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Leifeld J, Förster E, Reiss G, Hamad MIK. Considering the Role of Extracellular Matrix Molecules, in Particular Reelin, in Granule Cell Dispersion Related to Temporal Lobe Epilepsy. Front Cell Dev Biol 2022; 10:917575. [PMID: 35733853 PMCID: PMC9207388 DOI: 10.3389/fcell.2022.917575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
The extracellular matrix (ECM) of the nervous system can be considered as a dynamically adaptable compartment between neuronal cells, in particular neurons and glial cells, that participates in physiological functions of the nervous system. It is mainly composed of carbohydrates and proteins that are secreted by the different kinds of cell types found in the nervous system, in particular neurons and glial cells, but also other cell types, such as pericytes of capillaries, ependymocytes and meningeal cells. ECM molecules participate in developmental processes, synaptic plasticity, neurodegeneration and regenerative processes. As an example, the ECM of the hippocampal formation is involved in degenerative and adaptive processes related to epilepsy. The role of various components of the ECM has been explored extensively. In particular, the ECM protein reelin, well known for orchestrating the formation of neuronal layer formation in the cerebral cortex, is also considered as a player involved in the occurrence of postnatal granule cell dispersion (GCD), a morphologically peculiar feature frequently observed in hippocampal tissue from epileptic patients. Possible causes and consequences of GCD have been studied in various in vivo and in vitro models. The present review discusses different interpretations of GCD and different views on the role of ECM protein reelin in the formation of this morphological peculiarity.
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Affiliation(s)
- Jennifer Leifeld
- Department of Neuroanatomy and Molecular Brain Research, Medical Faculty, Ruhr University Bochum, Bochum, Germany
- Department of Biochemistry I—Receptor Biochemistry, Faculty of Chemistry and Biochemistry, Ruhr University Bochum, Bochum, Germany
- *Correspondence: Jennifer Leifeld, ; Eckart Förster,
| | - Eckart Förster
- Department of Neuroanatomy and Molecular Brain Research, Medical Faculty, Ruhr University Bochum, Bochum, Germany
- *Correspondence: Jennifer Leifeld, ; Eckart Förster,
| | - Gebhard Reiss
- Institute for Anatomy and Clinical Morphology, School of Medicine, Faculty of Health, Witten/ Herdecke University, Witten, Germany
| | - Mohammad I. K. Hamad
- Institute for Anatomy and Clinical Morphology, School of Medicine, Faculty of Health, Witten/ Herdecke University, Witten, Germany
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Peng SJ, Hsieh KLC, Lin YK, Tsai ML, Wong TT, Chang H. Febrile seizures reduce hippocampal subfield volumes but not cortical thickness in children with focal onset seizures. Epilepsy Res 2022; 179:106848. [PMID: 34992023 DOI: 10.1016/j.eplepsyres.2021.106848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Whether febrile seizures (FS) produce long-term injury to the hippocampus or other brain structures is a critical question concerning focal onset seizures in children. Our aims are to evaluate the effect of FS on subfields of the hippocampus, thalamic nuclei, amygdala, cortical thickness, and surface area quantitatively in children with FS who later developed focal seizures and to identify biomarkers based on MRI structures. METHODS Children who had focal onset seizures with or without previous FS and normal 3-T MRI findings were included retrospectively. The MRI was performed within 2 years after the onset of focal seizures. Age-matched controls were also recruited. Hippocampal subfields and thalamic nuclei, amygdala volumes, cortical thickness, and cortical surface area in individual cortical regions were segmented by FreeSurfer version 7.1.1. Volumetric and morphometric data among children who had focal seizures with or without previous FS, as well as controls, were compared and correlated with clinical parameters. RESULTS Children with a history of FS who had focal seizures exhibited smaller right cornu ammonis (CA) 1 and right molecular cell layer of the hippocampus, compared to those without FS. A larger left hippocampal fissure was also found in FS with focal seizures compared to age-matched controls. There were no statistically significant differences in each nucleus of the thalamus, amygdala, cortical thickness, and surface area of each cortical region among the three groups. A smaller whole hippocampal volume was found for the right hippocampus in children with FS and focal seizures compared to those without FS. A trend of negative correlation was found between the frequency of FS and the left and right CA1 subfield volume ratios of the hippocampus. CONCLUSIONS We concluded that multiple episodes of FS may be associated with a trivial difference in volume reduction in the CA1 and molecular layer of the right hippocampus and an enlarged hippocampal fissure of the left hippocampus, but not with individual cortical thicknesses, surface area, thalamic nuclei, or amygdala in children with focal onset seizures.The hippocampal subfield CA1 and molecular layer of the right hippocampus may be more vulnerable than the cortices in children with focal seizures who experienced multiple FS episodes. This study highlights the minimal differences in brain volumes among children with recent onset focal seizures with or without FS history and controls, suggesting that the brain injurious aspects of the FS and recent onset focal seizures may have been previously overstated. This suggests that physicians can be reassuring about brain injury associated with these seizure types when discussing outcomes with parents and patients.
