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Swarup O, Waxmann A, Chu J, Vogrin S, Lai A, Laing J, Barker J, Seiderer L, Ignatiadis S, Plummer C, Carne R, Seneviratne U, Cook M, Murphy M, D'Souza W. Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery. Epilepsy Behav 2021; 123:108241. [PMID: 34450387 DOI: 10.1016/j.yebeh.2021.108241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent's Hospital, Melbourne. METHODS Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance. RESULTS Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15)was observed in 34% (16/47), while a 'better quality of life' (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom. SIGNIFICANCE Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.
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Affiliation(s)
- Oshi Swarup
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia.
| | - Alexandra Waxmann
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Jocelyn Chu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Simon Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Joshua Laing
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - James Barker
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, Victoria 3050, Australia
| | - Linda Seiderer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Sophia Ignatiadis
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Chris Plummer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Faculty of Health Arts and Design, Swinburne University of Technology, John St, Hawthorn, Victoria 3122, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Department of Neurosciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Michael Murphy
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
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Petito GT, Wharen RE, Feyissa AM, Grewal SS, Lucas JA, Tatum WO. The impact of stereotactic laser ablation at a typical epilepsy center. Epilepsy Behav 2018; 78:37-44. [PMID: 29172137 DOI: 10.1016/j.yebeh.2017.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/29/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Stereotactic laser ablation (SLA) is a novel form of epilepsy surgery for patients with drug-resistant focal epilepsy. We evaluated one hundred consecutive surgeries performed for patients with epilepsy to address the impact of SLA on our therapeutic approach, as well as patient outcomes. METHODS A retrospective, single center analysis of the last one hundred neurosurgeries for epilepsy was performed from 2013 to 2015. Demographics, surgical procedures, and postoperative measures were assessed up to 5years to compare the effect of SLA on outcome. Confidence intervals (CI) and comparative tests of proportions compared outcomes for SLA and resective surgery. Procedural categorical comparison used Chi-square and Kaplan-Meier curves. Student t-test was utilized for single variables such as age at procedure and seizure onset. RESULTS One hundred surgeries for epilepsy yielded thirty-three SLAs and twenty-one resections with a mean of 21.7-month and 21.3-month follow-up, respectively. The temporal lobe was the most common target for SLA (92.6%) and resection (75%). A discrete lesion was present on brain magnetic resonance imaging (MRI) in 27/32 (84.4%) of SLA patients compared with 7/20 (35%) of resection patients with a normal MRI. Overall, 55-60% of patients became seizure-free (SF). Four of five patients with initial failure to SLA became SF with subsequent resection surgery. Complications were more frequent with resection although SF outcomes did not differ (Chi square; p=0.79). Stereotactic laser ablation patients were older than those with resections (47.0years vs. 35.4years, p=0.001). The mean length of hospitalization prior to discharge was shorter for SLA (1.18days) compared with open resection (3.43days; SD: 3.16 days) (p=0.0002). CONCLUSION We now use SLA as a first line therapy at our center in patients with lesional temporal lobe epilepsy (TLE) before resection. Seizure-free outcome with SLA and resection was similar but with a shorter length of stay. Long-term follow-up is recommended to determine sustained SF status from SLA.
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Affiliation(s)
- Gabrielle T Petito
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Robert E Wharen
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Sanjeet S Grewal
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - John A Lucas
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Hill TC, Rubin BA, Tyagi V, Theobald J, Silverberg A, Miceli M, Dugan P, Carlson C, Doyle WK. The Value of Diagnostic Bilateral Intracranial Electroencephalography in Treatment-Resistant Focal Epilepsy. World Neurosurg 2017; 103:1-10. [PMID: 28185968 DOI: 10.1016/j.wneu.2017.01.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/21/2017] [Accepted: 01/25/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We assessed the efficacy and risks of diagnostic bilateral intracranial electroencephalography (bICEEG) in patients with treatment-resistant epilepsy (TRE) with poorly lateralized epileptogenic zone on noninvasive studies as reflected by progress to resection, Engel outcome, and complication rate. METHODS This is a retrospective chart review of 199 patients with TRE who had diagnostic bICEEG at New York University Medical Center between 1994 and 2013. Study end points were progress to resection, surgical outcome, and perioperative complications. Univariate analysis was performed with analysis of variance, t test, or Fisher exact test; multivariable analysis was performed using discriminant function analysis. RESULTS bICEEG lateralized the epileptogenic zone and the patient had resection in 60.3% of cases. The number of depth electrodes used was positively correlated with resection, and surgical complications during bICEEG negatively correlated. Vagal nerve stimulators were implanted in 58.2% of patients who did not undergo resection and 20.7% of those who did. Among the 87 patients who progressed to resection and had more than 1-year follow-up, 47.1% were seizure free compared with 12.7% of the 55 who did not. Male sex correlated with good postoperative seizure control. The most common complication was infection requiring debridement, occurring in 3.1% of admissions (9 of 290). CONCLUSIONS At our center, 60% of patients undergoing bICEEG progress to resection and 57% of these had more than 90% reduction in seizures. We conclude that bICEEG allows the benefits of epilepsy surgery to be extended to patients with poorly lateralized and localized TRE.
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Affiliation(s)
- Travis C Hill
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Benjamin A Rubin
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Vineet Tyagi
- New York University School of Medicine, New York, New York, USA
| | - Jason Theobald
- New York University School of Medicine, New York, New York, USA
| | - Alyson Silverberg
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Mary Miceli
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Patricia Dugan
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Chad Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Werner K Doyle
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
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Hotan GC, Struck AF, Bianchi MT, Eskandar EN, Cole AJ, Westover MB. Decision analysis of intracranial monitoring in non-lesional epilepsy. Seizure 2016; 40:59-70. [PMID: 27348062 PMCID: PMC4967015 DOI: 10.1016/j.seizure.2016.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Up to one third of epilepsy patients develop pharmacoresistant seizures and many benefit from resective surgery. However, patients with non-lesional focal epilepsy often require intracranial monitoring to localize the seizure focus. Intracranial monitoring carries operative morbidity risk and does not always succeed in localizing the seizures, making the benefit of this approach less certain. We performed a decision analysis comparing three strategies for patients with non-lesional focal epilepsy: (1) intracranial monitoring, (2) vagal nerve stimulator (VNS) implantation and (3) medical management to determine which strategy maximizes the expected quality-adjusted life years (QALYs) for our base cases. METHOD We constructed two base cases using parameters reported in the medical literature: (1) a young, otherwise healthy patient and (2) an elderly, otherwise healthy patient. We constructed a decision tree comprising strategies for the treatment of non-lesional epilepsy and two clinical outcomes: seizure freedom and no seizure freedom. Sensitivity analyses of probabilities at each branch were guided by data from the medical literature to define decision thresholds across plausible parameter ranges. RESULTS Intracranial monitoring maximizes the expected QALYs for both base cases. The sensitivity analyses provide estimates of the values of key variables, such as the surgical risk or the chance of localizing the focus, at which intracranial monitoring is no longer favored. CONCLUSION Intracranial monitoring is favored over VNS and medical management in young and elderly patients over a wide, clinically-relevant range of pertinent model variables such as the chance of localizing the seizure focus and the surgical morbidity rate.
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Affiliation(s)
- G C Hotan
- Massachusetts Institute of Technology Department of Brain and Cognitive Sciences, Cambridge, MA, USA
| | - A F Struck
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA.
| | - M T Bianchi
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA
| | - E N Eskandar
- Massachusetts General Hospital Department of Neurosurgery, Boston, MA, USA
| | - A J Cole
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA
| | - M B Westover
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA
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