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Barkley AS, Sullivan LT, Gibson AW, Zalewski K, Mac Donald CL, Barber JK, Hakimian S, Ko AL, Ojemann JG, Hauptman JS. Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy. Neurosurgery 2022; 91:347-354. [PMID: 35506941 DOI: 10.1227/neu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables. OBJECTIVE To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year. METHODS A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively. RESULTS Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class (P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors. CONCLUSION APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
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Affiliation(s)
- Ariana S Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Liam T Sullivan
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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Mehvari Habibabadi J, Moein H, Jourahmad Z, Ahmadian M, Basiratnia R, Zare M, Hashemi Fesharaki SS, Badihian S, Barekatain M, Tabrizi N. Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country. Epilepsy Behav 2021; 122:108221. [PMID: 34352668 DOI: 10.1016/j.yebeh.2021.108221] [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: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. METHODS This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not-seizure free (NSF). RESULTS A total of 148 adult patients, with a mean age of 30.45 ± 9.23 years were included. The SF outcome was reported in 86.5% of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%. The mean follow-up duration was 26.7 ± 14.9 months. Temporal lobe lesions (76.3%) and mesial temporal sclerosis (MTS) (56.7%) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95% CI [1.08-2.87], p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI [1.03-1.35], p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI [1.06-2.81], p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI [1.18-1.70], p < 0.001) were positive predictors for a favorable outcome. CONCLUSION Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed.
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Affiliation(s)
| | - Houshang Moein
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Jourahmad
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | - Mana Ahmadian
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran.
| | - Reza Basiratnia
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Kashani Comprehensive Epilepsy Center, Kashani Hospital, Isfahan, Iran
| | | | - Shervin Badihian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Majid Barekatain
- Psychosomatic Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Hwang YH, Jung NY, Park CK, Chang WS, Jung HH, Chang JW. Factors Related to the Clinical Outcomes of Surgery for Extra–Temporal Lobe Epilepsy: Long-Term Follow-Up Results. World Neurosurg 2018; 115:e645-e649. [DOI: 10.1016/j.wneu.2018.04.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
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d’ Orio P, Pelliccia V, Gozzo F, Cardinale F, Castana L, Lo Russo G, Bottini G, Scarpa P, Cossu M. Epilepsy surgery in patients older than 50 years: Effectiveness, safety, and predictors of outcome. Seizure 2017. [DOI: 10.1016/j.seizure.2017.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Epilepsy surgery in the posterior part of the brain. Epilepsy Behav 2016; 64:273-282. [PMID: 27788449 DOI: 10.1016/j.yebeh.2016.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
Posterior cortex epilepsy surgery is rarely performed and is associated with a high number of surgical failures, partly because accurate localization of the epileptogenic zone in the posterior part of the brain is extremely difficult. We present the characteristics as well as the surgical outcome and its determinants of a cohort of 208 consecutive patients (adults/children: 125/83) operated on for drug-resistant posterior cortex epilepsy at the "Claudio Munari" Epilepsy Surgery Centre, Milan between May 1996 and May 2013 (mean postsurgical follow-up: 9.6years). In addition, we highlight the differences in anatomoelectroclinical features and outcome between (i) patients who necessitated an invasive preoperative evaluation and those who proceeded directly to surgery and (ii) adults and children. Mean age at epilepsy onset was 6.8years (91.4% with onset before 14years of age). A high seizure frequency was reported by 51% of subjects, interictal and ictal EEG features were localizing in 16% and 28% of cases, and 86% of patients had a positive, judged as more or less informative, MRI. Invasive presurgical evaluation by stereoelectroencephalography was performed in 54% of patients; explorations may schematically be grouped in three main implantation patterns. Globally, 70% of subjects achieved seizure freedom, and further, 10% achieved Engel class II, with the patients operated on in childhood achieving significantly better postsurgical results in terms of seizure freedom and drug discontinuation. Duration of epilepsy represented the most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success. Therefore, we recommend an early surgical referral in cases of pharmacoresistant posterior cortex seizures. Furthermore, we suggest that surgical failure might be predicted very early, namely within the first 6 postoperative months. We conclude that surgical management of posterior cortex epilepsy may attain excellent results.
