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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [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: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Bosco DB, Kremen V, Haruwaka K, Zhao S, Wang L, Ebner BA, Zheng J, Dheer A, Perry JF, Xie M, Nguyen AT, Worrell GA, Wu LJ. Impaired microglial phagocytosis promotes seizure development. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.12.31.573794. [PMID: 38260601 PMCID: PMC10802340 DOI: 10.1101/2023.12.31.573794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
In the central nervous system, triggering receptor expressed on myeloid cells 2 (TREM2) is exclusively expressed by microglia and is critical for microglial proliferation, migration, and phagocytosis. TREM2 plays an important role in neurodegenerative diseases, such as Alzheimer's disease and amyotrophic lateral sclerosis. However, little is known about the role TREM2 plays in epileptogenesis. To investigate this, we utilized TREM2 knockout (KO) mice within the murine intra-amygdala kainic acid seizure model. Electroencephalographic analysis, immunocytochemistry, and RNA sequencing revealed that TREM2 deficiency significantly promoted seizure-induced pathology. We found that TREM2 KO increased both acute status epilepticus and spontaneous recurrent seizures characteristic of chronic focal epilepsy. Mechanistically, phagocytic clearance of damaged neurons by microglia was impaired in TREM2 KO mice and the reduced phagocytic capacity correlated with increased spontaneous seizures. Analysis of human tissue from patients who underwent surgical resection for drug resistant temporal lobe epilepsy also showed a negative correlation between microglial phagocytic activity and focal to bilateral tonic-clonic generalized seizure history. These results indicate that microglial TREM2 and phagocytic activity may be important to epileptogenesis and the progression of focal temporal lobe epilepsy.
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Affiliation(s)
- Dale B. Bosco
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | | | - Shunyi Zhao
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Lingxiao Wang
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Blake A. Ebner
- Department of Laboratory Medicine and Pathology, Mayo Clinic; Rochester, MN, USA
| | - Jiaying Zheng
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Aastha Dheer
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Jadyn F. Perry
- Department of Immunology, Mayo Clinic; Rochester, MN, USA
| | - Manling Xie
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
| | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic; Rochester, MN, USA
| | | | - Long-Jun Wu
- Department of Neurology, Mayo Clinic; Rochester, MN, USA
- Department of Immunology, Mayo Clinic; Rochester, MN, USA
- Department of Neuroscience, Mayo Clinic; Jacksonville, FL, USA
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Youngerman BE, Banu MA, Khan F, McKhann GM, Schevon CA, Jagid JR, Cajigas I, Theodotou CB, Ko A, Buckley R, Ojemann JG, Miller JW, Laxton AW, Couture DE, Popli GS, Buch VP, Halpern CH, Le S, Sharan AD, Sperling MR, Mehta AD, Englot DJ, Neimat JS, Konrad PE, Sheth SA, Neal EG, Vale FL, Holloway KL, Air EL, Schwalb JM, D'Haese PF, Wu C. Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study. J Neurol Neurosurg Psychiatry 2023; 94:879-886. [PMID: 37336643 PMCID: PMC10776034 DOI: 10.1136/jnnp-2022-330979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. METHODS This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. RESULTS Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. CONCLUSIONS MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Matei A Banu
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Farhan Khan
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | | | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Iahn Cajigas
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian B Theodotou
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Buckley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vivek P Buch
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scheherazade Le
- Department of Neurology, Stanford Comprehensive Epilepsy Center, Stanford, California, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Elliot G Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida, USA
| | - Fernando L Vale
- Department of Neurological Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kaestner E, Rao J, Chang AJ, Wang ZI, Busch RM, Keller SS, Rüber T, Drane DL, Stoub T, Gleichgerrcht E, Bonilha L, Hasenstab K, McDonald C. Convolutional Neural Network Algorithm to Determine Lateralization of Seizure Onset in Patients With Epilepsy: A Proof-of-Principle Study. Neurology 2023; 101:e324-e335. [PMID: 37202160 PMCID: PMC10382265 DOI: 10.1212/wnl.0000000000207411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/30/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A new frontier in diagnostic radiology is the inclusion of machine-assisted support tools that facilitate the identification of subtle lesions often not visible to the human eye. Structural neuroimaging plays an essential role in the identification of lesions in patients with epilepsy, which often coincide with the seizure focus. In this study, we explored the potential for a convolutional neural network (CNN) to determine lateralization of seizure onset in patients with epilepsy using T1-weighted structural MRI scans as input. METHODS Using a dataset of 359 patients with temporal lobe epilepsy (TLE) from 7 surgical centers, we tested whether a CNN based on T1-weighted images could classify seizure laterality concordant with clinical team consensus. This CNN was compared with a randomized model (comparison with chance) and a hippocampal volume logistic regression (comparison with current clinically available measures). Furthermore, we leveraged a CNN feature visualization technique to identify regions used to classify patients. RESULTS Across 100 runs, the CNN model was concordant with clinician lateralization on average 78% (SD = 5.1%) of runs with the best-performing model achieving 89% concordance. The CNN outperformed the randomized model (average concordance of 51.7%) on 100% of runs with an average improvement of 26.2% and outperformed the hippocampal volume model (average concordance of 71.7%) on 85% of runs with an average improvement of 6.25%. Feature visualization maps revealed that in addition to the medial temporal lobe, regions in the lateral temporal lobe, cingulate, and precentral gyrus aided in classification. DISCUSSION These extratemporal lobe features underscore the importance of whole-brain models to highlight areas worthy of clinician scrutiny during temporal lobe epilepsy lateralization. This proof-of-concept study illustrates that a CNN applied to structural MRI data can visually aid clinician-led localization of epileptogenic zone and identify extrahippocampal regions that may require additional radiologic attention. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with drug-resistant unilateral temporal lobe epilepsy, a convolutional neural network algorithm derived from T1-weighted MRI can correctly classify seizure laterality.
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Affiliation(s)
- Erik Kaestner
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Jun Rao
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Allen J Chang
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Zhong Irene Wang
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Robyn M Busch
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Simon S Keller
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Theodor Rüber
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Daniel L Drane
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Travis Stoub
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Ezequiel Gleichgerrcht
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Leonardo Bonilha
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Kyle Hasenstab
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA
| | - Carrie McDonald
- From the University of California San Diego (E.K., J.R., C.M.), CA; Medical University of South Carolina (A.J.C., E.G.), Charleston; Cleveland Clinic (Z.I.W., R.M.B.), OH; University of Liverpool (S.S.K.), United Kingdom; University of Bonn (T.R.), DE; University of Emory (D.L.D., L.B.), Atlanta, GA; Rush University (T.S.), Chicago, IL; and San Diego State University (K.H.), San Diego, CA.
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Santos-Santos A, Morales-Chacón LM, Galan-Garcia L, Machado C. Short and long term prediction of seizure freedom in drug-resistant focal epilepsy surgery. Clin Neurol Neurosurg 2023; 230:107753. [PMID: 37245454 DOI: 10.1016/j.clineuro.2023.107753] [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: 09/23/2022] [Revised: 12/18/2022] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The selection of candidates for drug-resistant focal epilepsy surgery is essential to achieve the best post-surgical outcomes. OBJECTIVE To develop two prediction models for seizure freedom in the short and long-term follow-up and from them to create a risk calculator in order to individualize the selection of candidates for surgery and future therapies in each patients. METHODS A sample of 64 consecutive patients who underwent epilepsy surgery at two Cuban tertiary health institutions between 2012 and 2020 constituted the basis for the prediction models. Two models were obtained through the novel methodology, based on biomarker selection reached by resampling methods, cross-validation and high-accuracy index measured through the area under the receiving operating curve (ROC) procedure. RESULTS The first, to pre-operative model included five predictors: epilepsy type, seizures per month, ictal pattern, interictal EEG topography and normal or abnormal magnetic resonance imaging,. it's precision was 0.77 at one year, and with four years and more 0.63. The second model including variables from the trans-surgical and post-surgical stages: the interictal discharges in the post-surgical EEG, incomplete or complete resection of the epileptogenic zone, the surgical techniques employed and disappearance of the discharge in post-resection electrocorticography; the precision of this model was 0.82 at one year, and with four years and more 0.97. CONCLUSIONS The introduction of trans-surgical and post-surgical variables increase the prediction of the pre-surgical model. A risk calculator was developed using these prediction models, which could be useful as an accurate tool to improve the prediction in epilepsy surgery.
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Affiliation(s)
| | | | | | - Calixto Machado
- Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, President of the Cuban Society of Clinical Neurophysiology, Cuba
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6
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McIntosh AM, Wynd AW, Berkovic SF. Extended follow-up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery. Epilepsia 2023; 64:92-102. [PMID: 36268808 PMCID: PMC10098858 DOI: 10.1111/epi.17440] [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: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up. METHODS Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly. Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98). RESULTS Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizure-free after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74). SIGNIFICANCE Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.
