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Garvayo M, Dupont S, Frazzini V, Bielle F, Adam C, Bendary YE, Méré M, Samson S, Guesdon A, Navarro V, Mathon B. Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study. J Neurol 2024; 271:6197-6208. [PMID: 39069564 DOI: 10.1007/s00415-024-12599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients ≥ 50 years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients. METHODS We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged ≥ 50 years and compared the surgical safety and efficacy variables between this group and a control group of patients aged < 50 years through a case-control study. RESULTS Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged ≥ 50 years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7 years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p = 0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p = 0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p = 0.005). CONCLUSIONS This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged ≥ 50 years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.
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Affiliation(s)
- Marta Garvayo
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Valerio Frazzini
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Franck Bielle
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
- Department of Neuropathology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Claude Adam
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Yahia El Bendary
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Marie Méré
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Samson
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- ULR 4072 - PSITEC, University of Lille, Lille, France
- Institut Pasteur, INSERM, Institut de l'Audition, Université Paris Cité, Paris, France
| | - Alice Guesdon
- Department of Psychiatry, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Vincent Navarro
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.
- Sorbonne Université, GRC 23, Brain Machine Interface, APHP, Paris, France.
- Robotics and Surgical Innovation, Sorbonne Université GRC 33, APHP, Paris, France.
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Rácz A, Galvis-Montes DS, Borger V, Becker AJ, Pitsch J. Focused review: Clinico-neuropathological aspects of late onset epilepsies: Pathogenesis. Seizure 2024:S1059-1311(24)00182-1. [PMID: 38918105 DOI: 10.1016/j.seizure.2024.06.015] [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: 01/24/2024] [Revised: 05/21/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of the present study was to review the current knowledge on the neuropathological spectrum of late onset epilepsies. Several terms including 'neuropathology*' AND 'late onset epilepsy' (LOE) combined with distinct neuropathological diagnostic terms were used to search PubMed until November 15, 2023. We report on the relevance of definitional aspects of LOE with implications for the diagnostic spectrum of epilepsies. The neuropathological spectrum in patients with LOE is described and includes vascular lesions, low-grade neuroepithelial neoplasms and focal cortical dysplasias (FCD). Among the latter, the frequency of the FCD subtypes appears to differ between LOE patients and those with seizure onset at a younger age. Neurodegenerative neuropathological changes in the seizure foci of LOE patients require careful interdisciplinary interpretation with respect to the differential diagnosis of primary neurodegenerative changes or epilepsy-related changes. Innate and adaptive neuroinflammation represents an important cause of LOE with intriguing therapeutic options.
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Affiliation(s)
- Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Albert J Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Julika Pitsch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Vary O'Neal A, Tamani I, Mendo CW, Josephson CB, Burneo JG, Steven DA, Keezer MR. Epilepsy surgery in adults older than 50 years: A systematic review and meta-analysis. Epilepsia 2024; 65:1548-1559. [PMID: 38581402 DOI: 10.1111/epi.17972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Despite the general safety and efficacy of epilepsy surgery, there is evidence that epilepsy surgery remains underutilized. Although there are an increasing number of studies reporting epilepsy surgery in older adults, there is no consensus on whether epilepsy surgery is efficacious or safe for this population. Our objective was to systematically assess the efficacy as well as safety of resective surgery in people aged 50 years or older with drug-resistant epilepsy. METHODS We considered studies that examine the efficacy and safety of epilepsy surgery in adults aged 50 years and older. Study eligibility was limited to studies carried out after 1990, with a minimum of 10 participants and 6 months of follow-up. We searched the following databases for published studies: Ovid MEDLINE, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, and Web of Science Conference Proceedings Citation Index - Science. The risk of bias of each included study was independently assessed by two reviewers using the MINORS (Methodological Index for Non-Randomized Studies) instrument. RESULTS Eleven case series and 14 cohort studies met the criteria for inclusion, for a total of 1111 older adults who underwent epilepsy surgery along with 4111 adults younger than 50 years as control groups. The pooled cumulative incidence of older adults achieving seizure freedom after resective surgery was 70.1% (95% confidence interval [CI] = 65.3-74.7). There was no evident difference in the incidence of seizure freedom among older adults as compared to younger adults (risk ratio [RR] = 1.05, 95% CI = .97-1.14) in cohort studies. The pooled cumulative incidence of perioperative complications in older adults was 26.2% (95% CI = 21.3-31.7). Among them, 7.5% (95% CI = 5.8-9.5) experienced major complications. Older adults were significantly more at risk of experiencing any complication than younger adults (RR = 2.8, 95% CI = 1.5-5.4). SIGNIFICANCE Despite important considerations, epilepsy surgery may be considered appropriate among carefully selected individuals older than 50 years.
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Affiliation(s)
- Arielle Vary O'Neal
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
| | - Ishak Tamani
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Christian W Mendo
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- School of Public Health of the Université de Montréal, Montreal, Quebec, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary Centre for Health Informatics, Calgary, Alberta, Canada
| | - Jorge G Burneo
- Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary Centre for Health Informatics, Calgary, Alberta, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary Centre for Health Informatics, Calgary, Alberta, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark R Keezer
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
- School of Public Health of the Université de Montréal, Montreal, Quebec, Canada
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Arvaniti CK, Karagianni MD, Papageorgakopoulou MA, Brotis AG, Tasiou A, Fountas KN. The role of lobectomy in glioblastoma management: A systematic review and meta-analysis. BRAIN & SPINE 2024; 4:102823. [PMID: 39285857 PMCID: PMC11403262 DOI: 10.1016/j.bas.2024.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 09/19/2024]
Abstract
Introduction Lobectomy has recently been employed in the management of glioblastoma (GB). Compared to subtotal, gross total and supramarginal resection, lobectomy provides maximum cytoreduction and improves overall survival (OS). Research question The primary aim of this study is to compare lobectomy to other techniques for managing GB in terms of OS and progression-free survival (PFS). This study evaluated the association of the available surgical techniques for GB management with the reported relevant seizure outcome, operation time, length of stay, complication incidence, and Karnofsky performance status. Materials and methods A PRISMA-compliant systematic review and meta-analysis was performed. We searched PubMed, Scopus, and Web of Science from January 2013 until April 2023. Random-effects models were employed. The Newcastle-Ottawa scale (NOS) and the GRADE approach were used for estimating risk of bias and quality of evidence. Results We included six studies. Lobectomy demonstrated a mean OS of 25 months, compared to 13.72 months for gross total resection (GTR), and a PFS of 16.13 months, compared to 8.77 months for GTR. Comparing lobectomy to GTR, no statistically significant differences were observed regarding seizure management, length of stay, operation time, complications, and KPS due to limited amount of data. Discussion and conclusion Our analysis demonstrated that lobectomy compared to GTR has a tremendous impact on the OS and the PFS, which seems to be improved almost by a year. Lobectomy, while demanding from a technical standpoint, constitutes a safe surgical procedure but further studies should assess its exact role in the management of GB patients.
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Affiliation(s)
- Christina K Arvaniti
- Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece
| | - Maria D Karagianni
- Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece
| | | | - Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece
| | - Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, 41110, Greece
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Helmstaedter C, Tailby C, Witt JA. Neuropsychology of late-onset epilepsies. Seizure 2024:S1059-1311(24)00078-5. [PMID: 38555201 DOI: 10.1016/j.seizure.2024.03.010] [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: 01/18/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024] Open
Abstract
In an increasingly ageing society, patients ageing with epilepsy and those with late-onset epilepsies (LOE) represent a challenge for epilepsy care and treatment. Senescence itself bears risks of pathologies which in the form of acute focal damage (e.g. stroke) or slowly progressive degenerative damage can cause seizures and substantial cognitive impairment. There is converging evidence from studies in LOE that cognitive impairments are present from epilepsy onset before treatment is initiated and may even precede the emergence of seizures. This suggests that these impairments (like the seizures) are expressions of the underlying disease. Indeed, both seizures and cognitive impairments can be early indicators of disease conditions which lead to mental decline. Cognitive decline over time poses the challenge of disentangling the interrelation between seizures, treatment effects and underlying disease. This issue must be considered as some of the etiologies for causing neuropsychological decline can be addressed. Medication and active epilepsy can contribute to impairments and their impact may be reversible. Dementia is rare if seizures are what has brought the person to attention, and if this is not accompanied by other slowly developing features (such as cognitive of psychiatric changes). From a neuropsychological point of view choosing the right screening tools or assessments, obtaining the history and timeline of impairments in relation to epilepsy, and most importantly longitudinally following the patients regardless of whether epilepsy is ultimately controlled or not appear essential.