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Affiliation(s)
- Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Min-Lan Tsai
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Rathore C, Radhakrishnan K, Jeyaraj MK, Wattamwar PR, Baheti N, Sarma SP. Early versus late antiepileptic drug withdrawal following temporal lobectomy. Seizure 2020; 75:23-27. [DOI: 10.1016/j.seizure.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
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DeSalvo MN, Tanaka N, Douw L, Cole AJ, Stufflebeam SM. Contralateral Preoperative Resting-State Functional MRI Network Integration Is Associated with Surgical Outcome in Temporal Lobe Epilepsy. Radiology 2020; 294:622-627. [PMID: 31961245 DOI: 10.1148/radiol.2020191008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Although most patients with medically refractory temporal lobe epilepsy (TLE) experience seizure freedom after anterior temporal lobectomy, approximately 40% may continue to have seizures. Functional network integration, as measured with preoperative resting-state functional MRI, may help stratify patients who are more likely to experience postoperative seizure freedom. Purpose To relate preoperative resting-state functional MRI and surgical outcome in patients with medically refractory TLE. Materials and Methods Data from patients with medically intractable TLE were retrospectively analyzed. Patients underwent preoperative resting-state functional MRI between March 2010 and April 2013 and subsequent unilateral anterior temporal lobectomy. Postoperative seizure-free status was categorized using the Engel Epilepsy Surgery Outcome Scale. Global and regional resting-state functional MRI network properties on preoperative functional MRI scans related to integration were calculated and statistically compared between patients who experienced complete postoperative seizure freedom (Engel class IA) and all others (Engel class IB to class IV) using t tests and multiple logistic regression. Results Forty patients (mean age, 34 years ± 15 [standard deviation]; 21 female) were evaluated. Preoperative global network integration was different (P = .01) between patients who experienced seizure freedom after surgery and all other patients, with 9% lower leaf fraction and 10% lower tree hierarchy in patients with ongoing seizures. Preoperative regional network integration in the contralateral temporoinsular region was different (P = .04) between patients in these two groups. Specifically, the group-level leaf proportion was 59% lower in the entorhinal cortex, 73% lower in the inferior temporal gyrus, 43% lower in the temporal pole, and 69% lower in the insula in patients with ongoing seizures after surgery. When using multivariate regression, contralateral temporoinsular leaf proportion (P = .002) and epilepsy duration (P = .04) were predictive of postoperative seizure freedom, while age (P > .70) and age at seizure onset (P > .50) were not. Conclusion Lower network integration globally and involving the contralateral temporoinsular cortex on preoperative resting-state functional MRI scans is associated with ongoing postoperative seizures in patients with temporal lobe epilepsy. © RSNA, 2020.