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Affiliation(s)
- Anne M McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.,Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex W Wynd
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
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7
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González Otárula KA, Tan YL, Hall JA, Chang EF, Correa JA, Dubeau F, Sziklas V, Soucy JP, Guiot MC, Knowlton RC, Kobayashi E. Postsurgical seizure outcome in temporal lobe epilepsy patients with normal or subtle, nonspecific MRI findings. J Neurosurg 2022; 137:442-448. [PMID: 34972090 DOI: 10.3171/2021.10.jns2127] [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: 01/05/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to report postsurgical seizure outcome of temporal lobe epilepsy (TLE) patients with normal or subtle, nonspecific MRI findings and to identify prognostic factors related to seizure control after surgery. METHODS This was a retrospective study of patients who underwent surgery from 1999 to 2014 at two comprehensive epilepsy centers. Patients with a clear MRI lesion according to team discussion and consensus were excluded. Presurgical information, surgery details, pathological data, and postsurgical outcomes were retrospectively collected from medical charts. Multiple logistic regression analysis was used to assess the effect of clinical, surgical, and neuroimaging factors on the probability of Engel class I (favorable) versus class II-IV (unfavorable) outcome at last follow-up. RESULTS The authors included 73 patients (59% were female; median age at surgery 35.9 years) who underwent operations after a median duration of epilepsy of 13 years. The median follow-up after surgery was 30.6 months. At latest follow-up, 44% of patients had Engel class I outcome. Favorable prognostic factors were focal nonmotor aware seizures and unilateral or no spikes on interictal scalp EEG. CONCLUSIONS Favorable outcome can be achieved in a good proportion of TLE patients with normal or subtle, nonspecific MRI findings, particularly when presurgical investigation suggests a rather circumscribed generator. Presurgical factors such as the presence of focal nonmotor aware seizures and unilateral or no spikes on interictal EEG may indicate a higher probability of seizure freedom.
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Affiliation(s)
- Karina A González Otárula
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Yee-Leng Tan
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- 3Department of Neurology, National Neuroscience Institute, Singapore
| | - Jeffery A Hall
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Edward F Chang
- 2Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California
| | - José A Correa
- 4Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Viviane Sziklas
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- 6PET Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Marie-Christine Guiot
- 5Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; and
| | - Robert C Knowlton
- 2Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California
| | - Eliane Kobayashi
- 1Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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8
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Haemels M, Van Weehaeghe D, Cleeren E, Dupont P, van Loon J, Theys T, Van Laere K, Van Paesschen W, Goffin K. Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy. Acta Neurol Belg 2022; 122:325-335. [PMID: 33544336 DOI: 10.1007/s13760-020-01569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 01/30/2023]
Abstract
The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent 18F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, pFDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, pFDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.
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9
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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10
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Focal to bilateral motor seizures in temporal lobe epilepsy during video-EEG monitoring: effects on surgical outcome. Acta Neurol Belg 2021; 121:1677-1684. [PMID: 32813146 DOI: 10.1007/s13760-020-01471-7] [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: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine whether the occurrence of focal to bilateral motor seizures in the course of partial drug withdrawal during video-EEG monitoring (FTBMS-M) had a predictive value for seizure recurrence in surgically treated patients with mesial temporal lobe epilepsy (MTLE). We analyzed the outcomes of 59 patients who underwent temporal lobe resection at 12 month postoperative follow up. In total, 48 out of 59 patients were rendered seizure free (81.4%). We analyzed seizure recurrence after surgery with reference to: (i) occurrence of seizures after partial drug withdrawal during video-EEG monitoring (FTBMS-M); (ii) history of secondarily generalized seizures during antiepileptic drug treatment prior to presurgical evaluation (FTBMS-H) and (iii) other possible confounding factors (sex, age, epilepsy duration, side of surgery, presence of hippocampal sclerosis, and history of febrile seizures). We found no differences in the frequency of seizure recurrences between patients with FTBMS-M and patients without FTBMS-M (4/20 vs. 7/39; p = 0.848). Conversely, the frequency of seizure recurrence was significantly higher among the patients with FTBMS-H than among the patients without FTBMS-H (7/20 vs. 4/39; p = 0.021). The predictive value of FTBMS-H for postoperative seizure recurrence was confirmed in logistic regression analysis. We found a statistically significant influence of FTBMS-H on poor outcome after surgery, but not of FTBMS-M or other confounding variables, which suggests that withdrawal seizures do not affect postsurgical seizure control.
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11
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Fitzgerald Z, Morita-Sherman M, Hogue O, Joseph B, Alvim MKM, Yasuda CL, Vegh D, Nair D, Burgess R, Bingaman W, Najm I, Kattan MW, Blumcke I, Worrell G, Brinkmann BH, Cendes F, Jehi L. Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings. Epilepsia 2021; 62:2439-2450. [PMID: 34338324 PMCID: PMC8488002 DOI: 10.1111/epi.17024] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/15/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. METHODS We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2 years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. RESULTS Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical + EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. SIGNIFICANCE This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.
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Affiliation(s)
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael W. Kattan
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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12
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Benjumeda M, Tan YL, González Otárula KA, Chandramohan D, Chang EF, Hall JA, Bielza C, Larrañaga P, Kobayashi E, Knowlton RC. Patient specific prediction of temporal lobe epilepsy surgical outcomes. Epilepsia 2021; 62:2113-2122. [PMID: 34275140 DOI: 10.1111/epi.17002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Drug-resistant temporal lobe epilepsy (TLE) is the most common type of epilepsy for which patients undergo surgery. Despite the best clinical judgment and currently available prediction algorithms, surgical outcomes remain variable. We aimed to build and to evaluate the performance of multidimensional Bayesian network classifiers (MBCs), a type of probabilistic graphical model, at predicting probability of seizure freedom after TLE surgery. METHODS Clinical, neurophysiological, and imaging variables were collected from 231 TLE patients who underwent surgery at the University of California, San Francisco (UCSF) or the Montreal Neurological Institute (MNI) over a 15-year period. Postsurgical Engel outcomes at year 1 (Y1), Y2, and Y5 were analyzed as primary end points. We trained an MBC model on combined data sets from both institutions. Bootstrap bias corrected cross-validation (BBC-CV) was used to evaluate the performance of the models. RESULTS The MBC was compared with logistic regression and Cox proportional hazards according to the area under the receiver-operating characteristic curve (AUC). The MBC achieved an AUC of 0.67 at Y1, 0.72 at Y2, and 0.67 at Y5, which indicates modest performance yet superior to what has been reported in the state-of-the-art studies to date. SIGNIFICANCE The MBC can more precisely encode probabilistic relationships between predictors and class variables (Engel outcomes), achieving promising experimental results compared to other well-known statistical methods. Multisite application of the MBC could further optimize its classification accuracy with prospective data sets. Online access to the MBC is provided, paving the way for its use as an adjunct clinical tool in aiding pre-operative TLE surgical counseling.
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Affiliation(s)
- Marco Benjumeda
- Computational Intelligence Group, Department of Artificial Intelligence, Universidad Politécnica de Madrid, Madrid, Spain
| | - Yee-Leng Tan
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA, USA.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Karina A González Otárula
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Dharshan Chandramohan
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Jeffery A Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Concha Bielza
- Computational Intelligence Group, Department of Artificial Intelligence, Universidad Politécnica de Madrid, Madrid, Spain
| | - Pedro Larrañaga
- Computational Intelligence Group, Department of Artificial Intelligence, Universidad Politécnica de Madrid, Madrid, Spain
| | - Eliane Kobayashi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Robert C Knowlton
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA, USA
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13
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Shan W, Mao X, Wang X, Hogan RE, Wang Q. Potential surgical therapies for drug-resistant focal epilepsy. CNS Neurosci Ther 2021; 27:994-1011. [PMID: 34101365 PMCID: PMC8339538 DOI: 10.1111/cns.13690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.
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Affiliation(s)
- Wei Shan
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
| | - Xuewei Mao
- Shandong Key Laboratory of Industrial Control TechnologySchool of AutomationQingdao UniversityQingdaoChina
| | - Xiu Wang
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
| | - Robert E. Hogan
- Departments of Neurology and NeurosurgerySchool of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Qun Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
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14
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Perven G, Podkorytova I, Ding K, Agostini M, Alick S, Das R, Dave H, Dieppa M, Doyle A, Harvey J, Lega B, Zepeda R, Hays R. Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation. Epilepsy Behav Rep 2021; 15:100441. [PMID: 33898964 PMCID: PMC8058515 DOI: 10.1016/j.ebr.2021.100441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 01/04/2023] Open
Abstract
Bilateral ictal onsets may lead to surgery failure in mesial temporal lobe epilepsy. Bitemporal SEEG seizures were recorded despite of unilateral non-invasive tests. Patients with non-lesional MTLE need bitemporal invasive evaluation before resection.
Purpose Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure. Methods In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described. Results Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy. Conclusion We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.
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Affiliation(s)
- Ghazala Perven
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Irina Podkorytova
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Mark Agostini
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Sasha Alick
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Rohit Das
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Marisara Dieppa
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Alexander Doyle
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Jay Harvey
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Bradley Lega
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA.,Department of Neurosurgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8855, USA
| | - Rodrigo Zepeda
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Ryan Hays
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
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15
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Alsumaili M, Alkhateeb M, Khoja A, Alkhaja M, Alsulami A, Alqadi K, Baz S, Abalkhail T, Babtain F, Althubaiti I, Abu-Ata M, Alotaibi F. Seizure outcome after epilepsy surgery for patients with normal MRI: A Single center experience. Epilepsy Res 2021; 173:106620. [PMID: 33780709 DOI: 10.1016/j.eplepsyres.2021.106620] [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: 11/23/2020] [Revised: 02/12/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the surgical outcome in non-lesional intractable focal epilepsies in our center and to find possible predictors for better outcome. METHODS This is a retrospective study for 40 adult patients with intractable focal epilepsy following at KFSHRC-Riyadh, who underwent presurgical evaluation followed by resective surgery and continued follow up for a minimum of 2 years. The surgery outcome was evaluated based on the type of surgical procedure and histopathology results. RESULTS Out of all 40 patients studied, seizure freedom was achieved in 19 (47.5 %) and 17 (42.5 %) patients at the first and second year respectively in all non-lesional cases. Seizure freedom in non-lesional temporal lobe surgery was achieved in 10 (45 %) of patients at 2 years, 5 (38 %) in non-lesional frontal lobe patients at 2 years and 8 (44 %), 7 (38 %) for all extratemporal at 1 and 2 years respectively. Good prognosis was seen in patients with localized positron emission tomography (PET), had no aura and had a clear ictal onset either on scalp electroencephalogram (EEG) or subdural invasive electroencephalogram. SIGNIFICANCE The best surgical outcome is achievable in patients with non-lesional focal epilepsy. This study highlights the prognostic value of the PET scan and ictal scalp/subdural invasive EEG.
