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Boßelmann CM, Kegele J, Zerweck L, Klose U, Ethofer S, Roder C, Grimm AM, Hauser TK. Breath-Hold-Triggered BOLD fMRI in Drug-Resistant Nonlesional Focal Epilepsy-A Pilot Study. Clin Neuroradiol 2024; 34:315-324. [PMID: 38082172 PMCID: PMC11130005 DOI: 10.1007/s00062-023-01363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/01/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation. METHODS In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design. RESULTS Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). CONCLUSION This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.
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Affiliation(s)
- Christian M Boßelmann
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Leonie Zerweck
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Silke Ethofer
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Constantin Roder
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Alexander M Grimm
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
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Kim JR, Jo H, Park B, Park YH, Chung YH, Shon YM, Seo DW, Hong SB, Hong SC, Seo SW, Joo EY. Identifying important factors for successful surgery in patients with lateral temporal lobe epilepsy. PLoS One 2023; 18:e0288054. [PMID: 37384651 PMCID: PMC10310033 DOI: 10.1371/journal.pone.0288054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Lateral temporal lobe epilepsy (LTLE) has been diagnosed in only a small number of patients; therefore, its surgical outcome is not as well-known as that of mesial temporal lobe epilepsy. We aimed to evaluate the long-term (5 years) and short-term (2 years) surgical outcomes and identify possible prognostic factors in patients with LTLE. METHODS This retrospective cohort study was conducted between January 1995 and December 2018 among patients who underwent resective surgery in a university-affiliated hospital. Patients were classified as LTLE if ictal onset zone was in lateral temporal area. Surgical outcomes were evaluated at 2 and 5 years. We subdivided based on outcomes and compared clinical and neuroimaging data including cortical thickness between two groups. RESULTS Sixty-four patients were included in the study. The mean follow-up duration after the surgery was 8.4 years. Five years after surgery, 45 of the 63 (71.4%) patients achieved seizure freedom. Clinically and statistically significant prognostic factors for postsurgical outcomes were the duration of epilepsy before surgery and focal cortical dysplasia on postoperative histopathology at the 5-year follow-up. Optimal cut-off point for epilepsy duration was eight years after the seizure onset (odds ratio 4.375, p-value = 0.0214). Furthermore, we propose a model for predicting seizure outcomes 5 years after surgery using the receiver operating characteristic curve and nomogram (area under the curve = 0.733; 95% confidence interval, 0.588-0.879). Cortical thinning was observed in ipsilateral cingulate gyrus and contralateral parietal lobe in poor surgical group compared to good surgical group (p-value < 0.01, uncorrected). CONCLUSIONS The identified predictors of unfavorable surgical outcomes may help in selecting optimal candidates and identifying the optimal timing for surgery among patients with LTLE. Additionally, cortical thinning was more extensive in the poor surgical group.
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Affiliation(s)
- Jae Rim Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunjin Jo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Yu Hyun Park
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Yeon Hak Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Min Shon
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Dae-Won Seo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Won Seo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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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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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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Liu HG, Yang BW, Zhao BT, Zheng Z, Gao DM, Shao XQ, Zhang K, Zhang JG, Hu WH. The electroclinical features and surgical outcomes of inferior perisylvian epilepsy. Epilepsy Behav 2021; 121:108028. [PMID: 34058496 DOI: 10.1016/j.yebeh.2021.108028] [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: 02/10/2021] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize the clinical and electrophysiological observations of epilepsy originating from the inferior perisylvian cortex, and analyze the potential epileptic networks underlying the semiological manifestations. METHODS We retrospectively analyzed patients with refractory inferior perisylvian epilepsy (IPE) who had undergone resective surgery, and then reviewed the demographic, clinical, neuroelectrophysiological, neuroimaging, surgical, histopathological, and follow-up data of the patients from the respective medical records. The selected patients were then categorized in accordance with the results of semiological analysis. Quantitative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) analysis was performed to investigate the underlying neural network. RESULTS Of the 18 IPE patients assessed in this study, ipsilateral frontotemporal epileptic discharges or its onsets were the dominant interictal or ictal scalp EEG observations. In addition, oroalimentary or manual automatism was the most frequently documented manifestation, followed by facial tonic or clonic movements. Moreover, the semiological analysis identified and classified the patients into 2 patterns, and the PET statistical analyses conducted on these 2 groups revealed differences in the neural network between them. CONCLUSION Inferior perisylvian epilepsy possesses semiological manifestations similar to those of mesial temporal lobe epilepsy or rolandic opercular epilepsy, hence these conditions should be carefully differentiated. Performing lesionectomy or cortectomy, sparing the mesial temporal structures, was found to be an effective and safe treatment modality for IPE.