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Affiliation(s)
- Matthew N DeSalvo
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Naoaki Tanaka
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Linda Douw
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Andrew J Cole
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Steven M Stufflebeam
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
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Abstract
BACKGROUND This is an updated version of the original Cochrane review, published in 2015.Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary between at least 20% and up to 70%. If the epileptogenic zone can be located, surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.Secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence, and to identify the factors that correlate with remission of seizures postoperatively. SEARCH METHODS For the latest update, we searched the following databases on 11 March 2019: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to March 08, 2019), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) that included at least 30 participants in a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), with an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome related to postoperative seizure control. Cohort studies or case series were included in the previous version of this review. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportions of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS We identified 182 studies with a total of 16,855 included participants investigating outcomes of surgery for epilepsy. Nine studies were RCTs (including two that randomised participants to surgery or medical treatment (99 participants included in the two trials received medical treatment)). Risk of bias in these RCTs was unclear or high. Most of the remaining 173 non-randomised studies followed a retrospective design. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses, we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across domains.In terms of freedom from seizures, two RCTs found surgery (n = 97) to be superior to medical treatment (n = 99); four found no statistically significant differences between anterior temporal lobectomy (ATL) with or without corpus callosotomy (n = 60), between subtemporal or transsylvian approach to selective amygdalohippocampectomy (SAH) (n = 47); between ATL, SAH and parahippocampectomy (n = 43) or between 2.5 cm and 3.5 cm ATL resection (n = 207). One RCT found total hippocampectomy to be superior to partial hippocampectomy (n = 70) and one found ATL to be superior to stereotactic radiosurgery (n = 58); and another provided data to show that for Lennox-Gastaut syndrome, no significant differences in seizure outcomes were evident between those treated with resection of the epileptogenic zone and those treated with resection of the epileptogenic zone plus corpus callosotomy (n = 43). We judged evidence from the nine RCTs to be of moderate to very low quality due to lack of information reported about the randomised trial design and the restricted study populations.Of the 16,756 participants included in this review who underwent a surgical procedure, 10,696 (64%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to recording of adverse events to be very poor.In total, 120 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography, history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection, and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation, and presence of postoperative discharges were prognostic factors of outcome.Twenty-nine studies reported multi-variable models of prognostic factors, and showed that the direction of association of factors with outcomes was generally the same as that found in univariate analyses.We observed variability in many of our analyses, likely due to small study sizes with unbalanced group sizes and variation in the definition of seizure outcome, the definition of prognostic factors, and the influence of the site of surgery AUTHORS' CONCLUSIONS: Study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcomes. Future research should be of high quality, follow a prospective design, be appropriately powered, and focus on specific issues related to diagnostic tools, the site-specific surgical approach, and other issues such as extent of resection. Researchers should investigate prognostic factors related to the outcome of surgery via multi-variable statistical regression modelling, where variables are selected for modelling according to clinical relevance, and all numerical results of the prognostic models are fully reported. Journal editors should not accept papers for which study authors did not record adverse events from a medical intervention. Researchers have achieved improvements in cancer care over the past three to four decades by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Sarah J Nevitt
- University of LiverpoolDepartment of BiostatisticsBlock F, Waterhouse Building1‐5 Brownlow HillLiverpoolUKL69 3GL
| | - Jennifer Cotton
- The Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - Sacha Gandhi
- NHS Ayrshire and ArranDepartment of General SurgeryAyrUKKA6 6DX
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolMerseysideUKL9 7LJ
| | - Ajay Sudan
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
| | - Roberto Ramirez
- Royal Manchester Children's HospitalHospital RoadPendleburyManchesterUKM27 4HA
| | - Richard Newton
- Royal Manchester Children's HospitalDepartment of Paediatric NeurologyHathersage RoadManchesterUKM13 0JH
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Rathore C, Jeyaraj MK, Dash GK, Wattamwar P, Baheti N, Sarma SP, Radhakrishnan K. Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy. Neurology 2018; 91:e208-e216. [PMID: 29925547 DOI: 10.1212/wnl.0000000000005820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/10/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy. METHODS We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug. RESULTS Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort. CONCLUSION Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.
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Affiliation(s)
- Chaturbhuj Rathore
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India.
| | - Malcolm K Jeyaraj
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Gopal K Dash
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Pandurang Wattamwar
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Neeraj Baheti
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Sankara P Sarma
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
| | - Kurupath Radhakrishnan
- From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India
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Sun Z, Zuo H, Yuan D, Sun Y, Zhang K, Cui Z, Wang J. Predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy. Exp Ther Med 2015; 10:1896-1902. [PMID: 26640569 DOI: 10.3892/etm.2015.2753] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 07/13/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the predictive value of prognostic factors for the surgical outcome of patients with mesial temporal lobe epilepsy (MTLE) using Engel seizure classification. The clinical data of 121 patients with MTLE who underwent anterior temporal lobectomy (ATL) and received a 1-year minimum follow-up were collected between January 2005 and December 2008. Patients were divided into seizure and seizure-free groups according to the Engel seizure classification. Univariate analysis and multivariate logistic regression analysis were used to analyze the potential predictive and prognostic factors, including medical history, clinical features of seizures, magnetic resonance imaging (MRI) and video-electroencephalogram (EEG) monitoring results. Univariate analysis indicated no statistically significant differences in gender, age at seizure onset, age at surgery, history of traumatic brain injury, perinatal anoxia, intracranial infection, family history of seizure, auras or site of surgery between the two groups; however, significant differences were detected in pre-surgical seizure duration, history of febrile seizures, seizure types, MRI and video-EEG results. Multivariate logistic regression analysis demonstrated that a pre-surgical seizure duration of <10 years, history of positive febrile seizures, simple complex partial seizure, positive MRI results and unilateral local video-EEG spikes may be considered as predictors of a good prognosis. These results indicate that remission may be achieved in patients with MTLE via the collection of accurate clinical information and adequate pre-surgical evaluation.