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Affiliation(s)
- Mohammad Alsumaili
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Pediatric Department, Armed Forces Hospital, Khamis Mushayt, Saudi Arabia.
| | - Mashael Alkhateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Abeer Khoja
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Neurology Section, Medical Department, King Abdulaziz University, Building 10, Second Floor, Jeddah, Saudi Arabia.
| | - Mohammed Alkhaja
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Department of Internal Medicine, King Hamad University Hospital, House 2811, Road 445, Block 1204, Hamad Town, Busaiteen, Bahrain.
| | - Ashwaq Alsulami
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Khalid Alqadi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Salah Baz
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Tariq Abalkhail
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Ibrahim Althubaiti
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Mahmoud Abu-Ata
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia.
| | - Faisal Alotaibi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Neurology Section, Medical Department, Aldara Hospital and Medical Center, Riyadh, Saudi Arabia.
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16
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Kerr WT, Zhang X, Hill CE, Janio EA, Chau AM, Braesch CT, Le JM, Hori JM, Patel AB, Allas CH, Karimi AH, Dubey I, Sreenivasan SS, Gallardo NL, Bauirjan J, Hwang ES, Davis EC, D'Ambrosio SR, Al Banna M, Cho AY, Dewar SR, Engel J, Feusner JD, Stern JM. Epilepsy, dissociative seizures, and mixed: Associations with time to video-EEG. Seizure 2021; 86:116-122. [PMID: 33601302 PMCID: PMC7979505 DOI: 10.1016/j.seizure.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/23/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Video-electroencephalographic monitoring (VEM) is a core component to the diagnosis and evaluation of epilepsy and dissociative seizures (DS)-also known as functional or psychogenic seizures-but VEM evaluation often occurs later than recommended. To understand why delays occur, we compared how patient-reported clinical factors were associated with time from first seizure to VEM (TVEM) in patients with epilepsy, DS or mixed. METHODS We acquired data from 1245 consecutive patients with epilepsy, VEM-documented DS or mixed epilepsy and DS. We used multivariate log-normal regression with recursive feature elimination (RFE) to evaluate which of 76 clinical factors interacting with patients' diagnoses were associated with TVEM. RESULTS The mean and median TVEM were 14.6 years and 10 years, respectively (IQR 3-23 years). In the multivariate RFE model, the factors associated with longer TVEM in all patients included unemployment and not student status, more antiseizure medications (current and past), concussion, and ictal behavior suggestive of temporal lobe epilepsy. Average TVEM was shorter for DS than epilepsy, particularly for patients with depression, anxiety, migraines, and eye closure. Average TVEM was longer specifically for patients with DS taking more medications, more seizure types, non-metastatic cancer, and with other psychiatric comorbidities. CONCLUSIONS In all patients with seizures, trials of numerous antiseizure medications, unemployment and non-student status was associated with longer TVEM. These associations highlight a disconnect between International League Against Epilepsy practice parameters and observed referral patterns in epilepsy. In patients with dissociative seizures, some but not all factors classically associated with DS reduced TVEM.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
| | - Xingruo Zhang
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Chloe E Hill
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Justine M Le
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Corinne H Allas
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Ishita Dubey
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Janar Bauirjan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon R D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Mona Al Banna
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Sandra R Dewar
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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17
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Consequences of mesial temporal sparing temporal lobe surgery in medically refractory epilepsy. Epilepsy Behav 2021; 115:107642. [PMID: 33360404 PMCID: PMC9940265 DOI: 10.1016/j.yebeh.2020.107642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared long-term seizure outcome, neuropsychological outcome, and occupational outcome of anterior temporal lobectomy (ATL) with and without sparing of mesial structures to determine whether mesial sparing temporal lobectomy prevents memory decline and thus disability, with acceptable seizure outcome. METHODS We studied patients (n = 21) and controls (n = 21) with no evidence of mesial temporal sclerosis (MTS) on MRI who had surgery to treat drug-resistant epilepsy. Demographic and pre- and postsurgical clinical characteristics were compared. Patients had neuropsychological assessment before and after surgery. Neuropsychological analyses were limited to patients with left-sided surgery and available data (n = 14 in each group) as they were at risk of verbal memory impairment. The California Verbal Learning Test II (CVLT-II) (sum of trials 1-5, delayed free recall) and the Logical Memory subtest of the Wechsler Memory Scale III or IV (WMS-III or WMS-IV) (learning and delayed recall of prose passages) were used to assess verbal episodic learning and memory. Seizure and occupational outcomes were assessed. RESULTS The chance of attaining seizure freedom was similar in the two groups, so sparing mesial temporal structures did not lessen the chance of stopping seizures. Sparing mesial temporal structures mitigated the extent of postoperative verbal memory impairment, though some of these individuals suffered decline as a consequence of surgery. Occupational outcome was similar in both groups. SIGNIFICANCE Mesial temporal sparing resections provide a similar seizure outcome as ATL, while producing a better memory outcome. Anterior temporal lobectomy including mesial structure resection did not increase the risk of postoperative disability.
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18
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Morita-Sherman M, Louis S, Vegh D, Busch RM, Ferguson L, Bingaman J, Bulacio J, Najm I, Jones S, Zajichek A, Hogue O, Kattan MW, Blumcke I, Cendes F, Jehi L. Outcomes of resections that spare vs remove an MRI-normal hippocampus. Epilepsia 2020; 61:2545-2557. [PMID: 33063852 DOI: 10.1111/epi.16694] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)-normal hippocampus in patients with temporal lobe epilepsy. METHODS In this retrospective cohort study, we reviewed clinical, imaging, surgical, and histopathological data on 152 individuals with temporal lobe epilepsy and nonlesional hippocampi categorized into hippocampus-spared (n = 74) or hippocampus-resected (n = 78). Extra-hippocampal lesions were allowed. Pre- and postoperative cognitive data were available on 86 patients. Predictors of seizure and cognitive outcomes were identified using Cox-proportional hazard modeling followed by treatment-specific model reduction according to Akaike information criterion, and built into an online risk calculator. RESULTS Seizures recurred in 40% within one postoperative year, and in 63% within six postoperative years. Male gender (P = .03), longer epilepsy duration (P < .01), normal MRI (P = .04), invasive evaluation (P = .02), and acute postoperative seizures (P < .01) were associated with a higher risk of recurrence. We found no significant difference in postoperative seizure freedom rates at 5 years between those whose hippocampus was spared and those whose hippocampus was resected (P = .17). Seizure outcome models built with pre- and postoperative data had bootstrap validated concordance indices of 0.65 and 0.72. The dominant hippocampus-spared group had lower rates of decline in verbal memory (39% vs 70%; P = .03) and naming (41% vs 79%; P = .01) compared to the hippocampus-resected group. Partial hippocampus sparing had the same risk of verbal memory decline as for complete removal. SIGNIFICANCE Sparing or removing an MRI-normal hippocampus yielded similar long-term seizure outcome. A more conservative approach, sparing the hippocampus, only partially shields patients from postoperative cognitive deficits. Risk calculators are provided to facilitate clinical counseling.
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Affiliation(s)
| | - Shreya Louis
- Cleveland Clinic Lerner College of Medicine, Medical School, Cleveland, OH, USA
| | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Justin Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Jones
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland, OH, USA
| | | | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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19
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Grove RA, Madhavan D, Boone CHT, Braga CP, Papackova Z, Kyllo H, Samson K, Simeone K, Simeone T, Helikar T, Hanson CK, Adamec J. Aberrant energy metabolism and redox balance in seizure onset zones of epileptic patients. J Proteomics 2020; 223:103812. [PMID: 32418907 PMCID: PMC10588813 DOI: 10.1016/j.jprot.2020.103812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
Epilepsy is a disorder that affects around 1% of the population. Approximately one third of patients do not respond to anti-convulsant drugs treatment. To understand the underlying biological processes involved in drug resistant epilepsy (DRE), a combination of proteomics strategies was used to compare molecular differences and enzymatic activities in tissue implicated in seizure onset to tissue with no abnormal activity within patients. Label free quantitation identified 17 proteins with altered abundance in the seizure onset zone as compared to tissue with normal activity. Assessment of oxidative protein damage by protein carbonylation identified additional 11 proteins with potentially altered function in the seizure onset zone. Pathway analysis revealed that most of the affected proteins are involved in energy metabolism and redox balance. Further, enzymatic assays showed significantly decreased activity of transketolase indicating a disruption of the Pentose Phosphate Pathway and diversion of intermediates into purine metabolic pathway, resulting in the generation of the potentially pro-convulsant metabolites. Altogether, these findings suggest that imbalance in energy metabolism and redox balance, pathways critical to proper neuronal function, play important roles in neuronal network hyperexcitability and can be used as a primary target for potential therapeutic strategies to combat DRE. SIGNIFICANCE: Epileptic seizures are some of the most difficult to treat neurological disorders. Up to 40% of patients with epilepsy are resistant to first- and second-line anticonvulsant therapy, a condition that has been classified as refractory epilepsy. One potential therapy for this patient population is the ketogenic diet (KD), which has been proven effective against multiple refractory seizure types However, compliance with the KD is extremely difficult, and carries severe risks, including ketoacidosis, renal failure, and dangerous electrolyte imbalances. Therefore, identification of pathways disruptions or shortages can potentially uncover cellular targets for anticonvulsants, leading to a personalized treatment approach depending on a patient's individual metabolic signature.