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Affiliation(s)
- Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo-Wen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bao-Tian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Dong-Mei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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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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Andrews JP, Chang EF. Epilepsy: Neocortical. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Adry RARC, Meguins LC, Pereira CU, Silva Júnior SC, Araújo Filho GM, Marques LHN. Auras as a prognostic factor in anterior temporal lobe resections for mesial temporal sclerosis. Eur J Neurol 2018; 25:1372-1377. [DOI: 10.1111/ene.13740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- R. A. R. C. Adry
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - L. C. Meguins
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | | | - S. C. Silva Júnior
- Serviço de Neurocirurgia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - G. M. Araújo Filho
- Serviço de Psiquiatria; Departamento de Psiquiatria e Psicologia Médica; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto
| | - L. H. N. Marques
- Serviço de Neurologia; Departamento de Ciências Neurológicas; Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto; São José do Rio Preto Brazil
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Shih JJ, Fountain NB, Herman ST, Bagic A, Lado F, Arnold S, Zupanc ML, Riker E, Labiner DM. Indications and methodology for video‐electroencephalographic studies in the epilepsy monitoring unit. Epilepsia 2017; 59:27-36. [DOI: 10.1111/epi.13938] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Susan T. Herman
- Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Anto Bagic
- University of Pittsburgh Pittsburgh PA USA
| | | | - Susan Arnold
- University of Texas Southwestern Medical Center Dallas TX USA
| | - Mary L. Zupanc
- Children's Hospital of Orange County/University of California, Irvine Orange CA USA
| | - Ellen Riker
- National Association of Epilepsy Centers Washington DC USA
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Adry RARDC, Meguins LC, da Silva Júnior SC, Pereira CU, de Araújo Filho GM, Marques LHN. Factors predicting the outcome following surgical treatment of mesial temporal epilepsy due to mesial temporal sclerosis. Acta Neurochir (Wien) 2016; 158:2355-2363. [PMID: 27770263 DOI: 10.1007/s00701-016-2992-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS. OBJECTIVE The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL). METHODS Of 1,214 patients evaluated for surgery in the epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent ATL for MTS. Examinations and clinical data were analyzed and compared with the Engel Outcome Classification. RESULTS Of all the items analyzed, the MRI showed the greatest influence on patient outcome. As for the clinical evaluation and pathological antecedents, age at surgery, epilepsy duration, perinatal insults, family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure all had statistical significance. CONCLUSION In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with a favorable outcome for counseling patients in daily practice.
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Affiliation(s)
- Rodrigo Antonio Rocha da Cruz Adry
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
- Hospital Aliança, Salvador, Bahia, Brazil.