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Affiliation(s)
- Zhenxing Sun
- Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100084, P.R. China
| | - Huancong Zuo
- Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100084, P.R. China
| | - Dan Yuan
- Department of Neurology, The Luhe Teaching Hospital, Capital Medical University, Beijing 101149, P.R. China
| | - Yaxing Sun
- Department of Psychiatry, The Second Municipal Hospital of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Kai Zhang
- Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing 101149, P.R. China
| | - Zhiqiang Cui
- Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing 100084, P.R. China
| | - Jin Wang
- Department of Neurosurgery, Changgung Hospital, Tsinghua University Medical Center, Beijing 100084, P.R. China
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Abstract
BACKGROUND Focal epilepsies are caused by a malfunction of nerve cells localised in one part of one cerebral hemisphere. In studies, estimates of the number of individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to the age of the participants and which focal epilepsies are included, but have been reported as at least 20% and in some studies up to 70%. If the epileptogenic zone can be located surgical resection offers the chance of a cure with a corresponding increase in quality of life. OBJECTIVES The primary objective is to assess the overall outcome of epilepsy surgery according to evidence from randomised controlled trials.The secondary objectives are to assess the overall outcome of epilepsy surgery according to non-randomised evidence and to identify the factors that correlate to remission of seizures postoperatively. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialised Register (June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 to 4 July 2013), ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for relevant trials up to 4 July 2013. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), cohort studies or case series, with either a prospective and/or retrospective design, including at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently screened all references for eligibility, assessed study quality and risk of bias, and extracted data. Outcomes were proportion of participants achieving a good outcome according to the presence or absence of each prognostic factor of interest. We intended to combine data with risk ratios (RR) and 95% confidence intervals. MAIN RESULTS We identified 177 studies (16,253 participants) investigating the outcome of surgery for epilepsy. Four studies were RCTs (including one that randomised participants to surgery or medical treatment). The risk of bias in the RCTs was unclear or high, limiting our confidence in the evidence that addressed the primary review objective. Most of the remaining 173 non-randomised studies had a retrospective design; they were of variable size, were conducted in a range of countries, recruited a wide demographic range of participants, used a wide range of surgical techniques and used different scales used to measure outcomes. We performed quality assessment using the Effective Public Health Practice Project (EPHPP) tool and determined that most studies provided moderate or weak evidence. For 29 studies reporting multivariate analyses we used the Quality in Prognostic Studies (QUIPS) tool and determined that very few studies were at low risk of bias across the domains.In terms of freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy. We judged the evidence from the four RCTs to be of moderate to very low quality due to the lack of information reported about the randomised trial design and the restricted study populations.Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%. Overall, we found the quality of data in relation to the recording of adverse events to be very poor.In total, 118 studies examined between one and eight prognostic factors in univariate analysis. We found the following prognostic factors to be associated with a better post-surgical seizure outcome: an abnormal pre-operative MRI, no use of intracranial monitoring, complete surgical resection, presence of mesial temporal sclerosis, concordance of pre-operative MRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes. We found no evidence that history of head injury, presence of encephalomalacia, presence of vascular malformation or presence of postoperative discharges were prognostic factors of outcome. We observed variability between studies for many of our analyses, likely due to the small study sizes with unbalanced group sizes, variation in the definition of seizure outcome, definition of the prognostic factor and the influence of the site of surgery, all of which we observed to be related to postoperative seizure outcome. Twenty-nine studies reported multivariable models of prognostic factors and the direction of association of factors with outcome was generally the same as found in the univariate analyses. However, due to the different multivariable analysis approaches and selective reporting of results, meaningful comparison of multivariate analysis with univariate meta-analysis is difficult. AUTHORS' CONCLUSIONS The study design issues and limited information presented in the included studies mean that our results provide limited evidence to aid patient selection for surgery and prediction of likely surgical outcome. Future research should be of high quality, have a prospective design, be appropriately powered and focus on specific issues related to diagnostic tools, the site-specific surgical approach and other issues such as the extent of resection. Prognostic factors related to the outcome of surgery should be investigated via multivariable statistical regression modelling, where variables are selected for modelling according to clinical relevance and all numerical results of the prognostic models are fully reported. Protocols should include pre- and postoperative measures of speech and language function, cognition and social functioning along with a mental state assessment. Journal editors should not accept papers where adverse events from a medical intervention are not recorded. Improvements in the development of cancer care over the past three to four decades have been achieved by answering well-defined questions through the conduct of focused RCTs in a step-wise fashion. The same approach to surgery for epilepsy is required.