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Affiliation(s)
- Ryan A Grove
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, United States of America
| | - Deepak Madhavan
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, United States of America
| | - Cory H T Boone
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, United States of America
| | - Camila Pereira Braga
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, United States of America
| | - Zuzana Papackova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, CZ, Czech Republic; Czech University of Life Science Prague, Faculty of Agrobiology-Food and Natural Recourses, Department of Veterinary Science, Prague, CZ, Czech Republic
| | - Hannah Kyllo
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, United States of America
| | - Kaeli Samson
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE 68178, United States of America
| | - Kristina Simeone
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE 68178, United States of America
| | - Timothy Simeone
- Department of Pharmacology, Creighton University School of Medicine, Omaha, NE 68178, United States of America
| | - Tomas Helikar
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, United States of America
| | - Corrine K Hanson
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, United States of America
| | - Jiri Adamec
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, United States of America.
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20
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Mesraoua B, Deleu D, Al Hail HJ, Melikyan G, Abdalhalim Ali M, Haddad N, Mohamed Ali YO, Elsheikh L, Ayyad A, Perkins J, Palomo GA, Asadi-Pooya AA. Prevalence and Incidence of Drug-Resistant Temporal Lobe Epilepsy in Qatar. J Cent Nerv Syst Dis 2020; 12:1179573520935031. [PMID: 32636694 PMCID: PMC7323268 DOI: 10.1177/1179573520935031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Information on the epidemiology of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) from Qatar and the developing countries is scarce. To acquire knowledge on the incidence and prevalence of drug-resistant TLE-HS in Qatar, we designed this analytical and extrapolative systematic review of the existing literature. Material and methods: We searched the electronic database PubMed from 1947 until April, 2018, using the following search terms in the title: “epilepsy” OR “temporal lobe” OR “hippocampal sclerosis” AND “epidemiology” OR “incidence” OR “prevalence.” Relevant original studies, reviews, and their references, were included. We extrapolated from the previous international literature to estimate the epidemiology of drug-resistant TLE-HS in Qatar. Results: The estimated Qatar incidence of epilepsy varies from 50 to 61 per 100 000 persons per year, and the estimated prevalence of epilepsy is 6.54 per 1000 population; the estimated incidence of TLE varies from 9.5 to 11.6 patients per 100 000 population per year and the estimated prevalence of TLE is 1.76 patients per 1000 people, with 4721 patients having TLE in Qatar. Finally, the reviewed studies also helped in making an estimate of the Qatar prevalence of drug-resistant TLE-HS to be between 0.3 and 0.6 cases per 1000 people (804-1609 current patients) and the Qatar incidence of drug-resistant TLE-HS (2.3-4.3 cases per 100 000 people, per year) with 62 to 116 new patients per year. Conclusion: Our study suggests that 804 to 1609 current patients (with 62-116 additional patients per year) in Qatar are suffering from drug-resistant TLE-HS; emphasis should be placed on the surgical aspect of the current Qatar Comprehensive Epilepsy Program.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Dirk Deleu
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Hassan J Al Hail
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Gayane Melikyan
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | | | - Naim Haddad
- Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Yasir Osman Mohamed Ali
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Lubna Elsheikh
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ayyad
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Jon Perkins
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gonzalo Alarcon Palomo
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.,Neurology, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.,Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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21
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Arifin MT, Bakhtiar Y, Andar EBPS, Kurnia B H, Priambada D, Risdianto A, Kusnarto G, Tsaniadi K, Bunyamin J, Hanaya R, Arita K, Bintoro AC, Iida K, Kurisu K, Askoro R, Briliantika SP, Muttaqin Z. Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources. Sci Rep 2020; 10:8144. [PMID: 32424296 PMCID: PMC7235248 DOI: 10.1038/s41598-020-64968-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 11/08/2022] Open
Abstract
Approximately 26-30% of temporal lobe epilepsy (TLE) cases display a normal-appearing magnetic resonance image (MRI) leading to difficulty in determining the epileptogenic focus. This causes challenges in surgical management, especially in countries with limited resources. The medical records of 154 patients with normal-appearing MRI TLE who underwent epilepsy surgery between July 1999 and July 2019 in our epilepsy centre in Indonesia were examined. The primary outcome was the Engel classification of seizures. Anterior temporal lobectomy was performed in 85.1% of the 154 patients, followed by selective amygdalo-hippocampectomy and resection surgery. Of 82 patients (53.2%), Engel Class I result was reported in 69.5% and Class II in 25.6%. The median seizure-free period was 13 (95% CI,12.550-13.450) years, while the seizure-free rate at 5 and 12 years follow-up was 96.3% and 69.0%, respectively. Patients with a sensory aura had better seizure-free outcome 15 (11.575-18.425) years. Anterior temporal lobectomy and selective amygdala-hippocampectomy gave the same favourable outcome. Despite the challenges of surgical procedures for normal MRI TLE, our outcome has been favourable. This study suggests that epilepsy surgery in normal MRI TLE can be performed in centres with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia.
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Erie B P S Andar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Happy Kurnia B
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Dody Priambada
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ajid Risdianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Gunadi Kusnarto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Krisna Tsaniadi
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Surya P Briliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
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22
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Grewal SS, Alvi MA, Perkins WJ, Cascino GD, Britton JW, Burkholder DB, So E, Shin C, Marsh RW, Meyer FB, Worrell GA, Van Gompel JJ. Reassessing the impact of intraoperative electrocorticography on postoperative outcome of patients undergoing standard temporal lobectomy for MRI-negative temporal lobe epilepsy. J Neurosurg 2020; 132:605-614. [PMID: 30797216 DOI: 10.3171/2018.11.jns182124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Almost 30% of the patients with suspected temporal lobe epilepsy (TLE) have normal results on MRI. Success rates for resection of MRI-negative TLE are less favorable, ranging from 36% to 76%. Herein the authors describe the impact of intraoperative electrocorticography (ECoG) augmented by opioid activation and its effect on postoperative seizure outcome. METHODS Adult and pediatric patients with medically resistant MRI-negative TLE who underwent standardized ECoG at the time of their elective anterior temporal lobectomy (ATL) with amygdalohippocampectomy between 1990 and 2016 were included in this study. Seizure recurrence comprised the primary outcome of interest and was assessed using Kaplan-Meier and multivariable Cox regression analysis plots based on distribution of interictal epileptiform discharges (IEDs) recorded on scalp electroencephalography, baseline and opioid-induced IEDs on ECoG, and extent of resection. RESULTS Of the 1144 ATLs performed at the authors' institution between 1990 and 2016, 127 (11.1%) patients (81 females) with MRI-negative TLE were eligible for this study. Patients with complete resection of tissue generating IED recorded on intraoperative ECoG were less likely to have seizure recurrence compared to those with incomplete resection on univariate analysis (p < 0.05). No difference was found in seizure recurrence between patients with bilateral independent IEDs and unilateral IEDs (p = 0.15), presence or absence of opioid-induced epileptiform activation (p = 0.61), or completeness of resection of tissue with opioid-induced IEDs on intraoperative ECoG (p = 0.41). CONCLUSIONS The authors found that incomplete resection of IED-generating tissue on intraoperative ECoG was associated with an increased chance of seizure recurrence. However, they found that induction of epileptiform activity with intraoperative opioid activation did not provide useful intraoperative data predictive of improving operative results for temporal lobectomy in MRI-negative epilepsy.
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Affiliation(s)
- Sanjeet S Grewal
- 1Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; and
| | | | | | | | | | | | - Elson So
- 4Neurology, Mayo Clinic, Rochester, Minnesota
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23
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Yardi R, Morita-Sherman ME, Fitzgerald Z, Punia V, Bena J, Morrison S, Najm I, Bingaman W, Jehi L. Long-term outcomes of reoperations in epilepsy surgery. Epilepsia 2020; 61:465-478. [PMID: 32108946 DOI: 10.1111/epi.16452] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze longitudinal seizure outcomes following epilepsy surgery, including reoperations, in patients with intractable focal epilepsy. METHODS Clinicoradiological characteristics of patients who underwent epilepsy surgery from 1995 to 2016 with follow-up of ≥1 year were reviewed. In patients undergoing reoperations, the latest resection was considered the index surgery. The primary outcome was complete seizure freedom (Engel I) at last follow-up. Potentially significant outcome variables were first identified using univariate analyses and then fit in multivariate Cox proportional hazards models. RESULTS Of 898 patients fulfilling study criteria, 110 had reoperations; 92 had one resection prior to the index surgery and 18 patients had two or more prior resective surgeries. Two years after the index surgery, 69% of patients with no prior surgeries had an Engel score of I, as opposed to only 42% of those with one prior surgery, and 33% of those with two or more prior resections (P < .001). Among surgical outcome predictors, the number of prior epilepsy surgeries, female sex, lesional initial magnetic resonance imaging, no prior history of generalization, and pathology correlated with better seizure outcomes on univariate analysis. However, only sex (P = .011), history of generalization (P = .016), and number of prior surgeries (P = .002) remained statistically significant in the multivariate model. SIGNIFICANCE Although long-term seizure control is possible in patients with failed prior epilepsy surgery, the chances of success diminish with every subsequent resection. Outcome is additionally determined by inherent biological markers (sex and secondary generalization tendency), rather than traditional outcome predictors, supporting a hypothesis of "surgical refractoriness."
