaneous recurrent seizures, and zileuton-treated spontaneous recurrent seizures. Compared with patient control cases, the presences of Notch1 and hairy and enhancer of split-1 were upregulated in the temporal neocortex of patients with intractable temporal lobe epilepsy. Therefore, these results suggest that Notch1 signaling may play an important role in the onset of temporal lobe epilepsy via astrogliosis. Furthermore, zileuton may be a potential therapeutic strategy for temporal lobe epilepsy by blocking Notch1 signaling.
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Affiliation(s)
- Xijin Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhiyong Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yaping Yin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuejun Deng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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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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Palmini A, Paglioli E, Silva VD. Developmental tumors and adjacent cortical dysplasia: single or dual pathology? Epilepsia 2014; 54 Suppl 9:18-24. [PMID: 24328867 DOI: 10.1111/epi.12438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Developmental tumors often lead to refractory partial seizures and constitute a well-defined, surgically remediable epilepsy syndrome. Dysplastic features are often associated with these tumors, and their significance carries both practical and conceptual relevance. If associated focal cortical dysplasia (FCD) relates to the extent of the epileptogenic tissue, then presurgical evaluation and surgical strategies should target both the tumor and the surrounding dyslaminated cortex. Furthermore, the association has been included in the recently revised classification of FCD and the epileptogenicity of this associated dysplastic tissue is crucial to validate such revision. In addition to the possibility of representing dual pathology, the association of developmental tumors and adjacent dysplasia may instead represent a single developmental lesion with distinct parts distributed along a histopathologic continuum. Moreover, the possibility that this adjacent dyslamination is of minor epileptogenic relevance should also be entertained. Surgical data show that complete resection of the solid tumors and immediately adjacent tissue harboring satellites may disrupt epileptogenic networks and lead to high rates of seizure freedom, challenging the epileptogenic relevance of more extensive adjacent dyslaminated cortex. Whether the latter is a primary or secondary abnormality and whether dyslaminated cortex in the context of a second lesion may produce seizures after complete resection of the main lesion is still to be proven.
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Affiliation(s)
- André Palmini
- Porto Alegre Epilepsy Surgery Program, Services of Neurology and Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil; Department ofInternal Medicine, Faculty of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Coan AC, Cendes F. Understanding the spectrum of temporal lobe epilepsy: contributions for the development of individualized therapies. Expert Rev Neurother 2014; 13:1383-94. [DOI: 10.1586/14737175.2013.857604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang J, Liu W, Chen H, Xia H, Zhou Z, Mei S, Liu Q, Li Y. Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy. NEUROIMAGE-CLINICAL 2013; 4:35-44. [PMID: 24282678 PMCID: PMC3840005 DOI: 10.1016/j.nicl.2013.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/21/2013] [Accepted: 10/25/2013] [Indexed: 01/12/2023]
Abstract
Intracranial EEG (icEEG) monitoring is critical in epilepsy surgical planning, but it has limitations. The advances of neuroimaging have made it possible to reveal epileptic abnormalities that could not be identified previously and improve the localization of the seizure focus and the vital cortex. A frequently asked question in the field is whether non-invasive neuroimaging could replace invasive icEEG or reduce the need for icEEG in presurgical evaluation. This review considers promising neuroimaging techniques in epilepsy presurgical assessment in order to address this question. In addition, due to large variations in the accuracies of neuroimaging across epilepsy centers, multicenter neuroimaging studies are reviewed, and there is much need for randomized controlled trials (RCTs) to better reveal the utility of presurgical neuroimaging. The results of multiple studies indicate that non-invasive neuroimaging could not replace invasive icEEG in surgical planning especially in non-lesional or extratemporal lobe epilepsies, but it could reduce the need for icEEG in certain cases. With technical advances, multimodal neuroimaging may play a greater role in presurgical evaluation to reduce the costs and risks of epilepsy surgery, and provide surgical options for more patients with drug-resistant epilepsy.
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Affiliation(s)
- Jing Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, PR China
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Caboclo LOSF, Neves RS, Jardim AP, Hamad APA, Centeno RS, Lancellotti CLP, Scorza CA, Cavalheiro EA, Yacubian EMT, Sakamoto AC. Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:945-52. [PMID: 23295424 DOI: 10.1590/s0004-282x2012001200009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 04/17/2012] [Indexed: 11/21/2022]
Abstract
Pathology studies in epilepsy patients bring useful information for comprehending the physiopathology of various forms of epilepsy, as well as aspects related to response to treatment and long-term prognosis. These studies are usually restricted to surgical specimens obtained from patients with refractory focal epilepsies. Therefore, most of them pertain to temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and malformations of cortical development (MCD), thus providing information of a selected group of patients and restricted regions of the brain. Postmortem whole brain studies are rarely performed in epilepsy patients, however they may provide extensive information on brain pathology, allowing the analysis of areas beyond the putative epileptogenic zone. In this article, we reviewed pathology studies performed in epilepsy patients with emphasis on neuropathological findings in TLE with MTS and MCD. Furthermore, we reviewed data from postmortem studies and discussed the importance of performing these studies in epilepsy populations.