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Affiliation(s)
- Siobhan West
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH
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Bonilha L, Keller SS. Quantitative MRI in refractory temporal lobe epilepsy: relationship with surgical outcomes. Quant Imaging Med Surg 2015; 5:204-24. [PMID: 25853080 DOI: 10.3978/j.issn.2223-4292.2015.01.01] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/07/2015] [Indexed: 11/14/2022]
Abstract
Medically intractable temporal lobe epilepsy (TLE) remains a serious health problem. Across treatment centers, up to 40% of patients with TLE will continue to experience persistent postoperative seizures at 2-year follow-up. It is unknown why such a large number of patients continue to experience seizures despite being suitable candidates for resective surgery. Preoperative quantitative MRI techniques may provide useful information on why some patients continue to experience disabling seizures, and may have the potential to develop prognostic markers of surgical outcome. In this article, we provide an overview of how quantitative MRI morphometric and diffusion tensor imaging (DTI) data have improved the understanding of brain structural alterations in patients with refractory TLE. We subsequently review the studies that have applied quantitative structural imaging techniques to identify the neuroanatomical factors that are most strongly related to a poor postoperative prognosis. In summary, quantitative imaging studies strongly suggest that TLE is a disorder affecting a network of neurobiological systems, characterized by multiple and inter-related limbic and extra-limbic network abnormalities. The relationship between brain alterations and postoperative outcome are less consistent, but there is emerging evidence suggesting that seizures are less likely to remit with surgery when presurgical abnormalities are observed in the connectivity supporting brain regions serving as network nodes located outside the resected temporal lobe. Future work, possibly harnessing the potential from multimodal imaging approaches, may further elucidate the etiology of persistent postoperative seizures in patients with refractory TLE. Furthermore, quantitative imaging techniques may be explored to provide individualized measures of postoperative seizure freedom outcome.
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Affiliation(s)
- Leonardo Bonilha
- 1 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 2 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ; 3 Department of Radiology, The Walton Centre NHS Foundation Trust, Liverpool, UK ; 4 Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon S Keller
- 1 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 2 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ; 3 Department of Radiology, The Walton Centre NHS Foundation Trust, Liverpool, UK ; 4 Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Na M, Ge H, Shi C, Shen H, Wang Y, Pu S, Liu L, Wang H, Xie C, Zhu M, Wang J, Shi C, Lin Z. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: a survival analysis. Seizure 2014; 25:141-6. [PMID: 25455728 DOI: 10.1016/j.seizure.2014.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy (MTLE) as a result of hippocampal sclerosis (HS). However, approximately one-third of patients with intractable epilepsy did not become seizure-free after tailored resection strategies. It would be compelling to identify predictive factors of postoperative seizure outcomes. Our aim was to assess the correlation between HS classification and long-term postoperative seizure outcome in patients with MTLE due to HS. METHODS To investigate HS classification, semi-quantitative analysis and immunohistochemical staining of neuronal nuclei (NeuN) were performed on 100 postoperative hippocampal specimens. All patients had a 1-7 year postoperative follow-up. The postoperative seizure outcome was evaluated using International League Against Epilepsy (ILAE) outcome classification. RESULTS Three types of HS were recognized. The highest incidence of initial precipitating injury (IPI) was noted in the HS ILAE type 1 group (53.1%). The most favorable long-term seizure outcome was also noted in the HS ILAE type 1 group. The shortest epilepsy duration was recorded in the HS ILAE type 2 group (mean epilepsy duration=6.64 ± 5.83 years). The completely seizure free rate of patients in all groups declined with an increase in time. CONCLUSIONS Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery.
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Affiliation(s)
- Meng Na
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haitao Ge
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chen Shi
- Department of Neurosurgery, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Song Pu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haiyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuncheng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minwei Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Changbin Shi
- Section of Neurosurgery/Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Zhiguo Lin
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
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Abstract
Febrile seizure (FS) is the most common seizure disorder of childhood, and occurs in an age-related manner. FS are classified into simple and complex. FS has a multifactorial inheritance, suggesting that both genetic and environmental factors are causative. Various animal models have elucidated the pathophysiological mechanisms of FS. Risk factors for a first FS are a family history of the disorder and a developmental delay. Risk factors for recurrent FS are a family history, age below 18 months at seizure onset, maximum temperature, and duration of fever. Risk factors for subsequent development of epilepsy are neurodevelopmental abnormality and complex FS. Clinicians evaluating children after a simple FS should concentrate on identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child. A simple FS does not usually require further evaluation such as ordering electroencephalography, neuroimaging, or other studies. Treatment is acute rescue therapy for prolonged FS. Antipyretics are not proven to reduce the recurrence risk for FS. Some evidence shows that both intermittent therapy with oral/rectal diazepam and continuous prophylaxis with oral phenobarbital or valproate are effective in reducing the risk of recurrence, but there is no evidence that these medications reduce the risk of subsequent epilepsy. Vaccine-induced FS is a rare event that does not lead to deleterious outcomes, but could affect patient and physician attitudes toward the safety of vaccination.