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Affiliation(s)
- Ruta Yardi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Quantitative Health Sciences, Cleveland, Ohio
| | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
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24
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Ljunggren S, Andersson‐Roswall L, Imberg H, Samuelsson H, Malmgren K. Predicting verbal memory decline following temporal lobe resection for epilepsy. Acta Neurol Scand 2019; 140:312-319. [PMID: 31273754 DOI: 10.1111/ane.13146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to develop a prediction model for verbal memory decline after temporal lobe resection (TLR) for epilepsy. The model will be used in the preoperative counselling of patients to give individualized information about risk for verbal memory decline. MATERIALS AND METHODS A sample of 110 consecutive patients who underwent TLR for epilepsy at Sahlgrenska University Hospital between 1987 and 2011 constituted the basis for the prediction model. They had all gone through a formal neuropsychological assessment before surgery and 2 years after. Penalized regression and 20 × 10-fold cross-validation were used in order to build a reliable model for predicting individual risks. RESULTS The final model included four predictors: side of surgery; inclusion or not of the hippocampus in the resection; preoperative verbal memory function; and presence/absence of focal to bilateral tonic-clonic seizures (TCS) the last year prior to the presurgical investigation. The impact of a history of TCS is a new finding which we interpret as a sign of a more widespread network disease which influences neuropsychological function and the cognitive reserve. The model correctly identified 82% of patients with post-operative decline in verbal memory, and the overall accuracy was 70%-85% depending on choice of risk thresholds. CONCLUSIONS The model makes it possible to provide patients with individualized prediction regarding the risk of verbal memory decline following TLR. This will help them make more informed decisions regarding treatment, and it will also enable the epilepsy surgery team to prepare them better for the rehabilitation process.
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Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Lena Andersson‐Roswall
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen Gothenburg Sweden
- Department of Mathematical Sciences Chalmers University of Technology and the University of Gothenburg Gothenburg Sweden
| | - Hans Samuelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Psychology University of Gothenburg Gothenburg Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
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25
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Milovanović JR, Janković SM, Milovanović D, Ružić Zečević D, Folić M, Kostić M, Ranković G, Stefanović S. Contemporary surgical management of drug-resistant focal epilepsy. Expert Rev Neurother 2019; 20:23-40. [DOI: 10.1080/14737175.2020.1676733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Dragan Milovanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Marko Folić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Kostić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Goran Ranković
- Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Srđan Stefanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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26
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Yan Q, Gaspard N, Zaveri HP, Blumenfeld H, Hirsch LJ, Spencer DD, Alkawadri R. The connectivity index: an effective metric for grading epileptogenicity. J Neurosurg 2019; 133:971-978. [PMID: 31561212 DOI: 10.3171/2019.4.jns195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the performance of a metric of functional connectivity to classify and grade the excitability of brain regions based on evoked potentials in response to single-pulse electrical stimulation (SPES). METHODS Patients who underwent 1-Hz frequency stimulation at prospectively selected contacts between 2003 and 2014 at the Yale Comprehensive Epilepsy Center were included. The stimulated contacts were classified as the seizure onset zone (SOZ), highly irritative zone (possibly epileptogenic irritative zone [IZp]), and control contacts not involved in the epileptic activity. Response contacts were classified as SOZ, active interictal irritative zone (IZ), quiet, or other. The normalized number of responses was defined as the number of contacts with any evoked responses divided by the total number of recorded contacts, and the normalized distance is the ratio of the average distance between the site of stimulation and sites of evoked responses to the average distances between the site of stimulation and all other recording contacts. A new metric that the authors labeled the connectivity index (CI) is defined as the product of the 2 values. RESULTS A total of 57 stimulation sessions in 22 patients were analyzed. The CI of the SOZ was higher than for control contacts (median CI of 0.74 vs 0.16, p = 0.0002). The evoked responses after stimulation of SOZ were seen at further distances compared to control (median normalized distance 0.96 vs 0.62, p = 0.0005). It was 1.8 times more likely that a response would be recorded at the SOZ than in nonepileptic contacts after stimulation of a control site. Habitual seizures were triggered in 27% of patients and 35% of SOZ contacts (median stimulation intensity 4 mA) but in none of the control or IZp contacts. Non-SOZ contacts in multifocal or poor surgical outcome cases had a higher CI than non-SOZ contacts in patients with localizable onsets (median CI of 0.5 vs 0.12, p = 0.04). There was a correlation between the stimulation current intensity and the normalized number of evoked responses (r = + 0.49, p = 0.01) but not with distance (r = + 0.1, p = 0.64). CONCLUSIONS The authors found enhanced connectivity when stimulating the SOZ compared to stimulating control contacts; responses were more distant as well. Habitual auras and seizures provoked by SPES were highly predictive of brain sites involved in seizure generation.
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Affiliation(s)
- Qi Yan
- Departments of1Neurology and
- 3The Human Brain Mapping Program, Yale University, New Haven, Connecticut
| | - Nicolas Gaspard
- Departments of1Neurology and
- 3The Human Brain Mapping Program, Yale University, New Haven, Connecticut
- 4Hôpital Erasme-ULB, Cliniques Universitaires de Bruxelles, Bruxelles, Belgium; and
| | | | - Hal Blumenfeld
- Departments of1Neurology and
- 2Neurosurgery, School of Medicine, and
| | | | | | - Rafeed Alkawadri
- Departments of1Neurology and
- 3The Human Brain Mapping Program, Yale University, New Haven, Connecticut
- 5Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Blackmon K, Barr WB, Morrison C, MacAllister W, Kruse M, Pressl C, Wang X, Dugan P, Liu AA, Halgren E, Devinsky O, Thesen T. Cortical gray-white matter blurring and declarative memory impairment in MRI-negative temporal lobe epilepsy. Epilepsy Behav 2019; 97:34-43. [PMID: 31181427 PMCID: PMC8162756 DOI: 10.1016/j.yebeh.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) may be a distinct syndrome from TLE with mesial temporal sclerosis (TLE-MTS). Imaging and neuropsychological features of TLE-MTS are well-known; yet, these features are only beginning to be described in MRI-negative TLE. This study examined whether a quantitative measure of cortical gray and white matter blurring (GWB) was elevated in the temporal lobes ipsilateral to the seizure onset zone of individuals with MRI-negative TLE relative to TLE-MTS and healthy controls (HCs) and whether GWB elevations were associated with neuropsychological comorbidity. Gray-white matter blurring from 34 cortical regions and hippocampal volumes were quantified and compared across 28 people with MRI-negative TLE, 15 people with TLE-MTS, and 51 HCs. Declarative memory was assessed with standard neuropsychological tests and the intracarotid amobarbital procedure (IAP). In the group with MRI-negative TLE (left and right onsets combined), hippocampal volumes were within normal range but GWB was elevated, relative to HCs, across several mesial and lateral temporal lobe regions ipsilateral to the seizure onset zone. Gray-white matter blurring did not differ between the groups with TLE-MTS and HC or between the groups with TLE-MTS and MRI-negative TLE. The group with MRI-negative TLE could not be distinguished from the group with TLE-MTS on any of the standard neuropsychological tests; however, ipsilateral hippocampal volumes and IAP memory scores were lower in the group with TLE-MTS than in the group with MRI-negative TLE. The group with left MRI-negative TLE had lower general cognitive abilities and verbal fluency relative to the HC group, which adds to the characterization of neuropsychological comorbidities in left MRI-negative TLE. In addition, ipsilateral IAP memory performance was reduced relative to contralateral memory performance in MRI-negative TLE, indicating some degree of ipsilateral memory dysfunction. There was no relationship between hippocampal volume and IAP memory scores in MRI-negative TLE; however, decreased ipsilateral IAP memory scores were correlated with elevated GWB in the ipsilateral superior temporal sulcus of people with left MRI-negative TLE. In sum, GWB elevations in the ipsilateral temporal lobe of people with MRI-negative TLE suggest that GWB may serve as a marker for reduced structural integrity in regions in or near the seizure onset zone. Although mesial temporal abnormalities might be the major driver of memory dysfunction in TLE-MTS, a loss of structural integrity in lateral temporal lobe regions may contribute to IAP memory dysfunction in MRI-negative TLE.
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Affiliation(s)
- Karen Blackmon
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America; St. George's University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada.
| | - William B. Barr
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Chris Morrison
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - William MacAllister
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Michelle Kruse
- St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
| | - Christina Pressl
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,The Rockefeller University, Laboratory of Neural Systems, New York, NY 10065, United States of America
| | - Xiuyuan Wang
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,New York University School of Medicine, Department of Radiology, New York, NY 10016, United States of America
| | - Patricia Dugan
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Anli A. Liu
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Eric Halgren
- University of California San Diego, Multimodal Imaging Laboratory, San Diego, CA 92093, United States of America
| | - Orrin Devinsky
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
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Mariani V, Revay M, D'Orio P, Rizzi M, Pelliccia V, Nichelatti M, Bottini G, Nobili L, Tassi L, Cossu M. Prognostic factors of postoperative seizure outcome in patients with temporal lobe epilepsy and normal magnetic resonance imaging. J Neurol 2019; 266:2144-2156. [PMID: 31127383 DOI: 10.1007/s00415-019-09394-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To retrospectively analyse a single-centre consecutive surgical series of patients with temporal lobe epilepsy (TLE) and negative MRI. To identify factors associated with postoperative seizure outcome among several presurgical, surgical and postsurgical variables. METHODS Clinical records of 866 patients who received temporal lobe resections and with a minimum follow-up of 12 months were retrospectively searched for MRI-negative cases. Anamnestic, clinical, neurophysiological, surgical, histopathological and postsurgical data were collected. Seizure outcome was categorised as favourable (Engel's class I) and unfavourable (Engel's classes II-IV). Uni- and multivariate statistical analysis was performed to identify variables having a significant association with seizure outcome. RESULTS Forty-eight patients matched the inclusion criteria. 26 (54.1%) patients required invasive EEG evaluation with Stereo-electro-encephalography (SEEG) before surgery. Histological evaluation was unremarkable in 34 cases (70.8%), revealed focal cortical dysplasias in 13 cases and hippocampal sclerosis in 2. 28 (58.3%) patients were in Engel's class I after a mean follow-up of 82 months (SD ± 74; range 12-252). Multivariate analysis indicated auditory aura, contralateral diffusion of the discharge at Video-EEG monitoring and use of 18F-FDG PET as variables independently associated with seizure outcome. CONCLUSION Carefully selected patients with MRI-negative TLE can be good candidates for surgery. Surgery should be considered with caution in patients with clinical features of neocortical seizure onset and contralateral propagation of the discharge. Use of 18F-FDG PET may be helpful to improve SEEG and surgical strategies. The presented data help in optimising the selection of patients with MRI-negative TLE with good chances to benefit from surgery.