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Affiliation(s)
- C Helmstaedter
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany.
| | - C Tailby
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, 3084, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia; Department of Clinical Neuropsychology, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - J-A Witt
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
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Câmara B, Fava A, Matano F, Okano A, Ronconi D, Silva Costa B, Gadelha Figueiredo E, Chassoux F, Devaux B, Froelich S. Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 25:199-208. [PMID: 37133253 DOI: 10.1227/ons.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Transorbital endoscopic approaches have been described for pathologies of anterior and middle fossae. Standard lateral orbitotomy gives access to mesial temporal lobe, but the axis of work is partially obscured by the temporal pole and working corridor is limited. OBJECTIVE To evaluate the usefulness of an inferolateral orbitotomy to provide a more direct corridor to perform a transuncal selective amygdalohippocampectomy. METHODS Three adult cadaveric specimens were used for a total of 6 dissections. A step-by-step description and illustration of the transuncal corridor for a selective amygdalohippocampectomy were performed using the inferolateral orbitotomy through an inferior eyelid conjunctival incision. The anatomic landmarks were demonstrated in detail. Orbitotomies and angles of work were measured from computed tomography scans, and the area of resection was illustrated by postdissection MRI. RESULTS Inferior eyelid conjunctival incision was made for exposure of the inferior orbital rim. Inferolateral transorbital approach was performed to access the transuncal corridor. Endoscopic selective amygdalohippocampectomy was performed through the entorhinal cortex without damage to the temporal neocortex or Meyer's loop. The mean horizontal diameter of the osteotomy was 14.4 mm, and the vertical one was 13.6 mm. The mean angles of work were 65° and 35.5° in the axial and sagittal planes, respectively. Complete amygdalohippocampectomy was achieved in all 6 dissections. CONCLUSION Transuncal selective amygdalohippocampectomy was feasible in cadaveric specimens using the inferolateral transorbital endoscopic approach avoiding damage to the temporal neocortex and Meyer's loop. The inferior eyelid conjunctival incision may result in an excellent cosmetic outcome.
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Affiliation(s)
- Breno Câmara
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arianna Fava
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fumihiro Matano
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Atsushi Okano
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniel Ronconi
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Laboratoire de neurochirurgie expérimentale, Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Silva Costa
- Hospital Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | - Francine Chassoux
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sébastien Froelich
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Baciu M, O'Sullivan L, Torlay L, Banjac S. New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00884-6. [PMID: 37003897 DOI: 10.1016/j.neurol.2023.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.
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Affiliation(s)
- M Baciu
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L O'Sullivan
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - L Torlay
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - S Banjac
- Université Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
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Heerwig C, Möller H, Brückner K. Neuropsychology of epilepsy in old age – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Hebel JM, Holtkamp M. Epilepsy surgery in older patients – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Bottan JS, Suller Marti A, Burneo JG, Parrent AG, MacDougall KW, McLachlan RS, Mirsattari S, Diosy DC, Steven DA. Role of resective surgery in patients older than 60 years with therapy-resistant epilepsy. J Neurosurg 2022; 137:434-441. [PMID: 34920438 DOI: 10.3171/2021.9.jns211037] [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: 04/26/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy surgery for older adults is controversial owing to their longer duration of epilepsy and perceived higher surgical risk. However, because of an aging population and documented benefit of epilepsy surgery, surgery is considered more frequently for these patients. The authors' objective was to analyze the role of resective surgery in patients older than 60 years and to assess outcomes and safety. METHODS The authors conducted a retrospective analysis of 595 patients who underwent resective epilepsy surgery at their center from 1999 to 2018. Thirty-one patients aged 60 years or older were identified. Sixty patients younger than 60 years were randomly selected as controls. Population characteristics, results of presurgical evaluations, outcomes, and complications were analyzed. RESULTS No significant differences were found between the groups in terms of hemisphere dominance, side of surgery, presence of a lesion, and incidence of temporal lobe epilepsy. Epilepsy duration was greater in the older cohort (p = 0.019), and invasive EEG was more commonly employed in younger patients (p = 0.030). The rates of Engel class I outcome at 6 months, 1 year, and 2 years were 89.7%, 96.2%, and 94.7% for the older group and 75% (p = 0.159), 67.3% (p = 0.004), and 75.8% (p = 0.130) for the younger group, respectively. The proportion of seizure-free patients was greatest among those with temporal lobe epilepsy, particularly in the older group. Neurological complication rates did not differ significantly between groups, however medical and other minor complications occurred more frequently in the older group. CONCLUSIONS Patients older than 60 years had equal or better outcomes at 1 year after epilepsy surgery than younger patients. A trend toward a greater proportion of patients with lesional temporal lobe epilepsy was found in the older group. These results suggest that good seizure outcomes can be obtained in older patients despite longer duration of epilepsy.
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Affiliation(s)
- Juan S Bottan
- 1Neurosurgery Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Ana Suller Marti
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Jorge G Burneo
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
- 3Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Keith W MacDougall
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Richard S McLachlan
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Seyed Mirsattari
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - David C Diosy
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - David A Steven
- 2Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
- 3Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Medel‐Matus JS, Orozco‐Suárez S, Escalante RG. Factors not considered in the study of drug-resistant epilepsy: Psychiatric comorbidities, age, and gender. Epilepsia Open 2022; 7 Suppl 1:S81-S93. [PMID: 34967149 PMCID: PMC9340311 DOI: 10.1002/epi4.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
In basic research and clinical practice, the control of seizures has been the most important goal, but it should not be the only one. There are factors that remain poorly understood in the study of refractory epilepsy such as the age and gender of patients and the presence of psychiatric comorbidities. It is known that in patients with drug-resistant epilepsy (DRE), the comorbidities contribute to the deterioration of the quality of life, increase the severity, and worsen the prognosis of epilepsy. Some studies have demonstrated that patients diagnosed with a co-occurrence of epilepsy and psychiatric disorders are more likely to present refractory seizures and the probability of seizure remission after pharmacotherapy is reduced. The evidence of this association suggests the presence of shared pathogenic mechanisms that may include endocrine disorders, neuroinflammatory processes, disturbances of neurotransmitters, and mechanisms triggered by stress. Additionally, significant demographic, clinical, and electrographic differences have been observed between women and men with epilepsy. Epilepsy affects the female gender in a greater proportion, although there are no studies that report whether refractoriness affects more females. The reasons behind these sex differences are unclear; however, it is likely that sex hormones and sex brain differences related to chromosomal genes play an important role. On the other hand, it has been shown in industrialized countries that prevalence of DRE is higher in the elderly when compared to youngsters. Conversely, this phenomenon is not observed in developing regions, where more cases are found in children and young adults. The correct identification and management of these factors is crucial in order to improve the quality of life of the patients.
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Affiliation(s)
- Jesús Servando Medel‐Matus
- Department of PediatricsNeurology DivisionDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Sandra Orozco‐Suárez
- Unit of Medical Research in Neurological DiseasesSpecialty Hospital “Dr. Bernardo Sepúlveda”National Medical Center S.XXIMexico CityMexico
| | - Ruby G. Escalante
- Department of PediatricsNeurology DivisionDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
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Dave H, Guerra A, Rodriguez M, Podkorytova I, Lega B. Single center outcomes of intracranial evaluation and surgical intervention in the elderly population. Epilepsy Behav Rep 2022; 20:100569. [DOI: 10.1016/j.ebr.2022.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
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Thomas B, Aupy J, Penchet G, De Montaudouin M, Bartolomei F, Biraben A, Catenoix H, Chassoux F, Dupont S, Valton L, Michel V, Marchal C. Predictive factors of postoperative outcome in the elderly after resective epilepsy surgery. Rev Neurol (Paris) 2021; 178:609-615. [PMID: 34801264 DOI: 10.1016/j.neurol.2021.08.011] [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: 05/29/2021] [Revised: 07/25/2021] [Accepted: 08/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficiency of resective epilepsy surgery (RES) in patients over 50 years and determine prognostic factors. RESULTS Over the 147 patients over 50 years (54.9±3.8 years [50-69]) coming from 8 specialized French centres for epilepsy surgery, 72.1%, patients were seizure-free and 91.2% had a good outcome 12 months after RES. Seizure freedom was not associated with the age at surgery or duration of epilepsy. In multivariate analysis, seizure freedom was associated with MRI and neuropathological hippocampal sclerosis (HS) (P=0.009 and P=0.028 respectively), PET hypometabolism (P=0.013), temporal epilepsy (P=0.01). On the contrary, the need for intracranial exploration was associated with a poorer prognosis (P=0.001). Postoperative number of antiepileptic drugs was significantly lower in the seizure-free group (P=0.001). Neurological adverse event rate after surgery was 21.1% and 11.7% of patients had neuropsychological adverse effects overall transient. CONCLUSIONS RES is effective procedure in the elderly. Even safe it remains at higher risk of complication and population should be carefully selected. Nevertheless, age should not be considered as a limiting factor, especially when good prognostic factors are identified.
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Affiliation(s)
- B Thomas
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France; IMN, UMR CNRS 5293, University of Bordeaux, Bordeaux Neurocampus, Bordeaux, France.
| | - G Penchet
- Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France
| | - M De Montaudouin
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - F Bartolomei
- Clinical Neurophysiology and Epileptology Department, APHM, Timone Hospital, Marseille, France; INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France
| | - A Biraben
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - H Catenoix
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - F Chassoux
- Department of Neurosurgery, Sainte-Anne Hospital Centre, Paris, France
| | - S Dupont
- Epilepsy Unit, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - L Valton
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - V Michel
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
| | - C Marchal
- Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France
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Liu Y, Wu H, Li H, Dong S, Liu X, Li K, Du C, Meng Q, Zhang H. Severity Grading, Risk Factors, and Prediction Model of Complications After Epilepsy Surgery: A Large-Scale and Retrospective Study. Front Neurol 2021; 12:722478. [PMID: 34707556 PMCID: PMC8543040 DOI: 10.3389/fneur.2021.722478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To report complications after epilepsy surgery, grade the severity of complications, investigate risk factors, and develop a nomogram for risk prediction of complications. Methods: Patients with epilepsy surgery performed by a single surgeon at a single center between October 1, 2003 and April 30, 2019 were retrospectively analyzed. Study outcomes included severity grading of complications occurring during the 3-month period after surgery, risk factors, and a prediction model of these complications. Multivariable logistic regression analysis was used to calculate odds ratio and 95% confidence interval to identify risk factors. Results: In total, 2,026 surgical procedures were eligible. There were 380 patients with mild complications, 23 with moderate complications, and 82 with severe complications. Being male (odds ratio 1.29, 95% confidence interval 1.02–1.64), age at surgery (>40 years: 2.58, 1.55–4.31; ≤ 40: 2.25, 1.39–3.65; ≤ 30: 1.83, 1.18–2.84; ≤ 20: 1.71, 1.11–2.63), intracranial hemorrhage in infancy (2.28, 1.14–4.57), serial number of surgery ( ≤ 1,000: 1.41, 1.01–1.97; ≤ 1,500: 1.63, 1.18–2.25), type of surgical procedure (extratemporal resections: 2.04, 1.55–2.70; extratemporal plus temporal resections: 2.56, 1.80–3.65), surgery duration (>6 h: 1.94, 1.25–3.00; ≤ 6: 1.92, 1.39–2.65), and acute postoperative seizure (1.44, 1.06–1.97) were independent risk factors of complications. A nomogram including age at surgery, type of surgical procedure, and surgery duration was developed to predict the probability of complications. Conclusions: Although epilepsy surgery has a potential adverse effect on the patients, most complications are mild and severe complications are few. Risk factors should be considered during the perioperative period. Patients with the above risk factors should be closely monitored to identify and treat complications timely. The prediction model is very useful for surgeons to improve postoperative management.