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Affiliation(s)
- Sajun Chung
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
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12
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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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Yu S, Lin Z, Liu L, Pu S, Wang H, Wang J, Xie C, Yang C, Li M, Shen H. Long-term outcome of epilepsy surgery: A retrospective study in a population of 379 cases. Epilepsy Res 2014; 108:555-64. [DOI: 10.1016/j.eplepsyres.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/08/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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Abstract
Febrile seizures are the most common form of childhood seizures, affecting 2% to 5% of children. They are considered benign and self-limiting; however, a febrile seizure is a terrifying event for most parents, and is one of the most common causes of trips to the emergency room. A febrile seizure is "an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause." This definition excludes seizures with fever in children who have had a prior afebrile seizure. In 2011, The American Academy of Pediatrics (AAP) published a clinical practice guideline defining a febrile seizure as "a seizure accompanied by fever (temperature ≥ 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age." Febrile seizures are further classified as simple or complex. This article reviews the evaluation, management, and prognosis of simple and complex seizures, including febrile status epilepticus.
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Bebek N, Özdemir Ö, Sayitoglu M, Hatırnaz O, Baykan B, Gürses C, Sencer A, Karasu A, Tüzün E, Üzün I, Akat S, Cine N, Sargin Kurt G, Imer M, Ozbek U, Canbolat A, Gökyigit A. Expression analysis and clinical correlation of aquaporin 1 and 4 genes in human hippocampal sclerosis. J Clin Neurosci 2013; 20:1564-70. [PMID: 23928039 DOI: 10.1016/j.jocn.2012.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/28/2012] [Accepted: 12/02/2012] [Indexed: 01/26/2023]
Abstract
Mesial temporal sclerosis (MTS) is the most frequent cause of drug resistant symptomatic partial epilepsy. The mechanism and genetic background of this unique pathology are not well understood. Aquaporins (AQP) are regulators of water homeostasis in the brain and are expressed in the human hippocampus. We explored the role of AQP genes in the pathogenetic mechanisms of MTS through an evaluation of gene expression in surgically removed human brain tissue. We analyzed AQP1 and 4 mRNA levels by quantitative real-time polymerase chain reaction and normalized to ABL and cyclophilin genes, followed by immunohistochemistry for AQP4. Relative expressions were calculated according to the delta Ct method and the results were compared using the Mann-Whitney U test. Brain specimens of 23 patients with epilepsy who had undergone surgery for MTS and seven control autopsy specimens were investigated. Clinical findings were concordant with previous studies and 61% of the patients were seizure-free in the postoperative period. AQP1 and 4 gene expression levels did not differ between MTS patients and control groups. Immunofluorescence analysis of AQP4 supported the expression results, showing no difference. Previous studies have reported contradictory results about the expression levels of AQP in MTS. To our knowledge, only one study has suggested upregulation whereas the other indicated downregulation of perivascular AQP4. Our study did not support these findings and may rule out the involvement of AQP in human MTS.
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Affiliation(s)
- N Bebek
- Neurology Department, Istanbul Faculty of Medicine, Millet cad., 34390 Capa, Istanbul, Turkey; Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey.
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Winkler AS, Tluway A, Schmutzhard E. Febrile seizures in rural Tanzania: hospital-based incidence and clinical characteristics. J Trop Pediatr 2013; 59:298-304. [PMID: 23619600 DOI: 10.1093/tropej/fmt022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Febrile seizures may contribute to epilepsy later in life, but data in sub-Saharan Africa are scarce. We, therefore, conducted a hospital-based study on clinical characteristics of children with febrile seizures. METHODS Over 2 years, we screened all pediatric admissions of Haydom Lutheran Hospital, northern Tanzania, and recruited 197 children with febrile seizures. RESULTS The incidence of febrile seizures was 4% of all admitted children aged <10 years, with a mortality of almost 4%. The peak age at the first febrile seizure was 2 years. One of five children experienced repeated episodes, and the majority of children showed features of complex seizures. Approximately 20% of children had a positive family history of febrile seizures or epilepsy. CONCLUSION Febrile seizures represent a frequent cause for admission of children, bearing a rather high mortality. Most children exhibit complex febrile seizures, which may contribute to the development of epilepsy later in life.