| | - Lucas Crociati Meguins
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Sebastião Carlos da Silva Júnior
- Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Gerardo Maria de Araújo Filho
- Psychiatry. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Lúcia Helena Neves Marques
- Neurology. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Schmeiser B, Hammen T, Steinhoff B, Zentner J, Schulze-Bonhage A. Long-term outcome characteristics in mesial temporal lobe epilepsy with and without associated cortical dysplasia. Epilepsy Res 2016; 126:147-56. [DOI: 10.1016/j.eplepsyres.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Rosenow F, Klein KM, Hamer HM. Non-invasive EEG evaluation in epilepsy diagnosis. Expert Rev Neurother 2015; 15:425-44. [DOI: 10.1586/14737175.2015.1025382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Kumar A, Valentín A, Humayon D, Longbottom AL, Jimenez-Jimenez D, Mullatti N, Elwes RC, Bodi I, Honavar M, Jarosz J, Selway RP, Polkey CE, Malik I, Alarcón G. Preoperative estimation of seizure control after resective surgery for the treatment of epilepsy. Seizure 2013; 22:818-26. [DOI: 10.1016/j.seizure.2013.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/03/2013] [Accepted: 06/21/2013] [Indexed: 11/15/2022] Open
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Tanaka N, Peters JM, Prohl AK, Takaya S, Madsen JR, Bourgeois BF, Dworetzky BA, Hämäläinen MS, Stufflebeam SM. Clinical value of magnetoencephalographic spike propagation represented by spatiotemporal source analysis: correlation with surgical outcome. Epilepsy Res 2013; 108:280-8. [PMID: 24315019 DOI: 10.1016/j.eplepsyres.2013.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/05/2013] [Accepted: 11/03/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the correlation between spike propagation represented by spatiotemporal source analysis of magnetoencephalographic (MEG) spikes and surgical outcome in patients with temporal lobe epilepsy. METHODS Thirty-seven patients were divided into mesial (n=27) and non-mesial (n=10) groups based on the presurgical evaluation. In each patient, ten ipsilateral spikes were averaged, and spatiotemporal source maps of the averaged spike were obtained by using minimum norm estimate. Regions of interest (ROIs) were created including temporoparietal, inferior frontal, mesial temporal, anterior and posterior part of the lateral temporal cortex. We extracted activation values from the source maps and the threshold was set at half of the maximum activation at the peak latency. The leading and propagated areas of the spike were defined as those ROIs with activation reaching the threshold at the earliest and at the peak latencies, respectively. Surgical outcome was assessed based on Engel's classification. Binary variables were created from leading areas (restricted to the anterior and mesial temporal ROIs or not) and from propagation areas (involving the temporoparietal ROI or not), and for surgical outcome (Class I or not). Fisher's exact test was used for significance testing. RESULTS In total and mesial group, restricted anterior/mesial temporal leading areas were correlated with Class I (p<0.05). Temporoparietal propagation was correlated with Class II-IV (p<0.05). For the non-mesial group, no significant relation was found. CONCLUSIONS Spike propagation patterns represented by spatiotemporal source analysis of MEG spikes may provide useful information for prognostic implication in presurgical evaluation of epilepsy.
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Affiliation(s)
- Naoaki Tanaka
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129, USA.
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Anna K Prohl
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Shigetoshi Takaya
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Blaise F Bourgeois
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Matti S Hämäläinen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129, USA
| | - Steven M Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA 02129, USA
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Bercovici E, Kumar BS, Mirsattari SM. Neocortical temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:103160. [PMID: 22953057 PMCID: PMC3420667 DOI: 10.1155/2012/103160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 01/04/2012] [Accepted: 05/22/2012] [Indexed: 01/15/2023]
Abstract
Complex partial seizures (CPSs) can present with various semiologies, while mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of CPS, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. This paper provides a comprehensive review of the diagnostic workup, particularly the application of recent advances in electroencephalography and functional brain imaging, in neocortical temporal lobe epilepsy.