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Affiliation(s)
- Yong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Huanfa Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Dong
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaofang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kuo Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Changwang Du
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Meng
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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15
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Rácz A, Menne K, Borger V, Hampel KG, Vatter H, Helmstaedter C, Elger CE, Surges R. Outcome after resective epilepsy surgery in the elderly. J Neurosurg 2021:1-10. [PMID: 34624859 DOI: 10.3171/2021.4.jns204013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to compare complications, seizures, and neuropsychological outcomes after resective epilepsy surgery in patients ≥ 60 years of age who underwent operations to younger and matched controls. METHODS Charts of 2243 patients were screened for operated patients in the authors' center between 2000 and 2015. Patients with available postsurgical follow-up data who were operated on at the age of 60 years or older and matched (by gender, histopathology, and side of surgery) controls who were between 20 and 40 years of age at the time of surgery were included. Outcomes regarding postoperative seizure control were scored according to the Engel classification and group comparisons were performed by using chi-square statistics. RESULTS Data of 20 older patients were compared to those of 60 younger controls. Postoperative seizure control was favorable in the majority of the elderly patients (Engel classes I and II: 75% at 12 months, 65% at last follow-up), but the proportion of patients with favorable outcome tended to be larger in the control group (Engel classes I and II: 90% at 12 months, p = 0.092; 87% at last follow-up, p = 0.032, chi-square test). The surgical complication rate was higher in the elderly population (65% vs 27%, p = 0.002), but relevant persistent deficits occurred in 2 patients of each group only. Neuropsychological and behavioral assessments displayed considerable preoperative impairment and additional postoperative worsening, particularly of verbal skills, memory (p < 0.05), and mood in the elderly. CONCLUSIONS The overall favorable postsurgical outcome regarding seizure control and the moderate risk of disabling persistent neurological deficits in elderly patients supports the view that advanced age should not be a barrier per se for resective epilepsy surgery and underscores the importance of an adequate presurgical evaluation and of referral of elderly patients to presurgical assessment.
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16
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Kerezoudis P, Singh R, Parisi V, Worrell GA, Miller KJ, Marsh WR, Van Gompel JJ. Outcomes of epilepsy surgery in the older population: not too old, not too late. J Neurosurg 2021:1-10. [PMID: 34624847 DOI: 10.3171/2021.5.jns204211] [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: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients. METHODS The authors' institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002-2018. Cases were grouped into 50-59, 60-69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016-2019). RESULTS A total of 73 patients (n = 16 for 50-59 years, n = 47 for 60-69, and n = 10 for 70+) were treated at the authors' institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50-59 group, 77% for the 60-69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6-114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%-72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1-3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1-0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50-59, 60-69, and 70+ years, respectively. CONCLUSIONS While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.
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Affiliation(s)
| | - Rohin Singh
- 2Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Veronica Parisi
- 3IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy; and
| | | | - Kai J Miller
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - W Richard Marsh
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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17
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Zhao Y, Zhang C, Yang H, Liu C, Yu T, Lu J, Chen N, Li K. Recovery of cortical atrophy in patients with temporal lobe epilepsy after successful anterior temporal lobectomy. Epilepsy Behav 2021; 123:108272. [PMID: 34500432 DOI: 10.1016/j.yebeh.2021.108272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
The aims of this study were to investigate whether the cortical atrophy caused by temporal lobe epilepsy (TLE) was reversible after successful anterior temporal lobectomy (ATL) and to further observe whether possible changes are related to age at surgery and cognitive changes. Twelve patients with unilateral mesial TLE who received ATL and remained seizure free in one year follow-up were included. They underwent two MRI scans few days before and oneyear after surgery. Thirty age- and sex-matched healthy participants were recruited as controls. Group comparisons were used to test the differences in cortical thickness (CTh) between the pre-/postsurgical patients and controls. Longitudinal test was used to directly show postsurgical changes of the patients. Besides, the correlations between regional cortical volume (CVo) changes and age at surgery or cognitive changes were also tested. Compared with controls, the patients with TLE showed dispersed cortical thinning especially in the bilateral frontal lobes before surgery and no significant cortical thinning except for cortices near the resected areas after surgery. The longitudinal analysis showed CTh increment in the ipsilateral precentral and postcentral gyrus, cuneus and widespread in the contralateral cortex. In the volumetric analysis, the CVo changes in the contralateral hemisphere were negatively correlated with age at surgery and positively correlated with MoCA score changes. This study suggests that the cortical atrophy caused by TLE could recover after successful ATL. The recovery ability is greater in younger subjects and is positively related to cognitive recovery. These findings could serve as new clues that patients with TLE can benefit from timely and successful ATL.
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Affiliation(s)
- Yongxiang Zhao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China
| | - Chao Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China; Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221006, PR China
| | - Hongyu Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing 101100, PR China
| | - Chang Liu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Tao Yu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China
| | - Nan Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China.
| | - Kuncheng Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, PR China.
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18
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Bjellvi J, Cross JH, Gogou M, Leclercq M, Rheims S, Ryvlin P, Sperling MR, Rydenhag B, Malmgren K. Classification of complications of epilepsy surgery and invasive diagnostic procedures: A proposed protocol and feasibility study. Epilepsia 2021; 62:2685-2696. [PMID: 34405890 DOI: 10.1111/epi.17040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In epilepsy surgery, which aims to treat seizures and thereby to improve the lives of persons with drug-resistant epilepsy, the chances of attaining seizure relief must be carefully weighed against the risks of complications and expected adverse events. The interpretation of data regarding complications of epilepsy surgery and invasive diagnostic procedures is hampered by a lack of uniform definitions and method of data collection. METHODS Based on a review of previous definitions and classifications of complications, we developed a proposal for a new classification. This proposal was then subject to revisions after expert opinion within E-pilepsy, an EU-funded European pilot network of reference centers in refractory epilepsy and epilepsy surgery, later incorporated into the ERN (European Reference Network) EpiCARE. This version was discussed with recognized experts, and a final protocol was agreed to after further revision. The final protocol was evaluated in practical use over 1 year in three of the participating centers. One hundred seventy-four consecutive procedures were included with 35 reported complications. RESULTS This report presents a multidimensional classification of complications in epilepsy surgery and invasive diagnostic procedures, where complications are characterized in terms of their immediate effects, resulting permanent symptoms, and consequences on activities of daily living. SIGNIFICANCE We propose that the protocol will be helpful in the work to promote safety in epilepsy surgery and for future studies designed to identify risk factors for complications. Further work is needed to address the reporting of outcomes as regards neuropsychological function, activities of daily living, and quality of life.
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Affiliation(s)
- Johan Bjellvi
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - J Helen Cross
- UCL-NIHR BRC Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK.,Young Epilepsy, Lingfield, UK
| | - Maria Gogou
- Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK
| | - Mathilde Leclercq
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Member of the ERN EpiCARE, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Member of the ERN EpiCARE, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
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Vakharia VN, Vos SB, Winston GP, Gutman MJ, Wykes V, McEvoy AW, Miserocchi A, Sparks R, Ourselin S, Duncan JS. Intraoperative overlay of optic radiation tractography during anteromesial temporal resection: a prospective validation study. J Neurosurg 2021; 136:543-552. [PMID: 34330090 DOI: 10.3171/2020.12.jns203437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anteromesial temporal lobe resection (ATLR) results in long-term seizure freedom in patients with drug-resistant focal mesial temporal lobe epilepsy (MTLE). There is significant anatomical variation in the anterior projection of the optic radiation (OR), known as Meyer's loop, between individuals and between hemispheres in the same individual. Damage to the OR results in contralateral superior temporal quadrantanopia that may preclude driving in 33%-66% of patients who achieve seizure freedom. Tractography of the OR has been shown to prevent visual field deficit (VFD) when surgery is performed in an interventional MRI (iMRI) suite. Because access to iMRI is limited at most centers, the authors investigated whether use of a neuronavigation system with a microscope overlay in a conventional theater is sufficient to prevent significant VFD during ATLR. METHODS Twenty patients with drug-resistant MTLE who underwent ATLR (9 underwent right-side ATLR, and 9 were male) were recruited to participate in this single-center prospective cohort study. Tractography of the OR was performed with preoperative 3-T multishell diffusion data that were overlaid onto the surgical field by using a conventional neuronavigation system linked to a surgical microscope. Phantom testing confirmed overlay projection errors of < 1 mm. VFD was quantified preoperatively and 3 to 12 months postoperatively by using Humphrey and Esterman perimetry. RESULTS Perimetry results were available for all patients postoperatively, but for only 11/20 (55%) patients preoperatively. In 1/20 (5%) patients, a significant VFD occurred that would prevent driving in the UK on the basis of the results on Esterman perimetry. The VFD was identified early in the series, despite the surgical approach not transgressing OR tractography, and was subsequently found to be due to retraction injury. Tractography was also used from this point onward to inform retractor placement, and no further significant VFDs occurred. CONCLUSIONS Use of OR tractography with overlay outside of an iMRI suite, with application of an appropriate error margin, can be used during approach to the temporal horn of the lateral ventricle and carries a 5% risk of VFD that is significant enough to preclude driving postoperatively. OR tractography can also be used to inform retractor placement. These results warrant a larger prospective comparative study of the use of OR tractography-guided mesial temporal resection.