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Affiliation(s)
- Andrea S Winkler
- Department of Neurology, Technical University of Munich, 81675 Munich, Germany.
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Abstract
Febrile seizures are the most common type of childhood seizures, affecting 2% to 5% of children. A complex febrile seizure is one with focal onset, one that occurs more than once during a febrile illness, or one that lasts more than 10 to 15 minutes. Confusion still exists on the proper evaluation of a child presenting with a complex febrile seizure. There are ongoing research attempts to determine the link between complex febrile seizures and epilepsy. Further clarification and understanding of this disorder would be of great benefit to primary care providers and child neurologists.
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Affiliation(s)
- Anup D Patel
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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The appropriate neuroimaging study in persons with epilepsy. Neurol Sci 2011; 32:969-71. [PMID: 21647630 DOI: 10.1007/s10072-011-0640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
This article presents the appropriate neuroimaging for persons with epilepsy (PWE) in resource-limited facilities. PWE from the Epilepsy Clinic, Srinagarind Hospital between November 1, 2003 and January 30, 2005 were enrolled. The inclusion criteria were PWE aged more than 15 years who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. We compared the abnormal neuroimaging findings by both imaging modalities. A total of 180 out of 370 PWE met the inclusion criteria, comprising 101 men (56.1%) and 79 women (43.9%). There were 75 PWE who underwent only CT imagings, 85 PWE who underwent only MRI and 20 PWE who underwent both CT and MRI studies. CT scan significantly detected brain abnormalities more than MRI in PWE (P = 0.0131). It was also found that CT scan was superior than MRI in detecting stroke and cysticercosis in PWE, whereas MRI was significantly better in the diagnosis of hippocampal sclerosis. Clinicians should be able to choose appropriate brain imaging for PWE, particularly in resource-limited countries. MRI should be preserved for particular brain lesion owing to availability and cost effectiveness.
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Buckingham SE, Chervoneva I, Sharan A, Zangaladze A, Mintzer S, Skidmore C, Nei M, Evans J, Pequignot E, Sperling MR. Latency to first seizure after temporal lobectomy predicts long-term outcome. Epilepsia 2010; 51:1987-93. [DOI: 10.1111/j.1528-1167.2010.02721.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jehi L, Sarkis R, Bingaman W, Kotagal P, Najm I. When is a postoperative seizure equivalent to “epilepsy recurrence” after epilepsy surgery? Epilepsia 2010; 51:994-1003. [DOI: 10.1111/j.1528-1167.2010.02556.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Febrile seizures (FSs) are seizures that occur during fever, usually at the time of a cold or flu, and represent the most common cause of seizures in the pediatric population. Up to 5% of children between the ages of six months and five years-of-age will experience a FS. Clinically these seizures are categorized as benign events with little impact on the growth and development of the child. However, studies have linked the occurrence of FSs to an increased risk of developing adult epileptic disorders. There are many unanswered questions about FSs, such as the mechanism of their generation, the long-term effects of these seizures, and their role in epileptogenesis. Answers are beginning to emerge based on results from animal studies. This review summarizes the current literature on animal models of FSs, mechanisms underlying the seizures, and functional, structural, and molecular changes that may result from them.
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The mortality and morbidity of febrile seizures. ACTA ACUST UNITED AC 2009; 4:610-21. [PMID: 18978801 DOI: 10.1038/ncpneuro0922] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 09/04/2008] [Indexed: 11/08/2022]
Abstract
Approaches to the treatment and investigation of febrile seizures have changed since the main reference studies on outcomes were conducted in the 1960s and 1970s. We have, therefore, conducted a systematic review of literature from the past 15 years to see whether outcomes have also changed. We found that simple febrile seizures do not carry a risk of death, but there is a very small risk of death after complex febrile seizures (CFSs), particularly febrile status epilepticus. There is no evidence that SUDEP (sudden unexpected death in epilepsy) occurs in association with febrile seizures. The risk of later epilepsy after a febrile seizure lies between 2.0% and 7.5%, and the risk of developing epilepsy after CFSs is estimated at around 10-20%. There is no evidence of any risk of hippocampal or mesial temporal sclerosis (HS/MTS) in association with simple febrile seizures. Serial imaging has shown that HS/MTS develops in 0-25% of patients over time after prolonged febrile seizures; the range in prevalence reflects selection bias in different studies. The overall risk of HS/MTS associated with CFSs is around 3%. Approximately 40% of patients with medically refractory temporal lobe epilepsy and HS/MTS on neuroimaging have a history of febrile seizures.