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Affiliation(s)
- Eduard Bercovici
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Balagobal Santosh Kumar
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - Seyed M. Mirsattari
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
- Department of Medical Imaging, University of Western Ontario, London, ON, Canada
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Department of Psychology, University of Western Ontario, London, ON, Canada
- London Health Sciences Centre, B10-110, London, ON, Canada N6A 5A5
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Schneider F, Alexopoulos AV, Wang Z, Almubarak S, Kakisaka Y, Jin K, Nair D, Mosher JC, Najm IM, Burgess RC. Magnetic source imaging in non-lesional neocortical epilepsy: additional value and comparison with ICEEG. Epilepsy Behav 2012; 24:234-40. [PMID: 22542998 DOI: 10.1016/j.yebeh.2012.03.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 03/19/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the utility of magnetic source imaging (MSI) for localizing the epileptogenic zone (EZ) and predicting epilepsy surgery outcome in non-lesional neocortical focal epilepsy (NLNE) patients. METHODS Data from 18 consecutive patients with NLNE who underwent presurgical evaluation including intracranial electroencephalography (ICEEG) and MSI were studied. Follow-up after epilepsy surgery was ≥24 months. Intracranial electroencephalography and MSI results were classified using a sublobar classification. RESULTS Sublobar ICEEG focus was completely resected in 15 patients; seizure-free rate was 60%. Eight patients showed sublobar-concordant ICEEG/MSI results and complete resection of both regions; seizure-free rate was 87.5%. Seizure-free rate in cases not matching these criteria was only 30% (p=0.013). CONCLUSIONS Magnetoencephalography is a useful tool to localize the EZ and determine the site of surgical resection in NLNE patients. When sublobar concordance with ICEEG is observed, MSI increases the predictive value for a seizure-free epilepsy surgery outcome in these patients.
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Affiliation(s)
- Felix Schneider
- Cleveland Clinic Epilepsy Center, Neurological Institute, 9500 Euclid Avenue, Desk S-51, Cleveland, OH 44195, USA.
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McIntosh AM, Averill CA, Kalnins RM, Mitchell LA, Fabinyi GCA, Jackson GD, Berkovic SF. Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery. Epilepsia 2012; 53:970-8. [DOI: 10.1111/j.1528-1167.2012.03430.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alfstad KÅ, Lossius MI, Røste GK, Mowinckel P, Scheie D, Borota OC, Larsson PG, Nakken KO. Acute postoperative seizures after epilepsy surgery - a long-term outcome predictor? Acta Neurol Scand 2011; 123:48-53. [PMID: 20199515 DOI: 10.1111/j.1600-0404.2010.01343.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prognostic value of acute postoperative seizures (APS) after epilepsy surgery is much debated. This study evaluated APS, defined as seizures in the first week post-surgery, as a predictor of long-term seizure outcome, and investigated the utility of other potential outcome predictors. MATERIALS AND METHODS Medical records of 48 patients with temporal and extra-temporal epilepsy surgery were studied. Forty patients had lesional surgery. All had at least 2 year postoperative follow-up. RESULTS At 2 year follow-up, 25 patients (53%) were seizure free. Univariate analysis showed that APS (P = 0.048), using ≥ six AEDs prior to surgery (P = 0.03), pathological postoperative EEG (P = 0.043) and female gender (P = 0.012) were associated with seizure recurrence. CONCLUSIONS Univariate analysis indicate that APS, a high number of AEDs used prior to surgery, and pathological postoperative EEG are possible predictors of seizure recurrence after epilepsy surgery. Only gender retained significance in the multivariate analysis.
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Affiliation(s)
- K Å Alfstad
- National Centre for Epilepsy, Rikshospitalet University Hospital, Oslo, Norway.
