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Garvayo M, Dupont S, Frazzini V, Bielle F, Adam C, Bendary YE, Méré M, Samson S, Guesdon A, Navarro V, Mathon B. Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study. J Neurol 2024:10.1007/s00415-024-12599-4. [PMID: 39069564 DOI: 10.1007/s00415-024-12599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients ≥ 50 years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients. METHODS We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged ≥ 50 years and compared the surgical safety and efficacy variables between this group and a control group of patients aged < 50 years through a case-control study. RESULTS Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged ≥ 50 years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7 years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p = 0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p = 0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p = 0.005). CONCLUSIONS This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged ≥ 50 years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.
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Affiliation(s)
- Marta Garvayo
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Valerio Frazzini
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Franck Bielle
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
- Department of Neuropathology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Claude Adam
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Yahia El Bendary
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Marie Méré
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Samson
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- ULR 4072 - PSITEC, University of Lille, Lille, France
- Institut Pasteur, INSERM, Institut de l'Audition, Université Paris Cité, Paris, France
| | - Alice Guesdon
- Department of Psychiatry, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Vincent Navarro
- Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
- Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.
- Sorbonne Université, GRC 23, Brain Machine Interface, APHP, Paris, France.
- Robotics and Surgical Innovation, Sorbonne Université GRC 33, APHP, Paris, France.
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Piccenna L, O'Dwyer R, Leppik I, Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar MB, Akamatsu N, Cretin B, Krämer G, Faught E, Kwan P. Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly. Epilepsia 2023; 64:567-585. [PMID: 36266921 DOI: 10.1111/epi.17426] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
Older adults represent a highly heterogeneous population, with multiple diverse subgroups. Therefore, an individualized approach to treatment is essential to meet the needs of each unique subgroup. Most comparative studies focusing on treatment of epilepsy in older adults have found that levetiracetam has the best chance of long-term seizure freedom. However, there is a lack of studies investigating other newer generation antiseizure medications (ASMs). Although a number of randomized clinical trials have been performed on older adults with epilepsy, the number of participants studied was generally small, and they only investigated short-term efficacy and tolerability. Quality of life as an outcome is often missing but is necessary to understand the effectiveness and possible side effects of treatment. Prognosis needs to move beyond the focus on seizure control to long-term patient-centered outcomes. Dosing studies with newer generation ASMs are needed to understand which treatments are the best in the older adults with different comorbidities. In particular, more high-level evidence is required for older adults with Alzheimer's disease with epilepsy and status epilepticus. Future treatment studies should use greater homogeneity in the inclusion criteria to allow for clearer findings that can be comparable with other studies to build the existing treatment evidence base.
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Affiliation(s)
- Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Neuroscience Platform, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Azienda Socio Sanitaria Territoriale (ASST) - San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - Monica B Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Naoki Akamatsu
- Department of Neurology, Fukuoka Sanno Hospital, International University of Health and Welfare School of Medicine, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Xu K, Wang X, Zhou J, Guan Y, Li T, Luan G. The differential role of magnetic resonance imaging in predicting surgical outcomes between children versus adults with temporal lobe epilepsy. Front Neurosci 2022; 16:1037244. [PMID: 36466178 PMCID: PMC9709438 DOI: 10.3389/fnins.2022.1037244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE This study aims to investigate the clinical discrepancies and the different predictors of anterior temporal lobectomy (ATL) in children (<18 years at surgery) and adults (>18 years at surgery) with temporal lobe epilepsy (TLE). MATERIALS AND METHODS A total of 262 patients (56 children and 206 adults) with TLE who underwent ATL were included in this study. The clinical variables, including patients' characteristics, preoperative evaluations, pathology, surgical prognosis, and surgical predictors were assessed the discrepancies between TLE children versus adults using univariate and multivariate analyses. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom and AEDs withdrawal after ATL, and the difference between TLE children and adults was analyzed using the Log-Rank test. RESULTS There were significant differences including semiology, magnetic resonance imaging (MRI) examinations, numbers of preoperative AEDs, and pathologies between TLE children and adults (P < 0.05, Q < 0.05). The MRI-detected epileptic focus was the only independent predictor of seizure freedom (P = 0.002, Q = 0.036) in TLE children, and the concordance of MRI-detected focus with video-electroencephalography (video-EEG)-detected epileptic zone was the only variable associated with seizure freedom in TLE adults (OR = 2.686, 95% CI = 1.014-7.115, P = 0.047). The TLE children experienced a higher probability of AEDs withdrawal than adults after surgery (P = 0.005). SIGNIFICANCE There were remarkable differences in clinical manifestations, MRI examinations, number of preoperative AEDs, and pathologies between TLE children versus adults. TLE children had a higher possibility of AEDs withdrawal than adults after surgery. The favorable seizure outcome of ATL depended on the early complete resection of MRI-detected epileptogenic focus in TLE children, while the concordance of MRI-detected focus with EEG-detected epileptogenic zone was the only predictor of favorable seizure outcomes in TLE adults.