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Affiliation(s)
- Vejay N Vakharia
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Sjoerd B Vos
- 3Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Gavin P Winston
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London.,4Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | | | - Victoria Wykes
- 6Institute of Cancer and Genomic Sciences, University of Birmingham.,7Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham; and
| | - Andrew W McEvoy
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Anna Miserocchi
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Rachel Sparks
- 8School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, United Kingdom
| | - Sebastien Ourselin
- 8School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, United Kingdom
| | - John S Duncan
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
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20
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Tyrlíková I, Hummelová Z, Goldemundová S, Koriťáková E, Nečasová T, Tyrlík M, Brázdil M, Chrastina J, Hemza J, Rektor I. Memory outcomes of temporal lobe surgery in adults aged over 45 years. Acta Neurol Scand 2021; 144:81-91. [PMID: 33881170 DOI: 10.1111/ane.13427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE It is assumed that temporal lobe resection in older people is associated with worse seizure outcomes and potential postsurgical memory decline. We studied postsurgical memory development and surgical efficacy in patients over 45 years of age compared with younger patients. METHODS We studied 88 patients (51 male and 37 female) after temporal lobe surgery, which involved hippocampal resection. The patients were evaluated before surgery and in the first (72 patients) and/or third (57 patients) postsurgical year. The Wechsler Memory Scale III test was performed to evaluate the MQ postsurgical development. Engel's classification was used to evaluate the postsurgical seizure outcome. RESULTS The presurgical MQ (median 88) in ≥45 years age group was significantly lower than in both younger groups (median MQ = 100 for ≤30 years age group, p = 0.002; median MQ = 107 for 31-44 years age group, p = 0.002). Three years after the surgery, the MQ decreased significantly in ≤30 years age group (p = 0.012), while only non-significant MQ decline was observed in both older groups. We found no significant impact of age on the surgical outcome. CONCLUSION Higher age at the time of surgery does not significantly increase the risk for postsurgical memory decline; however, older patients are more likely to have lowered presurgical MQ. We did not find significant differences in the impact of surgery on seizure outcome among the age groups. Epilepsy surgery appears to be a safe and effective method in the age over 45 years even though an earlier surgery should be preferred.
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Affiliation(s)
- Ivana Tyrlíková
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
- Mid‐Atlantic Epilepsy and Sleep Center Bethesda MD USA
| | - Zuzana Hummelová
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
| | - Sabina Goldemundová
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
| | - Eva Koriťáková
- Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
| | - Tereza Nečasová
- Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
| | - Mojmír Tyrlík
- Department of Psychological and Brain Sciences Columbian College of Arts and Sciences The George Washington University Washington DC USA
| | - Milan Brázdil
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
- Centre of Neuroscience Central European Institute of Technology (CEITEC) Masaryk University Brno Czech Republic
| | - Jan Chrastina
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
| | - Jan Hemza
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
| | - Ivan Rektor
- First Department of Neurology and Department of Neurosurgery Brno Epilepsy Center St. Anne's Hospital and School of Medicine Brno Czech Republic
- Centre of Neuroscience Central European Institute of Technology (CEITEC) Masaryk University Brno Czech Republic
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Resective epilepsy surgery in patients aged 50years and older - a retrospective study regarding seizure outcome, memory performance, and psychopathology. Epilepsy Behav 2021; 118:107933. [PMID: 33839451 DOI: 10.1016/j.yebeh.2021.107933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess clinical and demographic characteristics in two cohorts of elderly patients with drug-resistant focal epilepsy, undergoing resective epilepsy surgery (RES). Further, to determine seizure, neuropsychological, and mental health outcomes after RES and evaluate possible influencing factors. METHODS Consecutive patients aged ≥50 years with temporal lobe epilepsy (TLE) who underwent curative RES in the Hamburg epilepsy surgery program (2004-2017) were identified. Data were retrospectively analyzed. Seizure outcome was classified according to ILAE and Engel outcome scales in patients with first-time surgeries and with reoperations. Previously reported predictors of the seizure outcome were evaluated using regression analyses. Changes in verbal memory were assessed for patients with complete pre- and postoperative datasets (n=30) using repeated-measures analysis of variance. For evaluation of possible predictors of psychopathologic changes after RES a regression analysis was conducted. RESULTS Fifty-one elderly patients underwent RES of the temporal lobe, including twelve aged ≥60 years, and five with reoperations. After one year, 65% of the patients with first-time surgeries were seizure free and 91% had a favorable outcome. At last follow-up, 49% were seizure free since surgery. Three reoperated patients had an Engel I outcome. Seizure outcome was not dependent on age at surgery, duration of epilepsy, or other evaluated variables. There was no significant decline in the memory performance after surgery. Significant improvements in mental health were found. CONCLUSION RES for drug-resistant TLE is safe, effective, and improves mental health also in patients aged ≥ 50 years. Thus, it should be evaluated as the treatment of choice also in this age group.
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Temporal Artery and Temporal Region Supplied by the Middle Cerebral Artery: An Anatomical Study. J Craniofac Surg 2021; 32:2873-2877. [PMID: 33710055 DOI: 10.1097/scs.0000000000007612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study was conducted to describe in detail the branching patterns of cortical branches from the middle cerebral artery supplying the feeding of the temporal region, to define the arterial structure of temporal artery (TA) and to determine the effect of this arterial supply to the temporal region. The arteries of brains (n = 22; 44 hemispheres) were prepared for dissection after filling them with colored latex. TA was defined, and its classification was described, specifying its relationship with other cortical branches. A new classification was defined related to TA terminology. TA was found in 95% of cadavers, and it originated as an early branch in 75% and from the inferior trunk in 24% of cadavers. TA was classified as Type 0: No TA, Type I: single branch providing two cortical branches, Type II: single branch providing three or more cortical branches and Type III: double TA. Type I-TA (45%) was the most common, and Type II-TA arterial diameter was significantly larger than that of other types. All cadavers showed the cortical branches of temporal region from middle cerebral artery, anterior TA , middle TA, posterior TA and temporooccipital artery, except temporopolar artery (81%). Temporopolar artery, anterior TA, and middle TA primarily originated from TA, an early branch, but posterior TA and temporooccipital artery primarily originated from the inferior trunk. Detailed knowledge about cortical branches together with TA and also this region's blood supply would enable increased prediction of complications, especially in cases with these region-related pathologies, and would make interventions safer.
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Borger V, Schneider M, Taube J, Potthoff AL, Keil VC, Hamed M, Aydin G, Ilic I, Solymosi L, Elger CE, Güresir E, Fimmers R, Schuss P, Helmstaedter C, Surges R, Vatter H. Resection of piriform cortex predicts seizure freedom in temporal lobe epilepsy. Ann Clin Transl Neurol 2020; 8:177-189. [PMID: 33263942 PMCID: PMC7818082 DOI: 10.1002/acn3.51263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022] Open
Abstract
Objective Transsylvian selective amygdalo‐hippocampectomy (tsSAHE) represents a generally recognized surgical procedure for drug‐resistant mesial temporal lobe epilepsy (mTLE). Although postoperative seizure freedom can be achieved in about 70% of tsSAHE, there is a considerable amount of patients with persisting postoperative seizures. This might partly be explained by differing extents of resection of various tsSAHE target volumes. In this study we analyzed the resected proportions of hippocampus, amygdala as well as piriform cortex in regard of postoperative seizure outcome. Methods Between 2012 and 2017, 82 of 103 patients with mTLE who underwent tsSAHE at the authors’ institution were included in the analysis. Resected proportions of hippocampus, amygdala and temporal piriform cortex as target structures of tsSAHE were volumetrically assessed and stratified according to favorable (International League Against Epilepsy (ILAE) class 1) and unfavorable (ILAE class 2–6) seizure outcome. Results Patients with favorable seizure outcome revealed a significantly larger proportion of resected temporal piriform cortex volumes compared to patients with unfavorable seizure outcome (median resected proportional volumes were 51% (IQR 42–61) versus (vs.) 13 (IQR 11–18), P = 0.0001). Resected proportions of hippocampus and amygdala did not significantly differ for these groups (hippocampus: 81% (IQR 73–88) vs. 80% (IQR 74–92) (P = 0.7); amygdala: 100% (IQR 100–100) vs. 100% (IQR 100–100) (P = 0.7)). Interpretation These results strongly suggest temporal piriform cortex to constitute a key target resection volume to achieve seizure freedom following tsSAHE.