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Affiliation(s)
- Valeria Mariani
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy. .,Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy. .,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan, Milan, Italy
| | - Piergiorgio D'Orio
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Michele Rizzi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Neuroscience, University of Parma, Parma, Italy
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriella Bottini
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, Istituto Giannina Gaslini, DINOGMI, University of Genova, Genoa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
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He X, Zhai F, Guan Y, Zhou J, Li T, Luan G. Surgical outcomes and prognostic factors of drug-resistant epilepsy secondary to encephalomalacia. Epilepsia 2019; 60:948-957. [PMID: 30980678 DOI: 10.1111/epi.14733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/06/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate long-term outcomes and prognostic factors in patients who underwent surgical resection for drug-resistant epilepsy secondary to encephalomalacia. METHODS A total of 143 patients with drug-resistant epilepsy who underwent surgical resection with a follow-up of at least 5 years were included. Seizure outcomes were evaluated based on the International League Against Epilepsy classification. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes. RESULTS Three months after surgery, 102 of 143 (71.3%) patients had achieved favorable seizure outcomes. Five years after surgery, 107 of 143 (74.8%) patients had achieved favorable seizure outcomes. Changes in the postoperative seizure status were observed in 22 of 143 (15.4%) patients during follow-up, but the difference in the seizure-free rate between 3 months and 5 years after surgery was not significant. Univariate and multivariate analyses revealed that only a monthly seizure frequency of >30 seizures (odds ratio = 3.42, 95% confidence interval = 1.19-9.76) and bilateral ictal onset rhythms (odds ratio = 4.46, 95% confidence interval = 1.61-12.39) were independent predictors of unfavorable seizure outcomes. SIGNIFICANCE Surgical resection is an effective treatment for patients with drug-resistant epilepsy secondary to encephalomalacia. Knowledge of the predictors of seizure outcomes may help during preoperative counseling and selection of optimal candidates for epilepsy surgery among patients with drug-resistant epilepsy secondary to encephalomalacia.
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Affiliation(s)
- Xinghui He
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Guoming Luan
- Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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30
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Magnetic Resonance–Guided Laser Interstitial Thermal Therapy Versus Stereotactic Radiosurgery for Medically Intractable Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications. World Neurosurg 2019; 122:e32-e47. [DOI: 10.1016/j.wneu.2018.08.227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022]
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A classification system for verifying the long-term efficacy of resective surgery for drug-resistant seizures. Epilepsy Res 2018; 141:23-30. [PMID: 29414384 DOI: 10.1016/j.eplepsyres.2018.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To verify the long-term efficacy of resective surgery, we created a classification system in which strictly defined patterns of postoperative seizure emergence are incorporated as basic components and the seizure states throughout the entire follow-up period are assessed comprehensively. METHODS In our system, Class I has three subclasses (A-C); subclasses A and B are identical to Engel I-A and I-B, respectively. Subclass C comprises patients whose disabling seizures remit within the first 2 years postoperatively. Patients in Class II have only 1-3 days with disabling seizures throughout follow-up after the first 2 years. Patients in Class III have a maximum of 3 seizure days annually, and those in Class IV have ≥4 seizure days annually after the first 2 years. Classes II-IV each have 2 subclasses (A and B): subclass A, late recurrence (i.e., the first seizure occurs after 2 years postoperatively); and subclass B, early recurrence (i.e., first seizure within 2 years). In 646 patients who underwent resective surgery (temporal lobe resection, 74.6%) and were followed for at least 8 years (mean, 14.6 years), we analyzed three patterns of postoperative seizures: early remission, late recurrence, and occasional seizures. In addition, we investigated the differences between the long-term seizure outcomes of the cohort as determined according to our system and the Engel scale. RESULTS Overall, 52.9% of the cohort experienced at least one disabling seizure postoperatively throughout the follow-up period; in 1/3 of these patients, the first seizure occurred after 2 years. In 73.8% of the 80 patients who manifested the running-down phenomenon, seizure remission occurred within the first 2 years. In addition, 36.7% of the 283 patients who had disabling seizures after 2 years experienced only 1-3 seizure days. Engel Class I-C included about 30% of the patients who had ≥4 seizure days after 2 years. The long-term seizure outcomes, determined according to our system, were: Class I, 56.2% (C, 9.1%) of the overall cohort; Class II, 16.1% (A, 11.0%); and Class III/IV, 27.7% (A, 6.6%). CONCLUSION Our system clarifies the actual effect of resective surgery more precisely than the Engel scale and thus may be useful for comparing outcomes between different surgical procedures or for identifying potential risk factors predicting unfavorable outcome.
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The oxymoron of image-guided resection in 3 T MRI-negative extratemporal epilepsy: Technique and postoperative results. Clin Neurol Neurosurg 2018; 166:16-22. [PMID: 29358107 DOI: 10.1016/j.clineuro.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We share our experience with extratemporal MRI-negative epilepsies that received "image-guided" resection with the use of neuronavigation after invasive presurgical video-EEG monitoring. We describe and discuss our technique of image generation, navigation system registration, and surgical resection. In addition, we evaluate seizure outcome with respect to the preoperatively planned versus achieved resection. PATIENTS AND METHODS Seven patients with 3 T MRI-negative extratemporal epilepsy received navigation-guided resective surgery. The resection plan was based on electrophysiological data from intracranial EEG recordings. For each case a resection segment was created in the neuronavigation device in a systematic manner. We compared the preoperatively planned segment to the achieved resection and looked for correlation with postoperative seizure outcome according to Engel classification, at last follow-up (mean 2.4 years, range 1-4 years). RESULTS Mean volume of planned resections was 23.8 ± 15.3 cm3 and of achieved resections 17 ± 10.4 cm3. There was complete overlap with planned resection in 4 patients and partial overlap in 3. Postoperative seizure outcome was class I in 4 patients (57%), IIIA in 1 patient and IVB in 2 patients. Three patients reached seizure-freedom (Engel IA). Volume of planned resection, volume difference of planned versus achieved resection and level of overlap (complete versus partial) did not significantly correlate to seizure outcome. CONCLUSION The use of neuronavigation for planning and executing a tailored resection in MRI-negative extratemporal epilepsy is elaborate but can be an effective procedure.
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He K, Jiang S, Song J, Wu Z, Chen L, Mao Y. Long-Term Outcomes of Surgical Treatment in 181 Patients with Supratentorial Cerebral Cavernous Malformation–Associated Epilepsy. World Neurosurg 2017; 108:869-875. [DOI: 10.1016/j.wneu.2017.08.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Kogias E, Klingler JH, Urbach H, Scheiwe C, Schmeiser B, Doostkam S, Zentner J, Altenmüller DM. 3 Tesla MRI-negative focal epilepsies: Presurgical evaluation, postoperative outcome and predictive factors. Clin Neurol Neurosurg 2017; 163:116-120. [PMID: 29101859 DOI: 10.1016/j.clineuro.2017.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate presurgical diagnostic modalities, clinical and seizure outcome as well as predictive factors after resective epilepsy surgery in 3 Tesla MRI-negative focal epilepsies. PATIENTS AND METHODS This retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated. RESULTS All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome. CONCLUSIONS In almost two thirds of temporal and extratemporal epilepsies defined as "non-lesional" by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center-University of Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, Medical Center-University of Freiburg, Germany
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Kogias E, Altenmüller DM, Klingler JH, Schmeiser B, Urbach H, Doostkam S. Histopathology of 3 Tesla MRI-negative temporal lobe epilepsies. J Clin Neurosci 2017; 47:273-277. [PMID: 29042148 DOI: 10.1016/j.jocn.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Histopathology of MRI-negative temporal lobe epilepsies (TLE) shows heterogeneous findings. The use of either 1.5 or 3 Tesla MRI for the selection of MRI-negative cases and use of older classification systems instead of the current ILAE classification system may account for this heterogeneity. We focus on histopathology of 3 Tesla MRI-negative TLE according to ILAE criteria and investigate potential correlation to seizure outcome 1 year postoperatively. MATERIALS AND METHODS Twenty specimens (9 neocortical, 11 hippocampal) from eleven 3 Tesla MRI-negative patients with TLE were examined in two steps. Standard stains and immunohistochemical reactions as well as Palmini and Wyler criteria were used prospectively during the initial examination. Retrospectively, all specimens were re-examined and re-evaluated. Phospho-6 and calretinin stains and the ILAE criteria were used during the review examination. RESULTS Initial examination revealed 7 focal cortical dysplasias (FCDs) Palmini type 1, two cases of cortical gliosis, 4 cases of hippocampal sclerosis (HS) Wyler grade 1 and seven cases of hippocampal gliosis. The review examination according to ILAE criteria revealed 4 FCDs type I and 5 mild malformations of cortical development. All hippocampal specimens showed "no HS/gliosis only" after the review examination. Histopathology showed no correlation to seizure outcome. DISCUSSION This is the first histopathological study to include only 3 Tesla MRI-negative cases. The use of ILAE criteria lead to the diagnosis of "no HS/gliosis only" of all hippocampal specimens, a finding not in line with previously reported series. The spectrum of diagnoses within neocortical specimens showed accordingly more mild findings.