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Acute postoperative seizures as predictors of seizure outcomes after epilepsy surgery. Epilepsy Res 2016; 127:119-125. [DOI: 10.1016/j.eplepsyres.2016.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/14/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022]
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Di Gennaro G, Casciato S, Quarato PP, Mascia A, D’Aniello A, Grammaldo LG, De Risi M, Meldolesi GN, Romigi A, Esposito V, Picardi A. Acute postoperative seizures and long-term seizure outcome after surgery for hippocampal sclerosis. Seizure 2015; 24:59-62. [DOI: 10.1016/j.seizure.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/31/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022] Open
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Garcia Gracia C, Yardi R, Kattan MW, Nair D, Gupta A, Najm I, Bingaman W, Gonzalez-Martinez J, Jehi L. Seizure freedom score: A new simple method to predict success of epilepsy surgery. Epilepsia 2014; 56:359-65. [DOI: 10.1111/epi.12892] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Camilo Garcia Gracia
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ruta Yardi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Michael W. Kattan
- Quantitative Health Sciences; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Dileep Nair
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Imad Najm
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - William Bingaman
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Jorge Gonzalez-Martinez
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
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Di Gennaro G, Casciato S, D’Aniello A, De Risi M, Quarato PP, Mascia A, Grammaldo LG, Meldolesi GN, Esposito V, Picardi A. Serial postoperative awake and sleep EEG and long-term seizure outcome after anterior temporal lobectomy for hippocampal sclerosis. Epilepsy Res 2014; 108:945-52. [DOI: 10.1016/j.eplepsyres.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/02/2014] [Accepted: 03/16/2014] [Indexed: 11/25/2022]
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Greiner HM, Horn PS, Arya R, Holland K, Turner M, Alsaidi MH, Leach JL, Mangano FT. Acute postoperative seizures and long-term outcome following pediatric epilepsy surgery. Seizure 2014; 23:483-6. [PMID: 24680553 DOI: 10.1016/j.seizure.2014.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Acute post-operative seizures (APOS) after epilepsy surgery, previously believed to be benign, are increasingly associated with poor long-term prognosis. Prior literature has focused primarily on adult temporal lobe epilepsy. This retrospective study aimed to identify the prevalence, prognostic significance and risk factors for APOS in pediatric epilepsy surgery at a single center. METHOD Retrospective chart review of all children aged 0-21 years undergoing resective surgery for epilepsy between 2009 and 2012 at a single center. APOS were defined as seizures within 30 days of resection. Surgical outcome was determined, using a minimum of 12 months postoperative follow-up for inclusion. RESULTS APOS, defined as a seizure within 30 days of resection, were identified in 50/112 (44%) of patients. APOS were a significant predictor of poor postoperative seizure outcome (ILAE 4-6); only 26% of those with APOS had a good outcome (ILAE 1-3), compared to 76% without APOS. Timing of postoperative seizure was not correlated with outcome. Most (54%) with APOS and good outcome had continued seizures between 14-30 days postoperatively. Patients with APOS after temporal (p=0.05) and extratemporal (p<0.001) resections had a significantly worse prognosis. APOS after hemispherectomy were not associated with a worse prognosis (p=0.22). Key risk factors for APOS include lack of ictal EEG lateralization to operated hemisphere/side of MRI abnormality. CONCLUSION This study shows an association between APOS and poor outcome in both temporal and extratemporal pediatric epilepsy surgery. Findings support the expansion of APOS duration to 30 days.
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Affiliation(s)
- Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ravindra Arya
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Holland
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michele Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James L Leach
- Division of Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hemispherectomy: the full half of the glass. Epilepsy Curr 2013; 13:213-4. [PMID: 24348108 DOI: 10.5698/1535-7597-13.5.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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