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Gyimesi C, Pannek H, Woermann FG, Elsharkawy AE, Tomka-Hoffmeister M, Hortsmann S, Aengenendt J, Horvath RA, Schulz R, Hoppe M, Janszky J, Ebner A. Absolute spike frequency and etiology predict the surgical outcome in epilepsy due to amygdala lesions. Epilepsy Res 2010; 92:177-82. [DOI: 10.1016/j.eplepsyres.2010.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/11/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
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Heers M, Rampp S, Kaltenhäuser M, Kasper BS, Doelken MT, Stefan H. Monofocal MEG in lesional TLE: Does video EEG monitoring add crucial information? Epilepsy Res 2010; 92:54-62. [DOI: 10.1016/j.eplepsyres.2010.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/08/2010] [Accepted: 08/15/2010] [Indexed: 11/27/2022]
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Van Gompel JJ, Meyer FB, Marsh WR, Lee KH, Worrell GA. Stereotactic electroencephalography with temporal grid and mesial temporal depth electrode coverage: does technique of depth electrode placement affect outcome? J Neurosurg 2010; 113:32-8. [PMID: 20170311 DOI: 10.3171/2009.12.jns091073] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracranial monitoring for temporal lobe seizure localization to differentiate neocortical from mesial temporal onset seizures requires both neocortical subdural grids and hippocampal depth electrode implantation. There are 2 basic techniques for hippocampal depth electrode implantation. This first technique uses a stereotactically guided 8-contact depth electrode directed along the long axis of the hippocampus to the amygdala via an occipital bur hole. The second technique involves direct placement of 2 or 3 4-contact depth electrodes perpendicular to the temporal lobe through the middle temporal gyrus and overlying subdural grid. The purpose of this study was to determine whether one technique was superior to the other by examining monitoring success and complications. METHODS Between 1997 and 2005, 41 patients underwent invasive seizure monitoring with both temporal subdural grids and depth electrodes placed in 2 ways. Patients in Group A underwent the first technique, and patients in Group B underwent the second technique. RESULTS Group A consisted of 26 patients and Group B 15 patients. There were no statistically significant differences between Groups A and B regarding demographics, monitoring duration, seizure localization, or outcome (Engel classification). There was a statistically significant difference at the point in time at which these techniques were used: Group A represented more patients earlier in the series than Group B (p < 0.05). The complication rate attributable to the grids and depth electrodes was 0% in each group. It was more likely that the depth electrodes were placed through the grid if there was a prior resection and the patient was undergoing a new evaluation (p < 0.05). Furthermore, Group A procedures took significantly longer than Group B procedures. CONCLUSIONS In this patient series, there was no difference in efficacy of monitoring, complications, or outcome between hippocampal depth electrodes placed laterally through temporal grids or using an occipital bur hole stereotactic approach. Placement of the depth electrodes perpendicularly through the grids and middle temporal gyrus is technically more practical because multiple head positions and redraping are unnecessary, resulting in shorter operative times with comparable results.
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Affiliation(s)
- Jamie J Van Gompel
- Department of Neurosurgery, Division of Epilepsy and Electroencephalography, Mayo Clinic, Rochester, Minnesota 55905, USA
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Carrette E, Vonck K, De Herdt V, Van Dycke A, El Tahry R, Meurs A, Raedt R, Goossens L, Van Zandijcke M, Van Maele G, Thadani V, Wadman W, Van Roost D, Boon P. Predictive factors for outcome of invasive video-EEG monitoring and subsequent resective surgery in patients with refractory epilepsy. Clin Neurol Neurosurg 2009; 112:118-26. [PMID: 20005033 DOI: 10.1016/j.clineuro.2009.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This is a descriptive study of patients who underwent invasive video-EEG monitoring (IVEM) at Ghent University Hospital. The aim of the study is to identify predictive factors for outcome of IVEM and resective surgery (RS). These factors may optimize the patient flow following the non-invasive presurgical evaluation towards IVEM and RS or other treatments. PATIENTS AND METHODS Over the past 16 years, 68/710 refractory epilepsy patients included in the presurgical evaluation protocol (M/F 41/27, mean age 33 years) underwent IVEM at Ghent University Hospital. Patient features and follow-up data were collected from the patients' medical files and the electronic patient database at the neurology and neurosurgery department. Predictive factors for IVEM outcome were identified by comparing features of patients with a positive IVEM outcome (i.e. ictal onset zone identification) and patients with a negative IVEM outcome. Predictive factors for RS outcome were identified by comparing features of patients with Engel class I and patients with Engel class II-IV outcome. RESULTS In 56/68 patients (82%) IVEM outcome was positive. The occurrence of a seizure-free interval in the patient's history and a non-localizing ictal scalp EEG in patients with a structural abnormality on MRI (p<0.05) were predictive factors for a negative IVEM outcome. 32/68 patients underwent RS. In 22/32 (70%) patients RS resulted in an Engel class I outcome. A structural abnormality on MRI was a predictive factor for a positive RS outcome in patients in whom a focal or regional focus was resected (p<0.05). CONCLUSION This study shows that IVEM identifies one or more ictal onset zone(s) in up to 80% of patients. The potential of IVEM to identify the ictal onset zone is unlikely in patients with a seizure-free interval in their medical history and a non-localizing ictal scalp EEG during the non-invasive presurgical evaluation. Half of these patients underwent RS with long-term seizure freedom in 70%. Patients with structural MRI lesions have the highest chance of seizure freedom. These findings may contribute to the optimization of patient management during both the invasive and non-invasive presurgical work-up.