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Bianchin MM, Velasco TR, Santos ACD, Sakamoto AC. On the relationship between neurocysticercosis and mesial temporal lobe epilepsy associated with hippocampal sclerosis: coincidence or a pathogenic relationship? Pathog Glob Health 2013; 106:280-5. [PMID: 23265552 DOI: 10.1179/2047773212y.0000000027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Neurocysticercosis (NCC) and mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) are two common worldwide forms of focal epilepsy. In regions where NCC is endemic, both diseases can be observed in the same patient. There is recent and growing evidence suggesting that NCC might contribute to or even cause MTLE-HS. In this article, we review the literature regarding NCC and temporal lobe epilepsy, specifically addressing the relationship between NCC and MTLE-HS. In addition, we review some scenarios where NCC seems to emerge as a causative agent or contributor to the development of MTLE-HS in some patients. This association is important because it may have an impact on the evaluation and treatment of a sizable proportion of patients with epilepsy. Insights from these clinical observations might also contribute to the understanding of the neurobiology of both NCC and MTLE-HS. We hope that our review might shed some light on this interesting interplay between two of the most common worldwide conditions associated with human focal epilepsy.
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Affiliation(s)
- Marino Muxfeldt Bianchin
- Basic Research and Advanced Investigations in Neurology, Division of Neurology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Bianchin MM, Velasco TR, Coimbra ER, Gargaro AC, Escorsi-Rosset SR, Wichert-Ana L, Terra VC, Alexandre V, Araujo D, dos Santos AC, Fernandes RMF, Assirati JA, Carlotti CG, Leite JP, Takayanagui OM, Markowitsch HJ, Sakamoto AC. Cognitive and surgical outcome in mesial temporal lobe epilepsy associated with hippocampal sclerosis plus neurocysticercosis: a cohort study. PLoS One 2013; 8:e60949. [PMID: 23613762 PMCID: PMC3632568 DOI: 10.1371/journal.pone.0060949] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/04/2013] [Indexed: 12/02/2022] Open
Abstract
Background Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC. Methods Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC. Findings cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R. = 1.66; 95% C.I. = 1.05–2.61; p = 0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R. = 1.16; 95% C.I. = 0.69–1.95; p = 0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R. = 2.02; 95% C.I. = 1.27–3.23; p = 0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R. = 2.50; 95% C.I. = 1.20–5.32; p = 0.012). Interpretation cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.
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Affiliation(s)
- Marino M Bianchin
- Center for Epilepsy Surgery (CIREP), Hospital das Clínicas de Ribeirão Preto, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Najm I, Jehi L, Palmini A, Gonzalez-Martinez J, Paglioli E, Bingaman W. Temporal patterns and mechanisms of epilepsy surgery failure. Epilepsia 2013; 54:772-82. [DOI: 10.1111/epi.12152] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Imad Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
| | - Lara Jehi
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
| | - Andre Palmini
- Porto Alegre Epilepsy Surgery Program; Neurology and Neurosurgery Services; Hospital São Lucas; Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS); Porto Alegre; Brazil
| | | | - Eliseu Paglioli
- Porto Alegre Epilepsy Surgery Program; Neurology and Neurosurgery Services; Hospital São Lucas; Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS); Porto Alegre; Brazil
| | - William Bingaman
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland; Ohio; U.S.A
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Schilling LP, Kieling RR, Pascoal TA, Kim HI, Lee MC, Kim YH, Paglioli E, Neto PR, Costa JC, Palmini A. Bilateral perisylvian ulegyria: An under-recognized, surgically remediable epileptic syndrome. Epilepsia 2013; 54:1360-7. [DOI: 10.1111/epi.12160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Lucas P. Schilling
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
| | - Renata R. Kieling
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
| | - Tharick A. Pascoal
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
| | - Hyoung-Ihl Kim
- Department of Medical System Engineering; Gwangju Institute of Science & Technology; Gwangju South Korea
| | - Min Cheol Lee
- Department of Pathology; Chonnam National University Medical School; Gwangju South Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine; Samsung Medical Center; Sungkyunkwan University College of Medicine; Seoul Korea
| | - Eliseu Paglioli
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
| | - Pedro R. Neto
- Department of Neurology, Neurosurgery and Psychiatry; McGill University; Montreal Quebec Canada
| | - Jaderson C. Costa
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
| | - Andre Palmini
- Porto Alegre Epilepsy Surgery Program; Hospital São Lucas; PUCRS; Porto Alegre Brazil
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Abstract
The spectrum of focal epileptogenic lesions and their clinical manifestations in children differ substantially from those seen in adults. In adults, mesial temporal sclerosis is the common lesion in surgical series; but in children, MTS is uncommon, and when it does occur, it exists frequently as dual pathology. The most common lesions in pediatric epilepsy surgery candidates are malformations of cortical development, developmental tumors, or encephalomalacia from infarction, hypoxia, trauma, or infection. Careful analysis of the lesion characteristics on brain MRI is sufficiently predictive of pathology in most cases. Histopathological evaluation remains the gold standard for diagnosis of mass lesions. The electroclinical phenotype of epilepsy in adults is largely determined by the anatomical location of the lesion and its connectivity. In children, in addition to the location of the lesion, the age at onset of the lesion and the age at onset of epilepsy have a major impact on the electroclinical phenotype. Children with congenital or early acquired lesions may manifest with generalized features on EEG and seizure semiology. Experience from various centers has demonstrated that a subset of these children benefit from epilepsy surgery despite a generalized epilepsy phenotype. All children with medically refractory epilepsy and a focal lesion should undergo evaluation for potential epilepsy surgery irrespective of the EEG findings and seizure semiology.