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Affiliation(s)
- Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Julia Taube
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Vera C Keil
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Gülsah Aydin
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Quality of life in elderly patients after surgery for drug-resistant epilepsy - The impact of seizure outcome, neurological deficits and anxiety. Epilepsy Behav 2020; 112:107410. [PMID: 32956942 DOI: 10.1016/j.yebeh.2020.107410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Health related quality of life (HRQoL) has become a pivotal outcome parameter after surgery for drug-resistant epilepsy. The aim of the study was to investigate HRQoL and its relationship to seizure outcome, neurological deficits and anxiety after epilepsy surgery in a specific subpopulation of elderly patients. METHODS A total of 85 elderly patients (older than 50 years) answered a standardized HRQoL questionnaire one year after epilepsy surgery. The questionnaire addressed the present self-assessed HRQoL in four subdomains (physical function, cognitive function, mood, social interaction). The questionnaire was based on the "Epilepsy Surgery Inventory-55", adapted for use in German speaking patients and validated by the QOLIE -10 and Beck Depression Inventory. RESULTS A total of 51 patients (60%) were completely seizure free (ILAE1) at last available outcome (LAO). Permanent neurological deficits were observed in 8 patients (7%). Correlation analysis confirmed significant association between seizure outcome and overall HRQoL (r = -0.368, p < .001). New permanent neurological deficits showed impact on both HRQoL and the "cognitive function" subdomain. Anxiety and subjective assessment of postoperative status were strongly correlated with overall HRQoL (r = 0.692, p < .001 and r = 0.591, p < .001 respectively) and remained as independent prognostic factors in a multivariate regression analysis. CONCLUSION Surgery for drug-resistant epilepsy in elderly improves patients' HRQoL. Both seizure freedom and new neurological deficits influence overall HRQoL. Interestingly, anxiety and patients' subjective assessment of postoperative status showed the highest impact on HRQoL in this subpopulation of epilepsy patients.
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Gómez-Ibáñez A, Garcés-Sánchez M, Hampel KG, Cano-López I, Conde-Sardón R, Gutiérrez-Martín A, Villanueva-Haba V. Epilepsy surgery beyond 50 years: Long-term seizure and cognitive outcomes. J Neurol Sci 2020; 414:116872. [DOI: 10.1016/j.jns.2020.116872] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
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Delev D, Taube J, Helmstaedter C, Hakvoort K, Grote A, Clusmann H, von Lehe M. Surgery for temporal lobe epilepsy in the elderly: Improving quality of life despite cognitive impairment. Seizure 2020; 79:112-119. [PMID: 32464533 DOI: 10.1016/j.seizure.2020.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Temporal lobe epilepsy (TLE) surgery is still underutilized, especially in the elderly population because of concerns related to postoperative complication rate and cognitive deterioration. The aim of the study was to evaluate surgical data, quality of life and neuropsychological outcome in elderly patients, who underwent resective surgery for drug resistant TLE. METHODS AND MATERIALS All patients underwent standardized presurgical assessment including clinical, neuroradiological, neuropsychological, and EEG examination. Elderly were considered all patients being 50 years or above (mean 56 yr., range 50-71 yr.). Neuropsychology was assessed before and after surgery, health-related quality of life (HRQOL) only after surgery. RESULTS A total of 94 consecutive elderly patients were analyzed. Temporo-mesial resections were performed in 85 patients (90 %). Seizure outcome was available in all patients with a mean follow-up of 5.2 years (1.2-19 ± 3.75 years). 57 patients (60.6 %) were completely seizure free (ILAE 1). The overall morbidity was 10 % including 5 surgical complications and 5 permanent neurological deficits. Neuropsychological assessments in 60 patients showed considerable preoperative impairment, losses in different domains in 25-45 % and gains in about 25 % of the patients. Postoperative HRQOL data was available in 75 patients, revealing significant increase of HRQOL in all domains. Complete seizure freedom was the strongest predictor for postoperative HRQOL (p < 0.001). CONCLUSION Surgery for drug resistant temporal lobe epilepsy is a feasible option for elderly patients as seizure control rates are comparable to the younger population. The acceptable rate of permanent neurological deficits and relevant improvements in quality of life, despite considerable postoperative cognitive impairment, justify surgical resection in properly selected elderly patients.
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Affiliation(s)
- Daniel Delev
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
| | - Julia Taube
- Dept. of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | | | - Karlijn Hakvoort
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Alexander Grote
- Clinic for Neurosurgery, Evangelic Hospital of Bethel, Bielefeld, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Marec von Lehe
- Department of Neurosurgery, Ruppiner Kliniken, Brandenburg Medical School, Neuruppin, Germany; Medical Faculty, University of Bonn Medical Center, Bonn, Germany
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Epilepsy and aging. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753149 DOI: 10.1016/b978-0-12-804766-8.00025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The intersection of epilepsy and aging has broad, significant implications. Substantial increases in seizures occur both in the elderly population, who are at a higher risk of developing new-onset epilepsy, and in those with chronic epilepsy who become aged. There are notable gaps in our understanding of aging and epilepsy at the basic and practical levels, which have important consequences. We are in the early stages of understanding the complex relationships between epilepsy and other age-related brain diseases such as stroke, dementia, traumatic brain injury (TBI), and cancer. Furthermore, the clinician must recognize that the presentation and treatment of epilepsy in the elderly are different from those of younger populations. Given the developing awareness of the problem and the capabilities of contemporary, multidisciplinary approaches to advance understanding about the biology of aging and epilepsy, it is reasonable to expect that we will unravel some of the intricacies of epilepsy in the elderly; it is also reasonable to expect that these gains will lead to further improvements in our understanding and treatment of epilepsy for all age groups.
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He X, Zhou J, Guan Y, Zhai F, Li T, Luan G. Prognostic factors of postoperative seizure outcomes in older patients with temporal lobe epilepsy. Neurosurg Focus 2020; 48:E7. [PMID: 32234988 DOI: 10.3171/2020.1.focus19796] [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: 10/08/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors of this study aimed to investigate surgical outcomes and prognostic factors in older patients with drug-resistant temporal lobe epilepsy (TLE) who had undergone resective surgery. METHODS Data on patients older than 45 years of age with drug-resistant TLE who had undergone resective surgery at Sanbo Brain Hospital, Capital Medical University, between January 2009 and August 2017 were retrospectively collected. Postoperative seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. Patients belonging to ILAE classes 1 and 2 were classified as having a favorable outcome, whereas patients belonging to ILAE classes 3-6 were classified as having an unfavorable outcome. Univariate analysis and multivariate logistic regression analysis were used to identify the potential predictors of seizure outcomes. RESULTS A total of 45 patients older than 45 years of age who had undergone resective epilepsy surgery for TLE were included in the present study. Eight (17.8%) of 45 patients had preoperative comorbidity in addition to seizures. The average age at the time of surgery was 51.76 years, and the average duration of epilepsy at the time surgery was 18.01 years. After an average follow-up period of 4.53 ± 2.82 years (range 2-10 years), 73.3% (33/45) of patients were seizure free. Surgical complications were observed in 13.3% of patients. Univariate and multivariate analyses revealed that an MRI-negative finding is the only independent predictor of unfavorable seizure outcomes (OR 0.06, 95% CI 0.01-0.67, p = 0.023). CONCLUSIONS Resective surgery is a safe and effective treatment for older patients with drug-resistant TLE. An MRI-negative finding independently predicts unfavorable seizure outcomes.
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Affiliation(s)
- Xinghui He
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,2Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; and
| | - Jian Zhou
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,2Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; and
| | - Yuguang Guan
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,2Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; and
| | - Feng Zhai
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,2Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; and
| | - Tianfu Li
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,3Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China
| | - Guoming Luan
- 1Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University.,2Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; and.,3Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China
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Ichikawa N, Fujimoto A, Okanishi T, Sato K, Enoki H. Efficacy and Safety of Epilepsy Surgery for Older Adult Patients with Refractory Epilepsy. Ther Clin Risk Manag 2020; 16:195-199. [PMID: 32273711 PMCID: PMC7104207 DOI: 10.2147/tcrm.s250178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/14/2020] [Indexed: 01/28/2023] Open
Abstract
Purpose The population of elderly patients with epilepsy has been growing rapidly and the chances of referring older patients with refractory epilepsy for surgical options could be increasing. In general, epilepsy surgery at higher ages has been less likely to be performed, because little is known regarding the risks and benefits in elderly patients. We, therefore, investigated surgical outcomes and comorbidities in a population ≥50 years old who underwent epilepsy surgery. Methods Patients ≥50 years old who underwent epilepsy surgery were identified from the database of our epilepsy center for the period from 2009 to 2017. Surgical complications and seizure outcome were reviewed, and seizure outcomes were evaluated using the International League Against Epilepsy (ILAE) surgery outcome scale. Results The mean age of 32 patients at the time of surgery was 56.1±5.1 years. The mean duration of epilepsy was 23.4±18.5 years and mean follow-up was 2.7±2.0 years. As of the most recent visit, 56.3% of patients remained completely seizure-free (ILAE Class I). The surgery-related complication rate was 11.5%, comprising permanent deficits in 3.8% and transient deficits in 7.7%. Conclusion These results suggest that epilepsy surgery may represent a valuable approach in selected adult patients.