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Affiliation(s)
- Evelien Carrette
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium.
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Kim DW, Lee SK, Nam H, Chu K, Chung CK, Lee SY, Choe G, Kim HK. Epilepsy with dual pathology: Surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis. Epilepsia 2009; 51:1429-35. [DOI: 10.1111/j.1528-1167.2009.02403.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uijl SG, Leijten FSS, Arends JBAM, Parra J, van Huffelen AC, Moons KGM. Prognosis after temporal lobe epilepsy surgery: the value of combining predictors. Epilepsia 2008; 49:1317-23. [PMID: 18557776 DOI: 10.1111/j.1528-1167.2008.01695.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Although several independent predictors of seizure freedom after temporal lobe epilepsy surgery have been identified, their combined predictive value is largely unknown. Using a large database of operated patients, we assessed the combined predictive value of previously reported predictors included in a single multivariable model. METHODS The database comprised a cohort of 484 patients who underwent temporal lobe surgery for drug-resistant epilepsy. Good outcome was defined as Engel class 1, one year after surgery. Previously reported independent predictors were tested in this cohort. To be included in our final prediction model, predictors had to show a multivariable p-value of <0.20. RESULTS The final multivariable model included predictors obtained from the patient's history (absence of tonic-clonic seizures, absence of status epilepticus), magnetic resonance imaging [MRI; ipsilateral mesial temporal sclerosis (MTS), space occupying lesion], video electroencephalography (EEG; absence of ictal dystonic posturing, concordance between MRI and ictal EEG), and fluorodeoxyglucose positron emission tomography (FDG-PET; unilateral temporal abnormalities), that were related to seizure freedom in our data. The model showed an expected receiver-operating characteristic curve (ROC) area of 0.63 [95% confidence interval (CI) 0.57-0.68] for new patient populations. Intracranial monitoring and surgery-related parameters (including histology) were not important predictors of seizure freedom. Among patients with a high probability of seizure freedom, 85% were seizure-free one year after surgery; however, among patients with a high risk of not becoming seizure-free, still 40% were seizure-free one year after surgery. CONCLUSION We could only moderately predict seizure freedom after temporal lobe epilepsy surgery. It is particularly difficult to predict who will not become seizure-free after surgery.
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Affiliation(s)
- Sabine G Uijl
- Department of Clinical Neurophysiology, Rudolf Magnus Institute of Neuroscience and University Medical Center Utrecht, Utrecht, The Netherlands.
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Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 2008; 49:1296-307. [PMID: 18410360 DOI: 10.1111/j.1528-1167.2008.01604.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The efficacy of surgery to treat drug-resistant temporal lobe epilepsy (TLE) has been demonstrated in a prospective randomized trial. It remains controversial which resection method gives best results for seizure freedom and neuropsychological function. This review of 53 studies addressing extent of resection in surgery for TLE identified seven prospective studies of which four were randomized. There is considerable variability between the intended resection and the volumetrically assessed end result. Even leaving hippocampus or amygdalum behind can result in seizure freedom rates around 50%. Most authors found seizure outcome in selective amygdalohippocampectomy (SAH) to be similar to that of lobectomy and there is considerable evidence for better neuropsychological outcome in SAH. Studies varied in the relationship between extent of mesial resection and seizure freedom, most authors finding no positive correlation to larger mesial resection. Electrophysiological tailoring saw no benefit from larger resection in 6 of 10 studies. It must be concluded that class I evidence concerning seizure outcome related to type and extent of resection of mesial temporal lobe structures is rare. Many studies are only retrospective and do not use MRI volumetry. SAH appears to have similar seizure outcome and a better cognitive outcome than TLR. It remains unclear whether a larger mesial resection extent leads to better seizure outcome.