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Affiliation(s)
- Evangelos Kogias
- Department of Neurosurgery, Medical Center- University of Freiburg, Germany.
| | | | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center- University of Freiburg, Germany
| | - Barbara Schmeiser
- Department of Neurosurgery, Medical Center- University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center- University of Freiburg, Germany
| | - Soroush Doostkam
- Institute of Neuropathology, Medical Center- University of Freiburg, Germany
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Ivanovic J, Larsson PG, Østby Y, Hald J, Krossnes BK, Fjeld JG, Pripp AH, Alfstad KÅ, Egge A, Stanisic M. Seizure outcomes of temporal lobe epilepsy surgery in patients with normal MRI and without specific histopathology. Acta Neurochir (Wien) 2017; 159:757-766. [PMID: 28281007 PMCID: PMC5385196 DOI: 10.1007/s00701-017-3127-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/16/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Seizure outcome following surgery in pharmacoresistant temporal lobe epilepsy patients with normal magnetic resonance imaging and normal or non-specific histopathology is not sufficiently presented in the literature. METHODS In a retrospective design, we reviewed data of 263 patients who had undergone temporal lobe epilepsy surgery and identified 26 (9.9%) who met the inclusion criteria. Seizure outcomes were determined at 2-year follow-up. Potential predictors of Engel class I (satisfactory outcome) were identified by logistic regression analyses. RESULTS Engel class I outcome was achieved in 61.5% of patients, 50% being completely seizure free (Engel class IA outcome). The strongest predictors of satisfactory outcome were typical ictal seizure semiology (p = 0.048) and localised ictal discharges on scalp EEG (p = 0.036). CONCLUSION Surgery might be an effective treatment choice for the majority of these patients, although outcomes are less favourable than in patients with magnetic resonance imaging-defined lesional temporal lobe epilepsy. Typical ictal seizure semiology and localised ictal discharges on scalp EEG were predictors of Engel class I outcome.
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Affiliation(s)
- Jugoslav Ivanovic
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway.
| | - Pål G Larsson
- Clinical Neurophysiologic Laboratory, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Ylva Østby
- Department of Clinical Psychology and Neuropsychology, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - John Hald
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Bård K Krossnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Jan G Fjeld
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Kristin Å Alfstad
- Department of Adult Epilepsy, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway
| | - Milo Stanisic
- Department of Neurosurgery, Oslo University Hospital, Sognsvannsveien 20, N-0027, Oslo, Norway
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Muhlhofer W, Tan Y, Mueller SG, Knowlton R. MRI
‐negative temporal lobe epilepsy—What do we know? Epilepsia 2017; 58:727-742. [DOI: 10.1111/epi.13699] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wolfgang Muhlhofer
- University of California San Francisco (UCSF) San Francisco California U.S.A
- University of Alabama Birmingham (UAB) Birmingham Alabama U.S.A
| | - Yee‐Leng Tan
- University of California San Francisco (UCSF) San Francisco California U.S.A
- National Neuroscience Institute Singapore Singapore
| | - Susanne G. Mueller
- University of California San Francisco (UCSF) San Francisco California U.S.A
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco California U.S.A
- Department of Radiology UCSF San Francisco CaliforniaU.S.A
| | - Robert Knowlton
- University of California San Francisco (UCSF) San Francisco California U.S.A
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Prevalence and Incidence of Drug-Resistant Mesial Temporal Lobe Epilepsy in the United States. World Neurosurg 2017; 99:662-666. [DOI: 10.1016/j.wneu.2016.12.074] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/13/2022]
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Ren ZW, Li YJ, Yu T, Ni DY, Zhang GJ, Du W, Piao YY, Zhou XX. High-frequency and brief-pulse stimulation pulses terminate cortical electrical stimulation-induced afterdischarges. Neural Regen Res 2017; 12:938-944. [PMID: 28761427 PMCID: PMC5514869 DOI: 10.4103/1673-5374.208576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Brief-pulse stimulation at 50 Hz has been shown to terminate afterdischarges observed in epilepsy patients. However, the optimal pulse stimulation parameters for terminating cortical electrical stimulation-induced afterdischarges remain unclear. In the present study, we examined the effects of different brief-pulse stimulation frequencies (5, 50 and 100 Hz) on cortical electrical stimulation-induced afterdischarges in 10 patients with refractory epilepsy. Results demonstrated that brief-pulse stimulation could terminate cortical electrical stimulation-induced afterdischarges in refractory epilepsy patients. In conclusion, (1) a brief-pulse stimulation was more effective when the afterdischarge did not extend to the surrounding brain area. (2) A higher brief-pulse stimulation frequency (especially 100 Hz) was more likely to terminate an afterdischarge. (3) A low current intensity of brief-pulse stimulation was more likely to terminate an afterdischarge
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Affiliation(s)
- Zhi-Wei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yong-Jie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Duan-Yu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Guo-Jun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Du
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yuan-Yuan Piao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiao-Xia Zhou
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
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Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy. J Neurol Sci 2016; 369:330-332. [PMID: 27653919 DOI: 10.1016/j.jns.2016.09.001] [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: 08/01/2016] [Revised: 08/22/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated. RESULTS One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver operating characteristic curve of timing of the last preoperative tonic-clonic seizure was a moderate indicator to anticipate surgery failure (area under the curve: 0.657, significance; 0.016). The best cutoff that maximizes sensitivity and specificity was 27months; with a sensitivity of 0.76 and specificity of 0.60. Cox-Mantel analysis confirmed that the chance of becoming free of seizures after surgery in patients with no or remote history of preoperative tonic-clonic seizures was significantly higher compared with patients with a recent history (i.e., in 27months before surgery) (p=0.0001). CONCLUSIONS The more remote the occurrence of preoperative tonic-clonic seizures, the better the postsurgical seizure outcome, with at least a two year gap being more favorable. A recent history of tonic-clonic seizures in a patient with MTLE may reflect more widespread epileptogenicity extending beyond the borders of mesial temporal structures.
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Asadi-Pooya AA, Asadollahi M, Tinker J, Nei M, Sperling MR. Post-epilepsy surgery psychogenic nonepileptic seizures. Epilepsia 2016; 57:1691-1696. [PMID: 27554951 DOI: 10.1111/epi.13513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated the prevalence of post-epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug-resistant epilepsy and the possible influence of risk factors on these seizures. METHODS In this retrospective study, we examined data from all patients with a clinical diagnosis of drug-resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson Comprehensive Epilepsy Center between 1986 and 2016. Postsurgical outcome was identified for up to 15 years after surgery. Diagnosis of PNES was verified in the epilepsy monitoring unit with video-electroencephalography (EEG) ictal recording. Potential associated factors were assessed by comparing patients with or without postoperative PNES. RESULTS A total of 1,105 patients were studied; 697 patients had postoperative seizures, and, of these, 27 patients (3.9%) had documented PNES after surgery. A full-scale intelligence quotient (IQ) <80 was significantly associated with post-epilepsy surgery PNES (odds ratio [OR] 2.89, p = 0.007, 95% confidence interval [CI] 1.33-6.29). A history of a preoperative psychiatric diagnosis was also significantly associated with post-epilepsy surgery PNES (OR 4.67, p = 0.0001, 95% CI 2.01-10.82). Other factors were not significantly associated with post-epilepsy surgery PNES. SIGNIFICANCE Post-epilepsy surgery PNES should be considered when patients report recurrent seizures after epilepsy surgery. Although these seizures probably occur relatively infrequently, attention to factors such as appearance of new ictal behaviors, a preoperative history of a psychiatric disorder, and a low full-scale IQ should raise suspicion and lead to appropriate diagnostic measures.
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Affiliation(s)
- Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
| | - Marjan Asadollahi
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer Tinker
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maromi Nei
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Seizure clusters in drug-resistant focal epilepsy. Epilepsia 2016; 57:e187-90. [PMID: 27417685 DOI: 10.1111/epi.13465] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 01/19/2023]
Abstract
We investigated clinical factors associated with seizure clustering in patients with drug-resistant focal epilepsy and any association between seizure clustering and outcome after surgery. We performed a retrospective study including patients with a diagnosis of drug-resistant focal epilepsy who underwent epilepsy surgery. Patients were prospectively registered in a database from 1986 until 2015. Seizure cluster was defined as two or more seizures occurring within 2 days. Potential risk factors for seizure clustering were assessed. To investigate any potential association between seizure clusters and seizure outcome after surgery, time to event analysis was used to produce a Kaplan-Meier estimate of seizure recurrence. We studied 764 patients. Seizure clusters were reported in 23.6% of patients with temporal lobe epilepsy (TLE) and 16.9% of extratemporal patients (p = 0.2). We could not identify any significant clinical factors associated with seizure clustering. Among patients with TLE, those who had history of seizure clusters fared better after surgery (p < 0.01). We found that seizure clusters relate to prognosis after temporal lobe surgery in drug-resistant TLE. These data may provide added value for surgical prognostication when combined with other data types. A better understanding of the neurobiology underlying seizure clusters is needed.