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Affiliation(s)
- Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, 430-8558, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, 430-8558, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, 430-8558, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, 430-8558, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, 430-8558, Japan
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Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet 2020; 395:735-748. [PMID: 32113502 DOI: 10.1016/s0140-6736(19)33064-8] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Masud Husain
- Department of Psychology, University of Oxford, Oxford UK
| | - Josemir W Sander
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Seizures and Epilepsy in the Elderly: Diagnostic and Treatment Considerations. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00310-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Epilepsy in the elderly: Unique challenges in an increasingly prevalent population. Epilepsy Behav 2020; 102:106724. [PMID: 31816480 DOI: 10.1016/j.yebeh.2019.106724] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022]
Abstract
Elderly individuals (aged at least 60 or 65 years) represent a rapidly growing segment of the population. The incidence and prevalence of epilepsy is higher in this age group than in any other. Diagnosing epilepsy in the elderly can be challenging because the causes and clinical manifestations of seizures often differ as compared with younger individuals. Particular differential diagnoses, such as syncope and amyloid spells, are commonly encountered in the elderly population. A diagnosis of epilepsy has important implications in the older adult, many of which already present a variety of concomitant complex medical problems, such as cognitive impairment, comorbid cerebrovascular disease, and frailty. The treatment of epilepsy in the elderly is complicated by a variety of factors related to aging, including physiological changes, medical comorbidities, and polypharmacy. In this narrative review, we will address the descriptive epidemiology, clinical presentation, differential diagnosis, diagnostic evaluation, treatment, and prognosis of epilepsy in the elderly individual.
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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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Mandalaywala MD, Crawford KM, Pinto SM. Management of Traumatic Brain Injury: Special Considerations for Older Adults. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Brotis A, Giannis T, Kapsalaki E, Dardiotis E, Fountas K. Complications after Anterior Temporal Lobectomy for Medically Intractable Epilepsy: A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2019; 97:69-82. [DOI: 10.1159/000500136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
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Aversi-Ferreira TA, Tamaishi-Watanabe BH, Magri MPDF, Aversi-Ferreira RA. Neuropsychology of the temporal lobe: Luria's and contemporary conceptions. Dement Neuropsychol 2019; 13:251-258. [PMID: 31555397 PMCID: PMC6753908 DOI: 10.1590/1980-57642018dn13-030001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022] Open
Abstract
Brain lesion studies currently employ techniques such as computed tomography, functional magnetic resonance imaging, single photon emission tomography and positron emission tomography. Famous neuropsychologist Alexander Romanovich Luria's studies on cognition were conducted without the use of imaging technology for many years, in a large number of patients with brain lesions, and explored complex behavior and specific brain functions involving the lobes and subareas. For instance, he carried out several specific studies on memory and mental organization, reported in his books. The objective of this study is to associate recent studies in neuropsychology with Luria's work specifically on the temporal lobe. According to the data studied, Luria's epistemological foundation remains the basis for neuropsychological studies today, but new data on the temporal lobe in relation to epilepsy and hippocampus analysis have been introduced into the scope of neuropsychology. This study focuses on earlier data from Luria's studies on the neuropsychological functions of the temporal lobe, comparing these with more recent data. However, in order to improve clinical aspects, a detailed study on the neuropsychological tests used for the temporal lobe should be performed.
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Affiliation(s)
- Tales Alexandre Aversi-Ferreira
- Federal University of AlfenasInstitute of Biomedical SciencesDepartment of AnatomyAlfenasMGBrazilLaboratory of Biomathematics and Physical Anthropology, Department of Anatomy, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
| | - Bruno Hideki Tamaishi-Watanabe
- Federal University of AlfenasInstitute of Biomedical SciencesDepartment of AnatomyAlfenasMGBrazilLaboratory of Biomathematics and Physical Anthropology, Department of Anatomy, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
| | - Micheli Patrícia de Fátima Magri
- Federal University of AlfenasInstitute of Biomedical SciencesDepartment of AnatomyAlfenasMGBrazilLaboratory of Biomathematics and Physical Anthropology, Department of Anatomy, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
- Universidade PaulistaDepartment of HealthNursing SchoolSão José do Rio PardoSPBrazilNursing School, Department of Health, Universidade Paulista, São José do Rio Pardo, SP, Brazil.
| | - Roqueline A.G.M.F. Aversi-Ferreira
- Federal University of AlfenasInstitute of Biomedical SciencesDepartment of AnatomyAlfenasMGBrazilLaboratory of Biomathematics and Physical Anthropology, Department of Anatomy, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
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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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Tayebi Meybodi A, Benet A, Griswold D, Dones F, Preul MC, Lawton MT. Anatomical Assessment of the Temporopolar Artery for Revascularization of Deep Recipients. Oper Neurosurg (Hagerstown) 2019; 16:335-344. [PMID: 29850897 DOI: 10.1093/ons/opy115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intracranial-intracranial and extracranial-intracranial bypass options for revascularization of deep cerebral recipients are limited and technically demanding. OBJECTIVE To assess the anatomical feasibility of using the temporopolar artery (TPA) for revascularization of the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and superior cerebellar arteries (SCA). METHODS Orbitozygomatic craniotomy was performed bilaterally on 8 cadaveric heads. The cisternal segment of the TPA was dissected. The TPA was cut at M3-M4 junction with its proximal and distal calibers and the length of the cisternal segment measured. Feasibility of the TPA-A1-ACA, TPA-A2-ACA, TPA-SCA, and TPA-PCA bypasses were assessed. RESULTS A total of 17 TPAs were identified in 16 specimens. The average distal TPA caliber was 1.0 ± 0.2 mm, and the average cisternal length was 37.5 ± 9.4 mm. TPA caliber was ≥ 1.0 mm in 12 specimens (70%). The TPA-A1-ACA bypass was feasible in all specimens, whereas the TPA reached the A2-ACA, SCA, and PCA in 94% of specimens (16/17). At the point of anastomosis, the average recipient caliber was 2.5 ± 0.5 mm for A1-ACA, and 2.3 ± 0.7 mm for A2-ACA. The calibers of the SCA and PCA at the anastomosis points were 2.0 ± 0.6 mm, and 2.7 ± 0.8 mm, respectively. CONCLUSION The TPA-ACA, TPA-PCA, and TPA-SCA bypasses are anatomically feasible and may be used when the distal caliber of the TPA stump is optimal to provide adequate blood flow. This study lays foundations for clinical use of the TPA for ACA revascularization in well-selected cases.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Dylan Griswold
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco
| | - Flavia Dones
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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O'Dwyer R, Byrne R, Lynn F, Nazari P, Stoub T, Smith MC, Sani S. Age is but a number when considering epilepsy surgery in older adults. Epilepsy Behav 2019; 91:9-12. [PMID: 29997038 DOI: 10.1016/j.yebeh.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND A quarter of patients with newly diagnosed epilepsy are older, yet they are less likely to be offered resective surgery potentially because of clinical bias that they incur increased surgical risks. There are few peer-reviewed case series that address this cohort and their outcomes. OBJECTIVE In the context of current literature, the objective of this study was to report on all epilepsy surgeries in patients aged 50 years or older from a tertiary care center over 15 years with an average follow-up period of 6 years. METHODS Patients with epilepsy who underwent surgery between 2001 and 2016 were reviewed retrospectively. Inclusion criteria were age > 50 at surgery, availability of presurgical evaluation data, and minimum one year of follow-up data. We identified 34 patients. Seizure outcome was evaluated using the Engel classification system. RESULTS Thirty-four patients aged 50 years and older out of 276 underwent epilepsy surgery. Average age at time of surgery was 55 years, and average duration of epilepsy was 30 years. Average length of follow-up was 6 years (1-15 years). Twenty-two out of 34 patients (64%) were seizure-free (Engel class I) at their last follow-up visit. Patients with lesional pathology on neuroimaging were more likely to achieve seizure freedom (p < 0.02). Parameters associated with poorer outcome included extratemporal epileptogenic focus (p = 0.07) and bitemporal interictal epileptiform activity (p = 0.003). CONCLUSION Our study cohort is one of the largest and most representative outcome studies of this age group, following the cohort for 6 years. Our findings demonstrated that when considering epilepsy surgery in an older adult, their age should not play a determining role in the decision-a finding that is more common in modern literature.
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Affiliation(s)
- Rebecca O'Dwyer
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA.
