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Li L, Lin S, Tan Z, Chen L, Zeng Q, Sun Y, Li C, Liu Z, Lin C, Ren X, Zhang T, Li Y, Su Q, Li Y, Cao D, Liao J, Zhu F, Chen Y. Resective epilepsy surgery for West syndrome: The Hypsarrhythmic Asymmetric Scoring Scheme is a determining predictor of seizure outcome. Seizure 2022; 101:205-210. [PMID: 36084526 DOI: 10.1016/j.seizure.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE It has been suggested that asymmetric hypsarrhythmia is associated with structural etiology. We devised the Hypsarrhythmic Asymmetric Scoring Scheme (HASS) to quantify the degree of hypsarrhythmic asymmetry in a retrospective series of patients who underwent surgical treatment at our center. The present study aimed to investigate the role of HASS in predicting the postsurgical seizure outcomes. METHODS We retrospectively analyzed the records of 46 children with hypsarrhythmia who underwent resective epilepsy surgery between 2018 and 2020 and were followed up for at least 1 year after surgery. Hypsarrhythmia severity in each hemisphere was quantified and scored. The HASS score was calculated as the difference between the two hemispheres. Univariate results were submitted to logistic regression models to identify independent predictors for favorable surgical outcomes. RESULTS Of the 46 patients who underwent resective surgery, Engel's class I-Ⅱ outcomes were achieved in 34 (73.9%). The Engel I-Ⅱ group had a significantly higher HASS score than the Engel Ⅲ-Ⅳ group (p<0.001). Multivariate analysis showed that the HASS score was the only significant predictor of good outcomes (p = 0.011). Further receiver operating characteristic analysis showed that a threshold of 7 yielded a better seizure outcome with a sensitivity of 97.06% and specificity of 83.33%. SIGNIFICANCE As the first hypsarrhythmia scoring system specially designed for presurgical evaluation, the HASS score may contribute to predicting the postsurgical seizure outcome from the electroencephalography perspective.
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Affiliation(s)
- Lin Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Sufang Lin
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Zeshi Tan
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Qi Zeng
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Yang Sun
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Cong Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Zhenzhen Liu
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Chun Lin
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Xiaofan Ren
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Tian Zhang
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Ying Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Yilian Li
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Dezhi Cao
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China; Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Jianxiang Liao
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China; Department of Neurology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China
| | - Fengjun Zhu
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China.
| | - Yan Chen
- Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong Province 518038, China.
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Kämpfer C, Racz A, Quesada CM, Elger CE, Surges R. Predictive value of electrically induced seizures for postsurgical seizure outcome. Clin Neurophysiol 2020; 131:2289-2297. [PMID: 32674959 DOI: 10.1016/j.clinph.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether semiological similarity of electrically induced seizures (EIS) and spontaneously occurring habitual seizures (SHS) is associated with postsurgical seizure outcome in patients undergoing invasive video-EEG monitoring (VEM) before resective epilepsy surgery. METHODS Data of patients undergoing invasive VEM were retrospectively reviewed and included if at least one EIS and SHS during VEM occurred and the brain region in which EIS were elicited was resected. Seizure outcome was evaluated at three follow-up (FU) visits after surgery (1, 2 years and last available FU) according to the classification by Engel and the International League Against Epilepsy (ILAE). The level of semiological similarity of EIS and SHS was rated blinded to the surgical outcome. Statistics were done using Fisher's exact test and a mixed linear-logistic regression model. RESULTS 65 patients were included. Postsurgical seizure freedom was achieved in 51% (ILAE class 1) and 58% (Engel class I) at last FU (median 36 months). Patients with identical EIS and SHS displayed significantly better postsurgical seizure outcomes (ILAE class 1 at last FU: 76% vs. 31%, p < 0.001; Engel class I: 83% vs. 39%, p < 0.001). CONCLUSION EIS are useful to confirm the location of the epileptogenic zone. A high level of similarity between EIS and SHS is associated with a favorable postsurgical seizure outcome. SIGNIFICANCE EIS may be used as an additional predictor of postsurgical outcome when counselling patients to proceed to resective epilepsy surgery.
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Affiliation(s)
- Christopher Kämpfer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Carlos M Quesada
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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