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Affiliation(s)
- Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Zhang X, Zhang G, Yu T, Xu C, Zhu J, Yan X, Ma K, Gao R. Temporal-insular spreading time in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Medicine (Baltimore) 2022; 101:e30114. [PMID: 35984139 PMCID: PMC9387976 DOI: 10.1097/md.0000000000030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Insular involvement in temporal lobe epilepsy (TLE) has gradually been recognized since the widespread use of stereoelectroencephalography (SEEG). However, the correlation between insular involvement and failed temporal lobe surgery remains unclear. In this study, we analyzed the surgical outcomes of TLE patients who underwent temporal and insular SEEG recordings and explored the predictors of failed anterior temporal lobectomy (ATL) in these patients with temporal seizures. Forty-one patients who underwent ATL for drug-resistant TLE were examined using temporal and insular SEEG recordings. The clinical characteristics, SEEG data, and postoperative seizure outcomes of these patients were analyzed, and multivariate analysis was used to identify the predictors of surgical outcome. In this series, the ictal temporal discharges invaded the insula in 39 (95.1%) patients. Twenty-three (56.1%) patients were seizure-free (Engel class I) after ATL with at least 1 year follow-up. Only temporal-insular spreading time (TIST) was an independent predictor of postoperative seizure-free outcomes (P = .035). By creating receiver operating characteristic curves for TIST, 400 milliseconds was identified as the cutoff for classification. All patients were classified into 2 groups (TIST ≤ 400 milliseconds and TIST > 400 milliseconds) based on the cutoff value; the difference in seizure-free rates between the 2 groups was significant (P = .001). The very early insular involvement in TLE may be associated with poorer seizure outcomes after ATL. Our findings may be helpful for estimating the appropriate operative procedures and will be valuable for evaluating the prognosis of TLE patients with temporal-insular SEEG recordings and temporal lobectomy.
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Affiliation(s)
- Xi Zhang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xi Zhang, Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China (e-mail: )
| | - Guojun Zhang
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Zhu
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Asadi-Pooya AA, Farazdaghi M. Cluster analysis: Predicting the seizure outcome in temporal lobe epilepsy. Epilepsy Behav 2022; 126:108495. [PMID: 34923259 DOI: 10.1016/j.yebeh.2021.108495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We applied the Two-Step cluster analysis on a large cohort of patients with temporal lobe epilepsy (TLE). We hypothesized that there are distinct clusters of patients with TLE based on their clinical characteristics and these clusters may predict their seizure outcome. METHODS This was a longitudinal study of a prospectively developed database. All patients with a diagnosis of TLE were studied at the outpatient epilepsy clinic, Shiraz, Iran, from 2008 until 2021. The Two-Step cluster analysis (Schwarz's Bayesian Criterion: BIC) was applied to the whole dataset considering the demographic data, clinical characteristics, imaging, and electroencephalography data. The seizure outcome was compared between the clusters of patients. RESULTS Three hundred and seventy-four patients had the inclusion criteria and were studied. The Two-Step cluster analysis showed that there were two distinct clusters of patients with TLE. The most important clinical predictors were the presence (or absence) of focal impaired awareness seizures or focal to bilateral tonic-clonic seizures, aura with seizures, and the brain imaging findings. The seizure outcomes were significantly different between these two clusters (p = 0.008). CONCLUSION The Two-Step cluster analysis could identify two distinct clusters of patients with TLE; these data are helpful in providing prognosis and counseling for patients and their care-givers. These data may also be used to develop a practical outcome prediction tool for patients with TLE.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kerezoudis P, Singh R, Parisi V, Worrell GA, Miller KJ, Marsh WR, Van Gompel JJ. Outcomes of epilepsy surgery in the older population: not too old, not too late. J Neurosurg 2021:1-10. [PMID: 34624847 DOI: 10.3171/2021.5.jns204211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients. METHODS The authors' institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002-2018. Cases were grouped into 50-59, 60-69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016-2019). RESULTS A total of 73 patients (n = 16 for 50-59 years, n = 47 for 60-69, and n = 10 for 70+) were treated at the authors' institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50-59 group, 77% for the 60-69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6-114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%-72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1-3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1-0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50-59, 60-69, and 70+ years, respectively. CONCLUSIONS While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.
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Affiliation(s)
| | - Rohin Singh
- 2Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Veronica Parisi
- 3IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy; and
| | | | - Kai J Miller
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - W Richard Marsh
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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He X, Liu D, Yang Z, Zhang J, Li S, Yang Z. Side of Lesions Predicts Surgical Outcomes in Patients With Drug-Resistant Temporal Lobe Epilepsy Secondary to Focal Cortical Dysplasia Type IIIa. Front Neurol 2020; 11:580221. [PMID: 33362691 PMCID: PMC7758315 DOI: 10.3389/fneur.2020.580221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate the surgical outcomes and analyze the predictors of surgical outcomes in patients undergoing anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) secondary to focal cortical dysplasia (FCD) type IIIa. Methods: Data on patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL at Xiangya Hospital, Central South University from January 2014 to April 2018, were collected retrospectively. International League Against Epilepsy (ILAE) classification was used to evaluate postoperative seizure outcomes. Predictors of surgical outcomes were identified by using univariate and multivariate analyses. Results: A total of 43 patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL were included in this study. Twenty patients had right ATL, and 23 patients had left ATL. With a follow-up of 2-6 years, 76.7% (33 of 43) of patients were seizure-free. Univariate and multivariate analysis results indicated that lesions on the right side independently predict postoperative seizure freedom (OR, 0.08; 95% CI, 0.01-0.72; P = 0.024). Conclusion: ATL is an effective therapy for patients with drug-resistant TLE secondary to FCD type IIIa. Patients with lesions on the right side are more likely to achieve postoperative seizure freedom.
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Affiliation(s)
- Xinghui He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junmei Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Sushan Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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Huang Y, Li Q, Yang Q, Huang Z, Gao H, Xu Y, Liao L. WITHDRAWN: Analysis of Risk Factors for Prognosis and Infection of Child with Refractory Epilepsy Via Artificial Intelligence Neural Network Image Information. Neurosci Lett 2020:S0304-3940(20)30468-7. [PMID: 32585258 DOI: 10.1016/j.neulet.2020.135198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yueyan Huang
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Qingfeng Li
- Department of Radiology, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China.
| | - Qian Yang
- Center for Diagnosis and Research of Pathological Diseases, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Zhijing Huang
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Hongbo Gao
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Yunan Xu
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Lianghua Liao
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
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