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Fiona Lynn
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Pouya Nazari
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Travis Stoub
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Smith
- Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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d'Orio P, Rizzi M, Mariani V, Pelliccia V, Lo Russo G, Cardinale F, Nichelatti M, Nobili L, Cossu M. Surgery in patients with childhood-onset epilepsy: analysis of complications and predictive risk factors for a severely complicated course. J Neurol Neurosurg Psychiatry 2019; 90:84-89. [PMID: 30100551 DOI: 10.1136/jnnp-2018-318282] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/12/2018] [Accepted: 07/15/2018] [Indexed: 11/03/2022]
Abstract
OBJECT To compare the occurrence of surgery-related complications in patients with childhood-onset focal epilepsy operated on in the paediatric or in the adult age. To investigate risk factors for surgery-related complications in the whole cohort, with special attention to age at surgery and severe morbidity. METHODS A cohort of 1282 patients operated on for childhood-onset focal epilepsy was retrospectively analysed. Occurrence of surgery-related complications, including a severely complicated course (SCC: surgical complication requiring reoperation and/or permanent neurological deficit and/or death), was compared between patients operated on in the paediatric age (<16 year-old; 452 cases) and, respectively, in adulthood (≥16 year-old; 830 cases). The whole cohort of patients was also evaluated for risk factors for a SCC. RESULTS At last contact (median follow-up 98 months), 74.5% of patients were in Engel's class I (78.0% of children and 73.0% of adults). One hundred patients (7.8%) presented a SCC (6.4% for children and 8.6% for adult patients). Postoperative intracranial haemorrhages occurred more frequently in adult cases. At multivariate analysis, increasing age at operation, multilobar surgery, resections in the rolandic/perirolandic and in insulo-opercular regions were independent risk factors for a SCC. CONCLUSIONS Surgery for childhood-onset focal epilepsy provides excellent results on seizures and an acceptable safety profile at any age. Nevertheless, our results suggest that increasing age at surgery is associated with an increase in odds of developing severe surgery-related complications. These findings support the recommendation that children with drug-resistant, symptomatic (or presumed symptomatic) focal epilepsy should be referred for a surgical evaluation as early as possible after seizure onset.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Rizzi
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Department of Neuroscience, University of Parma, Parma, Italy
| | - Valeria Mariani
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Nichelatti
- Service of Biostatistics, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Lino Nobili
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Child Neuropsychiatry Unit, DINOGMI, University of Genoa, Genoa, Italy, Istituto Giannina Gaslini, Genova, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Punia V, Bulacio J, Gonzalez-Martinez J, Abdelkader A, Bingaman W, Najm I, Stojic A. Extra operative intracranial EEG monitoring for epilepsy surgery in elderly patients. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:92-95. [PMID: 30112277 PMCID: PMC6092550 DOI: 10.1016/j.ebcr.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECT The objective of the study is to investigate and report our experience with extra operative intracranial EEG monitoring for evaluation of epilepsy surgery among elderly (≥ 60 years) patients. METHODS After IRB approval, we searched our prospectively maintained epilepsy surgery database to find patients who underwent eiEEG at the age of 60 years or older. Electronic medical records were reviewed to extract clinical and surgery-related information. Patients who underwent resective epilepsy surgery after eiEEG and had at least 1 year of clinical follow-up were assessed for seizure outcome. Categorical and continuous variables were compared using Pearson chi-square and Student's t-test, respectively. RESULTS A total of 21 patients, with 13 (62%) women, underwent eiEEG in our center at the age of 60 years or older. The mean age at time of implantation was 63.8 ± 2.7 years. Sub-dural grids (SDG) were implanted in five (24%) patients, whereas sixteen (76%) patients underwent stereo-EEG (SEEG) implantation. Median number of contacts in SDG were 106 (56-136) and depth electrodes in SEEG were 12 (9-14). There were 2 complications, including one mortality due to intracerebral hemorrhage. Sixteen (76%) patients underwent respective epilepsy surgery after eiEEG and eleven (69%) achieved Engel class I outcome on the last follow-up [mean follow-up duration of 2.7 (± 1.8) years]. CONCLUSION We noticed an increased utilization of eiEEG in elderly patients after the introduction of SEEG at our center. Overall, we found that eiEEG can help achieve good seizure outcomes in the elderly population. However, the one eiEEG-related mortality serves a word of caution about the potential risks in this population.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Jorge Gonzalez-Martinez
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Ahmed Abdelkader
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - William Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Andrey Stojic
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States of America
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Vakharia VN, Duncan JS, Witt JA, Elger CE, Staba R, Engel J. Getting the best outcomes from epilepsy surgery. Ann Neurol 2018. [PMID: 29534299 PMCID: PMC5947666 DOI: 10.1002/ana.25205] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690
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Affiliation(s)
- Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom, and Chalfont Centre for Epilepsy
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Richard Staba
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jerome Engel
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Kerezoudis P, McCutcheon B, Murphy ME, Rajjoub KR, Ubl D, Habermann EB, Worrell G, Bydon M, Van Gompel JJ. Thirty-day postoperative morbidity and mortality after temporal lobectomy for medically refractory epilepsy. J Neurosurg 2018. [DOI: 10.3171/2016.12.jns162096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETemporal lobectomy is a well-established treatment modality for the management of medically refractory epilepsy in appropriately selected patients. The aim of this study was to assess 30-day morbidity and mortality after temporal lobectomy in cases registered in a national database.METHODSA retrospective cohort analysis was conducted using a multiinstitutional surgical registry compiled between 2006 and 2014. The authors identified patients who underwent anterior temporal lobectomy and/or amygdalohippocampectomy for a primary diagnosis of intractable epilepsy. Univariate and multivariable analyses with regard to patient demographics, comorbidities, operative characteristics, and 30-day outcomes were applied.RESULTSA total of 216 patients were included in the study. The median age was 38 years and 46% of patients were male. The median length of stay was 3 days and the 30-day mortality rate was 1.4%. Fourteen patients (6.5%) developed at least one major complication. Return to the operating room was observed in 7 patients (3.2%). Readmission within 30 days and discharge to a location other than home were available for 2011–2014 (n = 155) and occurred in 11% and 10.3% of patients, respectively. Multivariable regression analysis revealed that increasing age was an independent predictor of discharge disposition other than home and that male sex was a significant risk factor for the development of a major complication. Interestingly, the presence of the attending neurosurgeon and a resident during the procedure was significantly associated with decreased odds of prolonged length of stay (i.e., > 75th percentile [5 days]) and discharge to a location other than home.CONCLUSIONSUsing a multiinstitutional surgical registry, 30-day outcome data after temporal lobectomy for medically intractable epilepsy demonstrates a mortality rate of 1.4%, a major complication rate of 6.5%, and a readmission rate of 11%. Temporal lobectomy is an extremely effective therapy for seizures originating there—however, surgical intervention must be weighed against its morbidity and mortality outcomes.
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Affiliation(s)
| | - Brandon McCutcheon
- 1Department of Neurologic Surgery,
- 2Mayo Clinic Neuro-Informatics Laboratory,
| | - Meghan E. Murphy
- 1Department of Neurologic Surgery,
- 2Mayo Clinic Neuro-Informatics Laboratory,
| | | | - Daniel Ubl
- 4Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and
| | - Elizabeth B. Habermann
- 4Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and
| | - Gregory Worrell
- 5Department of Neurology, Mayo Clinic, Rochester, Minnesota; and
| | - Mohamad Bydon
- 1Department of Neurologic Surgery,
- 2Mayo Clinic Neuro-Informatics Laboratory,
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Lang JD, Grell L, Hagge M, Onugoren MD, Gollwitzer S, Graf W, Schwarz M, Coras R, Blümcke I, Sommer B, Rössler K, Buchfelder M, Schwab S, Stefan H, Hamer HM. Long-term outcome after epilepsy surgery in older adults. Seizure 2018; 57:56-62. [PMID: 29604610 DOI: 10.1016/j.seizure.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/03/2018] [Accepted: 02/22/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The incidence of epilepsy in older adults is growing, as does the incidence of comorbidities. Therefore, when it comes to epilepsy surgery in medically intractable epilepsy, age is often seen as a limiting factor. To investigate the outcome after epilepsy surgery in a population of older adults, we compared the benefit for patients aged 50-59 years with those aged 60 years and older in respect of efficacy and safety. METHOD Patients aged ≥50 years with medically intractable epilepsy who underwent epilepsy surgery from 1990 to 2013 were selected from the database of a German epilepsy center. All of them received a standardised and detailed presurgical diagnostic evaluation. Follow-up included at least four scheduled visits with EEG, MRI and neuropsychological testing. Outcome was assessed using the Engel outcome scale. RESULTS 79 patients aged between 50 and 67 years were followed-up for a median of 4.7 years (2-16 years). 68% of patients were free of disabling seizures (Engel class I, ≥60 years: 75%) and 58% were seizure-free (Engel class IA, ≥60 years: 70%). 90% of our patients suffered from temporal lobe epilepsy (TLE), 9% from frontal lobe epilepsy (FLE) and one occipital lobe epilepsy (OLE). After surgery, 9% discontinued or tapered their medication. Permanent surgical complications occurred in 10% of cases and transient neurological deficits were seen in 11%. Older patients had a higher risk for postoperative hygroma (≥60 years 15%; <60 years 8%) and were more prone to postoperative memory deficits (≥60 years 45%), especially after resection of the dominant temporal lobe. Verbal and figural memory testing did not differ significantly between the groups. CONCLUSIONS The results support the view that in selected older patients, epilepsy surgery shows equal or even higher success rates as compared to younger patients. However, patients of older age may be at greater risk for postoperative hygroma and memory deficits, especially after dominant temporal lobe resections.