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Affiliation(s)
- Ahsan N V Moosa
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Vanhaesebrouck AE, Posch B, Baker S, Plessas IN, Palmer AC, Constantino-Casas F. Temporal lobe epilepsy in a cat with a pyriform lobe oligodendroglioma and hippocampal necrosis. J Feline Med Surg 2012; 14:932-7. [PMID: 22791561 PMCID: PMC11108005 DOI: 10.1177/1098612x12454419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A 14-year-old male domestic shorthair cat presented with an acute onset of aggressive behaviour, fear and hypersalivation. Neurological examination revealed bilateral mydriasis and left-sided facial twitching and hemiparesis. Magnetic resonance imaging (MRI) showed moderate bilateral symmetrical T2-hyperintensity along the entire hippocampus and bilateral asymmetric T2-hyperintensity in the pyriform lobes. Marked bilateral contrast enhancement of the hippocampus was evident on post-contrast T1-weighted images. The partial complex seizures were refractory to medical treatment and the cat was euthanased 4 days after admission. The clinical and MRI findings were consistent with feline hippocampal necrosis (FHN). On histopathology, neuronal necrosis and astrocytosis were present in the hippocampi and pyriform lobes. In addition, an oligodendroglioma was detected in the right pyriform lobe. Contrary to previous reports of FHN in which no underlying cause could be identified, we believe that in this case the seizure focus arose from a neoplastic lesion within the right pyriform lobe. This unique case report represents the so-called 'dual pathology' of temporal lobe epilepsy in humans, in which an extrahippocampal lesion within the temporal lobe results in hippocampal sclerosis.
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Kuba R, Tyrlíková I, Pažourková M, Hermanová M, Horáková I, Brázdil M, Rektor I. Grey–white matter abnormalities in temporal lobe epilepsy associated with hippocampal sclerosis: Inter-observer analysis, histopathological findings, and correlation with clinical variables. Epilepsy Res 2012; 102:78-85. [DOI: 10.1016/j.eplepsyres.2012.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/02/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
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Raghavendra S, Nooraine J, Mirsattari SM. Role of electroencephalography in presurgical evaluation of temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:204693. [PMID: 23198144 PMCID: PMC3503287 DOI: 10.1155/2012/204693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/18/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
Abstract
Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.
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Affiliation(s)
| | - Javeria Nooraine
- Department of Neurology, Vikram Hospital, Bangalore 560052, India
| | - Seyed M. Mirsattari
- Departments of Clinical Neurological Sciences, Medical Imaging, Medical Biophysics, and Psychology, University of Western Ontario, London, ON, Canada N6A 5A5
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White Matter Atrophy in Patients with Mesial Temporal Lobe Epilepsy: Voxel-Based Morphometry Analysis of T1- and T2-Weighted MR Images. Radiol Res Pract 2012; 2012:481378. [PMID: 23150823 PMCID: PMC3488412 DOI: 10.1155/2012/481378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis is highly refractory to clinical treatment. MRI voxel-based morphometry (VBM) of T1-weighted images has revealed a widespread pattern of gray matter (GM) and white matter (WM) atrophy in MTLE. Few studies have investigated the role of T2-weighted images in revealing WM atrophy using VBM. Objectives. To compare the results of WM atrophy between T1- and T2-weighted images through VBM. Methods. We selected 28 patients with left and 27 with right MTLE and 60 normal controls. We analyzed T1- and T2- weighted images with SPM8, using VBM/DARTEL algorithm to extract maps of GM and WM. The second level of SPM was used to investigate areas of WM atrophy among groups. Results. Both acquisitions showed bilateral widespread WM atrophy. T1-weighted images showed higher sensibility to detect areas of WM atrophy in both groups of MTLE. T2-weighted images also showed areas of WM atrophy in a more restricted pattern, but still bilateral and with a large area of superposition with T1-weighted images. Conclusions. In MTLE, T1-weighted images are more sensitive to detect subtle WM abnormalities using VBM, compared to T2 images, although both present a good superposition of statistical maps.
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Otte WM, Bielefeld P, Dijkhuizen RM, Braun KP. Focal neocortical epilepsy affects hippocampal volume, shape, and structural integrity: A longitudinal MRI and immunohistochemistry study in a rat model. Epilepsia 2012; 53:1264-73. [DOI: 10.1111/j.1528-1167.2012.03531.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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