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Affiliation(s)
- Johannes Schramm
- Department of Neurosurgery, Bonn University Medical Center, University of Bonn, Bonn, Germany.
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Kral T, von Lehe M, Podlogar M, Clusmann H, Süssmann P, Kurthen M, Becker A, Urbach H, Schramm J. Focal cortical dysplasia: long term seizure outcome after surgical treatment. J Neurol Neurosurg Psychiatry 2007; 78:853-6. [PMID: 17287239 PMCID: PMC2117728 DOI: 10.1136/jnnp.2006.105361] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Studies of long term outcome after epilepsy surgery for cortical malformations are rare. In this study, we report our experience with surgical treatment and year to year long term outcome for a subgroup of patients with focal cortical dysplasia (FCD). METHODS We retrospectively analysed the records of 49 patients (females n = 26; males n = 23; mean age 25 (11) years) with a mean duration of epilepsy of 18 years (range 1-45). Preoperative MRI, histological results based on the Palmini classification and clinical year to year follow-up according to the International League Against Epilepsy (ILAE) classification were available in all patients. RESULTS 98% of patients had a lesion on preoperative MRI. In addition to lobectomy (n = 9) or lesionectomy (n = 40), 14 patients had multiple subpial transections of the eloquent cortex. The resected tissue was classified as FCD type II b in 41 cases with an extratemporal (88%) and FCD type II a in 8 cases with a temporal localisation (100%). After a mean follow-up of 8.1 (4.5) years, 37 patients (76%) were seizure free, a subgroup of 23 patients (47%) had been completely seizure free since surgery (ILAE class 1a) and 4 patients (8%) had only auras (ILAE class 2). Over a 10 year follow-up, the proportion of satisfactory outcomes decreased, mainly within the first 3 years. During long term follow-up, 48% stopped antiepileptic drug treatment, 34% received a driver's license and 57% found a job or training. CONCLUSION Surgical treatment of epilepsy with FCD is not only successful in the short term but also has a satisfying long term outcome which remains constant after 3 years of follow-up but is not associated with better employment status or improvement in daily living.
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Affiliation(s)
- T Kral
- Department of Neurosurgery, University of Bonn, Medical Centre, Sigmund Freud Strasse 25, 53105 Bonn, Germany.
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Beniczky S, Oturai PS, Alving J, Sabers A, Herning M, Fabricius M. Source analysis of epileptic discharges using multiple signal classification analysis. Neuroreport 2006; 17:1283-7. [PMID: 16951570 DOI: 10.1097/01.wnr.0000230517.93714.f6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple signal classification is an alternative to the traditional dipole fitting source analysis methods. Our aim was to assess the clinical usefulness of this algorithm and to compare the localization of the epileptiform electroencephalography discharges with the regions of altered cerebral blood flow in 10 patients with complex partial seizures undergoing preoperative investigation. We performed multiple signal classification analysis of ictal and interictal discharges, and registered single-photon emission computed tomography. Localization of the ictal, but not the interictal discharges, as determined by multiple signal classification analysis was consistent with the regions showing perfusion changes on the single-photon emission computed tomography. Multiple signal classification analysis is a promising tool in localizing foci in patients with complex partial seizures and may contribute to the preoperative evaluation.
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Affiliation(s)
- Sándor Beniczky
- Department of Clinical Neurophysiology, Department of Neurology, Copenhagen University, Glostrup Hospital, Glostrup, Denmark
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