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Affiliation(s)
- Johannes D Lang
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - Laura Grell
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Mareike Hagge
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Müjgan Dogan Onugoren
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Stephanie Gollwitzer
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Wolfgang Graf
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Michael Schwarz
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Roland Coras
- Institute of Neuropathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Ingmar Blümcke
- Institute of Neuropathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Björn Sommer
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Karl Rössler
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Stefan Schwab
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Hermann Stefan
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Hajo M Hamer
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Punia V, Abdelkader A, Busch RM, Gonzalez-Martinez J, Bingaman W, Najm I, Stojic A. Time to push the age limit: Epilepsy surgery in patients 60 years or older. Epilepsia Open 2018; 3:73-80. [PMID: 29588990 PMCID: PMC5839305 DOI: 10.1002/epi4.12099] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To summarize the existing literature on resective epilepsy surgery (RES) in older adults (≥60 years old) and examine seizure and neuropsychological outcomes in a single‐center large cohort of older adults undergoing RES and their comparison to a consecutive, younger (25‐ to45‐year‐old) adult population who underwent RES in routine clinical practice. Methods First, a comprehensive literature review was performed. Then, we identified older adults who underwent RES at our center (2000–2015). Outcome analysis was performed on patients who had ≥1 year of clinical follow‐up. A younger cohort of patients who underwent RES during the same period was selected for comparison. The 2 groups were compared with respect to demographic and disease variables as well as key clinical outcomes. Results Seizure outcomes on 58 older patients were reported in existing literature; 72% achieved Engel class I outcome ≥1 year postoperatively. Sixty‐four older adults underwent RES at our center, accounting for 2.8% of all RES during the study period. A total of 51 older adults (Mage = 65) among them had ≥1‐year clinical follow‐up; 80% achieved Engel I outcome after a mean follow‐up of 3.2 years. This was comparable to the 68% Engel class I outcome among 50 consecutive younger adults, despite later age of onset, longer epilepsy duration, and more comorbidities (all p < 0.001) among older adults. The majority (86%) of older adults were referred to our center after years of suffering from drug‐resistant epilepsy. There were no group differences in surgical complications. However, 1 older adult passed away post‐RES. There was no difference in post‐RES neuropsychological outcomes compared to younger adults, except significantly higher number of older adults showed a decline in confrontational naming. Significance RES in well‐selected older adults is a safe and effective therapy, and advanced age should not preclude consideration of surgical therapy in older adults with pharmacoresistant epilepsy.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A
| | | | - Robyn M Busch
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A.,Psychiatry & Psychology Neurological Institute Cleveland Clinic Cleveland Ohio U.S.A
| | - Jorge Gonzalez-Martinez
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A.,Department of Neurosurgery Neurological Institute Cleveland Clinic Cleveland Ohio U.S.A
| | - William Bingaman
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A.,Department of Neurosurgery Neurological Institute Cleveland Clinic Cleveland Ohio U.S.A
| | - Imad Najm
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A
| | - Andrey Stojic
- Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A
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Does early postoperative drug regimen impact seizure control in patients undergoing temporal lobe resections? J Neurol 2018; 265:500-509. [PMID: 29307009 DOI: 10.1007/s00415-017-8700-z] [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: 10/17/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of postoperative antiepileptic drug (AED) load on seizure control in patients who underwent surgical treatment for pharmacoresistant mesiotemporal lobe epilepsy during the first two postoperative years. PATIENTS AND METHODS 532 consecutive patients (48.7% males and 51.7% females) who underwent surgical treatment for mesiotemporal lobe epilepsy were retrospectively evaluated regarding effects of AED load on seizures control during the first 2 years following epilepsy surgery. We analyzed whether postoperative increases in postoperative AED load are associated with better seizure control in patients initially not seizure free, and if postoperative decreases in postoperative AED load would increase the risk for seizure persistence or recurrence. For statistical analyses, Fisher's exact and Wilcoxon test were applied. RESULTS 68.9, 64.0 and 59.1% of patients were completely seizure free (Engel Ia) at 3, 12 and 24 months after surgery, respectively. Patients in whom daily drug doses were increased did not have a higher rate of seizure freedom at any of the three follow-up periods. Of 16 patients achieving secondary seizure control at 12 months after surgery, only one did so with an increase in drug load in contrast to 15 patients who experienced a running down of seizures independent of drug load increases. Decreases in drug load did not significantly increase the risk for seizure recurrence. Of postoperatively seizure free patients at 3 months after surgery in whom AED were consequently reduced, 85% remained completely seizure free at 1 year and 76% at 1 year after surgery, respectively, as opposed to 86% each when AED was not reduced (differences n.s.). Mean daily drug load was significantly lower in seizure free patients at 12 and 24 months compared to patients with ongoing seizures. CONCLUSION In this large patient cohort stratified to the epilepsy syndrome neither did a postoperative reduction in drug load significantly increase the risk for seizure relapse nor did increases in drug dosages lead to improved seizure control. Mean drug load was on average lower in seizure free- than non-seizure free patients at 12 and 24 months of follow-up. Secondary seizure control after initial postoperative seizures in > 90% of cases occurred as a running down, independent of an AED increase. Thus, the effect of the surgical intervention rather than the postoperative drug regimen was the key determinant for seizure control. This finding supports a curative role of temporal lobe surgery rather than an effect rendering the majority of patients' pharmacoresponsive with a critical role of the antiepileptic drug regime for seizure control.
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Schmeiser B, Daniel M, Kogias E, Böhringer D, Egger K, Yang S, Foit NA, Schulze-Bonhage A, Steinhoff BJ, Zentner J, Lagrèze WA, Gross NJ. Visual field defects following different resective procedures for mesiotemporal lobe epilepsy. Epilepsy Behav 2017; 76:39-45. [PMID: 28954709 DOI: 10.1016/j.yebeh.2017.08.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/15/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the most common side effects of mesiotemporal lobe resection in patients with medically intractable epilepsy are visual field defects (VFD). While peripheral defects usually remain unnoticed by patients, extended VFD influence daily life activities and can, in particular, affect driving regulations. This study had been designed to evaluate frequency and extent of VFD following different surgical approaches to the mesiotemporal area with respect to the ability to drive. MATERIALS AND METHODS This study comprises a consecutive series of 366 patients operated at the Epilepsy Center in Freiburg for intractable mesiotemporal lobe epilepsy from 1998 to 2016. The following procedures were performed: standard anterior temporal lobectomy (ATL: n=134; 37%), anterior temporal or keyhole resection (KH: n=53; 15%), and selective amygdalohippocampectomy via the transsylvian (tsAHE: n=145; 40%) and the subtemporal (ssAHE: n=34; 9%) approach. Frequency and extent of postoperative VFD were evaluated in relation to different surgical procedures. According to the German driving guidelines, postoperative VFD were classified as driving-relevant VFD with the involvement of absolute, homonymous central scotoma within 20° and driving-irrelevant VFD with either none or exclusively minor VFD sparing the center. RESULTS Postoperative visual field examinations were available in 276 of 366 cases. Postoperative VFD were observed in 202 of 276 patients (73%) and were found to be driving-relevant in 133 of 276 patients (48%), whereas 69 patients (25%) showed VFD irrelevant for driving. Visual field defects were significantly less likely following ssAHE compared with other temporal resections, and if present, they were less frequently driving-relevant (p<0.05), irrespective of the side of surgery. CONCLUSION Subtemporal sAHE (ssAHE) caused significantly less frequently and less severely driving-relevant VFD compared with all other approaches to the temporal lobe, irrespective of the side of surgery.
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Affiliation(s)
- Barbara Schmeiser
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany.
| | - Moritz Daniel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Trust and UCL Institute of Ophthalmology, London, United Kingdom; Eye Center, Medical Center - University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany
| | - Evangelos Kogias
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center - University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | - Shan Yang
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | - Niels Alexander Foit
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Department of Epileptology, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | | | - Josef Zentner
- Department of Neurosurgery, Medical Center - University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
| | - Wolf Alexander Lagrèze
- Eye Center, Medical Center - University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany
| | - Nikolai Johannes Gross
- Eye Center, Medical Center - University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany
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d’ Orio P, Pelliccia V, Gozzo F, Cardinale F, Castana L, Lo Russo G, Bottini G, Scarpa P, Cossu M. Epilepsy surgery in patients older than 50 years: Effectiveness, safety, and predictors of outcome. Seizure 2017. [DOI: 10.1016/j.seizure.2017.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schmeiser B, Wagner K, Schulze-Bonhage A, Mader I, Wendling AS, Steinhoff BJ, Prinz M, Scheiwe C, Weyerbrock A, Zentner J. Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable? Neurosurgery 2017; 81:992-1004. [DOI: 10.1093/neuros/nyx138] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/24/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used.
OBJECTIVE
To analyze epileptological and neuropsychological results as well as complications of different surgical strategies.
METHODS
This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures.
RESULTS
Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome.
CONCLUSION
Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.
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Affiliation(s)
- Barbara Schmeiser
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Kathrin Wagner
- Department of Epileptology, University Hospital Freiburg, Freiburg, Germany
| | | | - Irina Mader
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | | | | | - Marco Prinz
- Institute of Neuropathology, University Hospital Freiburg, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Punia V, Abdelkader A, Stojic A. Breaking the age barrier: Epilepsy surgery in septuagenarians. Epilepsy Behav 2017; 70:94-96. [PMID: 28411522 DOI: 10.1016/j.yebeh.2017.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022]
Abstract
Resective epilepsy surgery (RES) has traditionally been offered to young patients (<50years). The reservation about offering RES to the elderly is multifactorial with their advanced age and comorbidities being the primary reason. The elderly age group (≥65years of age) is one of the fastest growing populations. The arbitrary age limits for RES need reconsideration in the face of an ever increasing elderly population. Considering such changes in demographics, we report the first case series in the literature of seven septuagenarians who underwent RES in the form of anterior temporal lobectomy (ATL). The 10-year median survival probability based on their comorbidities and age was more than 50%. Six patients had good surgical outcome (Engle I/II) with four of them being completely free of disabling seizures after a median follow-up of almost 2years. No significant medical or surgical morbidity was observed. However, three out of the four patients undergoing pre- and post-RES neuropsychological testing showed decline in memory function. Seizure-related injuries were noted in four out of seven patients and may have been a motivation to proceed with RES in our cohort. Our experience suggests that RES can be a safe and effective therapy in well-selected, septuagenarian patients with drug-resistant epilepsy. Neuropsychological outcomes after RES in this population need further evaluation.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States.
| | - Ahmed Abdelkader
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States
| | - Andrey Stojic
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, United States
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