1
|
Castro-Macías JI, San-Juan D, Anschel D, Cuellar-Figueroa VA. Electrocorticographic Patterns in Frontal Epilepsy and Long-Term Outcomes. J Clin Neurophysiol 2024:00004691-990000000-00145. [PMID: 38916879 DOI: 10.1097/wnp.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION The prognostic significance of tailored resection guided with intraoperative electrocorticography (iECoG) in frontal lobe epilepsy surgery has not been fully elucidated. OBJECTIVES To analyze influence of preresection and postresection iECoG patterns on long-term seizure control of adults with frontal lobe epilepsy undergoing epilepsy surgery. METHODS We retrospectively analyzed 27 patients undergoing epilepsy surgery from two centers with preresection and postresection iECoG and reported clinical variables, preresection and postresection iECoG patterns, and outcome using the Engel Outcome Scale. Descriptive statistics, Kaplan-Meier, the logistic regression model, and analysis of variance tests were used. RESULTS Fifteen males (55.6%), a mean and mode follow-up after surgery of 43 (range 2-117) and 19 months, respectively. At 6 months, seizure frequency outcome according to Engel Scale was I 74.1% (20/27), II 7.4% (2/27), III 3.7% (1/27), and IV 14.8% (4/27). We found that 51.9% (14/27) and 40.8% (11/27) of patients without residual epileptiform discharges in postresective iECoG become seizure-free at 6 and 12 months of follow-up, respectively, compared with other postresective iECoG patterns. CONCLUSIONS Disregarding the presence of lack of residual epileptiform discharges (interictal epileptiform discharges) after resection, Engel I outcome was seen between 74.1% and 63% at 6- and 12-month postresection follow-up, suggesting the outcome might be in relation with other factors.
Collapse
Affiliation(s)
| | - Daniel San-Juan
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, México
| | - David Anschel
- St. Charles Epilepsy/New York University Comprehensive Epilepsy Center, St. Charles Hospital, Port Jefferson, New York, U.S.A.; and
| | | |
Collapse
|
2
|
Lin F, Gao Z, Li C, Wang D, He Q, Kang D, Lin Y. Intra-operative electrocorticography results and postoperative pathological findings are associated with epileptic outcomes in patients with cerebral cavernous malformations presenting with epilepsy. Epilepsy Res 2021; 174:106672. [PMID: 34020147 DOI: 10.1016/j.eplepsyres.2021.106672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether intraoperative electrocorticography (ECoG) results and postoperative pathological findings are associated with long-term epileptic outcomes in patients with cerebral cavernous malformations (CCMs). METHODS AND MATERIALS To identify all consecutive patients with surgically treated CCM-related epilepsy (CRE) referred to our hospital, our prospectively maintained database of patients with CCM was reviewed (NCT03467295). For these patients, an ECoG-guided extended lesionectomy was performed, in which the CCM, surrounding hemosiderin, and detected epileptic foci were removed. Intraoperative ECoG results and postoperative pathological findings were documented in detail. Engel Class I was defined as a favorable outcome, while Engel Class II-IV was considered an unfavorable outcome. The patients were followed up for at least 2 years. The relationship between ECoG results, postoperative pathological findings, and epileptic outcomes was analyzed. RESULTS A total of 522 patients with CCM were reviewed, and 85 patients with epileptic CCM were enrolled in this study. At the last clinical visit, 83.5 % of the patients experienced favorable postoperative outcomes. Multivariate analysis revealed that residual epileptic waves detected by intraoperative ECoG (OR 13.64; Cl 2.13-87.11; p = 0.006) and concomitant focal cortical dysplasia (FCD) (OR 11.37; Cl 1.63-79.27; p = 0.014) were independent factors significantly correlated with long-term epileptic outcomes. Most (61; 93.8 %) of the 65 patients with CRE without FCD achieved favorable outcomes. CONCLUSION Residual epileptiform discharges after excision and concomitant FCD may be associated with poorer long-term epileptic outcomes in patients with CRE. Close follow-up and strict administration of oral antiepileptic drugs may be needed for these patients.
Collapse
Affiliation(s)
- Fuxin Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Ziwei Gao
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Chunwang Li
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Dengliang Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Qiu He
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Dezhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| | - Yuanxiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fujian Province, PR China.
| |
Collapse
|
3
|
San-Juan D, Álvarez-Perera LÁ, Dávila-Rodríguez DO, Ramos-Jiménez C, Alcocer-Barrada V, Lilia-Tena M, Anschel DJ, Cruz JP, Martínez-Juárez IE. Neurosurgical therapy for Status Epilepticus in Oligoastrocytoma Patient: A case report. World Neurosurg 2019; 124:277-281. [PMID: 30682510 DOI: 10.1016/j.wneu.2019.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Super refractory epilepticus status (SRSE) is a life-threatening neurologic emergency defined as 'status epilepticus (SE) that continues 24 hours or more after the onset of anaesthesia, including those cases in which the SE recurs on the reduction or withdrawal of anaesthesia', which occur in 10-15% of SE patients and rarely has been resolved surgically. METHODS A 20-year-old man with SRSE and a long history of left parieto-occipital oligoastrocytoma was admitted for convulsive SE that become SRSE and underwent lesionectomy guided by electrocorticography and neuro-navigation for local tumor recurrence. Histopathological diagnosis was oligoastrocytoma. RESULTS SRSE was aborted and the patient recovery fully without any functional deficits. CONCLUSIONS The lesionectomy guided by electrocorticography and neuro- navigation should be considered as a treatment option for patients with SRSE.
Collapse
Affiliation(s)
- Daniel San-Juan
- Clinical Research Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | | | | | | | - Víctor Alcocer-Barrada
- Neurosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Martha Lilia-Tena
- Pathology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - David J Anschel
- Comprehensive Epilepsy Center of Long Island, St. Charles Hospital, Port Jefferson, NY, USA
| | - Jocelyn Pérez Cruz
- Neuro-intensive care Unit. National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | |
Collapse
|