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Affiliation(s)
- Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maromi Nei
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ashwini Sharan
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Bernhardt BC, Bernasconi A, Liu M, Hong SJ, Caldairou B, Goubran M, Guiot MC, Hall J, Bernasconi N. The spectrum of structural and functional imaging abnormalities in temporal lobe epilepsy. Ann Neurol 2016; 80:142-53. [PMID: 27228409 DOI: 10.1002/ana.24691] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although most temporal lobe epilepsy (TLE) patients show marked hippocampal sclerosis (HS) upon pathological examination, 40% present with no significant cell loss but gliotic changes only. To evaluate effects of hippocampal pathology on brain structure and functional networks, we aimed at dissociating multimodal magnetic resonance imaging (MRI) characteristics in patients with HS (TLE-HS) and those with gliosis only (TLE-G). METHODS In 20 TLE-HS, 19 TLE-G, and 25 healthy controls, we carried out a novel MRI-based hippocampal subfield surface analysis that integrated volume, T2 signal intensity, and diffusion markers with seed-based hippocampal functional connectivity. RESULTS Compared to controls, TLE-HS presented with marked ipsilateral atrophy, T2 hyperintensity, and mean diffusivity increases across all subfields, whereas TLE-G presented with dentate gyrus hypertrophy, focal increases in T2 intensity and mean diffusivity. Multivariate assessment confirmed a more marked ipsilateral load of anomalies across all subfields in TLE-HS, whereas anomalies in TLE-G were restricted to the subiculum. A between-cohort dissociation was independently suggested by resting-state functional connectivity analysis, revealing marked hippocampal decoupling from anterior and posterior default mode hubs in TLE-HS, whereas TLE-G did not differ from controls. Back-projection connectivity analysis from cortical targets revealed consistently decreased network embedding across all subfields in TLE-HS, while changes in TLE-G were limited to the subiculum. Hippocampal disconnectivity strongly correlated to T2 hyperintensity and marginally to atrophy. INTERPRETATION Multimodal MRI reveals diverging structural and functional connectivity profiles across the TLE spectrum. Pathology-specific modulations of large-scale functional brain networks lend novel evidence for a close interplay of structural and functional disruptions in focal epilepsy. Ann Neurol 2016;80:142-153.
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Affiliation(s)
- Boris C Bernhardt
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Min Liu
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Benoit Caldairou
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Maged Goubran
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Radiology, Stanford School of Medicine, Stanford University, CA
| | - Marie C Guiot
- Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeff Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Cao K, Liu M, Wang C, Liu Q, Yang K, Tao L, Guo X. Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e3743. [PMID: 27281073 PMCID: PMC4907651 DOI: 10.1097/md.0000000000003743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022] Open
Abstract
To estimate children's long-term seizure outcomes after hemispheric surgery and the associated predictors.A systematic review of 4 databases and a meta-analysis were performed from January 1, 1995 to August 31, 2015. The databases included PubMed, Embase, Science Direct, and Web of Science; patients were classified into the Engel Class I group and the Engel Class II to IV group, according to their seizure outcomes. Nine potential predictors were then stratified across the groups and estimated using the Wilcoxon rank-sum test for continuous variables and the Chi-squared test for categorical variables.The search yielded 15 retrospective studies, with a total sample size of 380. Five years after surgery, 268 (0.71, 95% confidence interval [CI]: 0.64-0.78) children were seizure free; the seizure onset age in the Engel Class I group was significantly higher than that of the Engel Class II to IV group (standardized mean difference [SMD] = 0.26, 95% CI: 0.03-0.49, P = 0.028); specifically, when predicting the positive long-term outcomes, the odds ratio for late onset age (≥3.6 months, median value of the Engel Class II-IV group) versus early onset age was 2.65 (95% CI: 1.454-4.836, z = 3.18, P = 0.001). The abnormal magnetic resonance imaging (MRI) findings were more predictive for positive seizure outcomes than the normal findings (odds ratio [OR] = 4.60, 95% CI: 1.27-16.62, P = 0.02).Following hemispheric surgery, the long-term prognosis of children with epilepsy was good. Late seizure onset (age ≥ 3.6 months) and abnormal MRI findings were positive predictors for long-term seizure control in children.
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Affiliation(s)
- Kai Cao
- From the Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University (KC, CW, QL, KY, LT, XG); Beijing Municipal Key Laboratory of Clinical Epidemiology (KC, CW, QL, KY, LT, XG); Beijing Key Laboratory of Environment Toxicology (ML); School of Public Health, Capital Medical University (ML); and Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory (KC), Beijing, China
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Cortical gene expression correlates of temporal lobe epileptogenicity. ACTA ACUST UNITED AC 2016; 23:181-90. [PMID: 27354343 DOI: 10.1016/j.pathophys.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Despite being one of the most common neurological diseases, it is unknown whether there may be a genetic basis to temporal lobe epilepsy (TLE). Whole genome analyses were performed to test the hypothesis that temporal cortical gene expression differs between TLE patients with high vs. low baseline seizure frequency. METHODS Baseline seizure frequency was used as a clinical measure of epileptogenicity. Twenty-four patients in high or low seizure frequency groups (median seizures/month) underwent anterior temporal lobectomy with amygdalohippocampectomy for intractable TLE. RNA was isolated from the lateral temporal cortex and submitted for expression analysis. Genes significantly associated with baseline seizure frequency on likelihood ratio test were identified based on >0.90 area under the ROC curve, P value of <0.05. RESULTS Expression levels of forty genes were significantly associated with baseline seizure frequency. Of the seven most significant, four have been linked to other neurologic diseases. Expression levels associated with high seizure frequency included low expression of Homeobox A10, Forkhead box A2, Lymphoblastic leukemia derived sequence 1, HGF activator, Kelch repeat and BTB (POZ) domain containing 11, Thanatos-associated protein domain containing 8 and Heparin sulfate (glucosamine) 3-O-sulfotransferase 3A1. CONCLUSIONS This study describes novel associations between forty known genes and a clinical marker of epileptogenicity, baseline seizure frequency. Four of the seven discussed have been previously related to other neurologic diseases. Future investigation of these genes could establish new biomarkers for predicting epileptogenicity, and could have significant implications for diagnosis and management of temporal lobe epilepsy, as well as epilepsy pathogenesis.
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Mesial Temporal Lobe Epilepsy. World Neurosurg 2016; 89:78-83. [DOI: 10.1016/j.wneu.2016.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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Wang X, Zhang C, Wang Y, Hu W, Shao X, Zhang JG, Zhang K. Prognostic factors for seizure outcome in patients with MRI-negative temporal lobe epilepsy: A meta-analysis and systematic review. Seizure 2016; 38:54-62. [PMID: 27182689 DOI: 10.1016/j.seizure.2016.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to identify predictors of postoperative seizure freedom in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. METHOD Publications were screened from electronic databases (MEDLINE, EMBASE), epilepsy archives, and bibliographies of relevant articles that were written in English. We recorded all possible risk factors that might predict seizure outcome after surgery. We calculated odds ratio (OR) with corresponding 95% confidence intervals (95% CI) of predictors for postoperative seizure freedom. Heterogeneity was assessed with I(2). All meta-analyses were performed using Review Manager. RESULTS Epilepsy duration (OR=2.57, 95% CI=1.21-5.47, p<0.05, I(2)=1%) and ictal or interictal electroencephalographic anomalies precisely localized in the ipsilateral temporal lobe (OR=3.89, 95% CI=1.66-9.08, p<0.01, I(2)=0 and OR=3.38, 95% CI=1.57-7.25, p<0.05, I(2)=0, respectively) were significantly associated with a higher rate of seizure freedom after surgery. However, the positron emission tomography (PET) results were not predictive of postoperative seizure freedom (OR=2.11, 95% CI=0.95-4.65, p=0.06, I(2)=0). No significant difference in seizure freedom was observed between the positive and negative pathology groups (OR=1.36, 95% CI=0.70-2.63, p=0.36, I(2)=0). CONCLUSIONS A shorter epilepsy duration and scalp electroencephalogram (EEG) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy.
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Affiliation(s)
- Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China.
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Asadi-Pooya AA, Nei M, Sharan A, Sperling MR. Patient Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Nonlesional Temporal Lobe Epilepsy. World Neurosurg 2016; 91:205-9. [PMID: 27086259 DOI: 10.1016/j.wneu.2016.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the possible influence of risk factors on seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy (TLE). METHODS This retrospective study recruited patients with drug-resistant nonlesional TLE who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center and were followed for a minimum of 1 year. Patients had been prospectively registered in a database from 1991 to 2014. Postsurgical outcome was classified into 2 groups: seizure free or relapsed. The possible risk factors influencing long-term seizure outcome after surgery were investigated. RESULTS Ninety-five patients (42 males and 53 females) were studied. Fifty-four (56.8%) patients were seizure free. Only a history of febrile seizure in childhood affected the risk of postoperative seizure recurrence (odds ratio, 0.22; 95% confidence interval, 0.06-0.83; P = 0.02). Gender, race, family history of epilepsy, history of status epilepticus, duration of disease before surgery, aura symptoms, IQ, and seizure type or frequency were not predictors of outcome. CONCLUSIONS Many patients with drug-resistant nonlesional TLE responded favorably to surgery. The only factor predictive of seizure outcome after surgery was a history of febrile seizure in childhood. It is critical to distinguish among different types of TLE when assessing outcome after surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Maromi Nei
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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