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Ontogeny of calbindin immunoreactivity in the human hippocampal formation with a special emphasis on granule cells of the dentate gyrus. Int J Dev Neurosci 2008; 27:115-27. [DOI: 10.1016/j.ijdevneu.2008.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 11/17/2008] [Accepted: 12/10/2008] [Indexed: 11/21/2022] Open
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Aull-Watschinger S, Pataraia E, Czech T, Baumgartner C. Outcome predictors for surgical treatment of temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 2008; 49:1308-16. [DOI: 10.1111/j.1528-1167.2008.01732.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Decision-making in temporal lobe epilepsy surgery: The contribution of basic non-invasive tests. Seizure 2008; 17:364-73. [DOI: 10.1016/j.seizure.2007.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 09/13/2007] [Accepted: 11/13/2007] [Indexed: 11/21/2022] Open
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Auer T, Barsi P, Bone B, Angyalosi A, Aradi M, Szalay C, Horvath RA, Kovacs N, Kotek G, Fogarasi A, Komoly S, Janszky I, Schwarcz A, Janszky J. History of simple febrile seizures is associated with hippocampal abnormalities in adults. Epilepsia 2008; 49:1562-9. [PMID: 18503555 DOI: 10.1111/j.1528-1167.2008.01679.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY BACKGROUND It is unclear whether the hippocampal abnormality in temporal lobe epilepsy (TLE) is a consequence or the cause of afebrile or febrile seizures (FSs). We investigated whether hippocampal abnormalities are present in healthy adults>15 years after a simple FS. METHODS Eight healthy subjects (5 men) with a history of simple FS (FS+ group) and eight sex- and aged-matched control subjects (FS- group) were investigated by three MR methods: blinded visual inspection of the MRI pictures; automatic voxel-based volumetry; and T2 relaxation time measurements. RESULTS The mean total volume of the two hippocampi was 5.36 +/- 1.33 cm(3)in the FS+ group and 6.63 +/- 1.46 cm(3)in the FS- group (p = 0.069). The T2 values in the anterior part of the left hippocampus (p = 0.036) and in the middle part of the right hippocampus (p = 0.025) were elevated in the FS+ subjects. The mean volume of the right hippocampus was 3.05 +/- 0.8 cm(3)in the FS+ men and 4.05 +/- 0.48 cm(3)in the FS- men (p = 0.043). The mean total volume of the two hippocampi was 5.38 +/- 1.4 cm(3)in the FS+ men and 7.48 +/- 1.14 cm(3)in the FS- men (p = 0.043). There were three FS+ men in whom hippocampal abnormalities including hippocampal sclerosis (HS) and dysgenesis were observed on visual inspection. CONCLUSIONS A history of simple FS in childhood can be associated with hippocampal abnormalities in adults. These abnormalities are probably more pronounced in men. Simple FS may not be as a benign event as previously thought. Our findings suggest that hippocampal abnormalities associated with FS are not necessarily epileptogenic.
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Affiliation(s)
- Tibor Auer
- Department of Neurology, University of Pécs, Pécs, Hungary
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Kipervasser S, Nagar S, Chistik V, Kramer U, Fried I, Neufeld MY. The prognostic significance of interictal epileptiform activity in postoperative EEGs of patients with mesial temporal lobe epilepsy. Clin EEG Neurosci 2007; 38:137-42. [PMID: 17844942 DOI: 10.1177/155005940703800309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It has not been established whether electroencephalography (EEG) is a contributing factor in predicting the outcome of surgery for epilepsy. We conducted a prospective study on 26 patients (M/F 14/12, age: 33 +/- 7.5 years, range 19-48) with mesial temporal lobe epilepsy (MTLE) who were followed for 2 years after surgery and who underwent routine EEG recordings 5.6 +/- 3 months (range 3-12) postoperatively. Interictal epileptiform activity (IEA) on the EEG was compared in 17 seizure-free patients to 9 patients with recurrent seizures. The two groups were similar in gender, age, febrile convulsions, trauma, family history, seizure frequency prior to surgery, epilepsy duration and number of antiepileptic drugs. Following surgery, 17 study patients (65%) became seizure free; 9 (35%) had seizure recurrence. Post-operative EEG recordings showed IEA in 8/26 study patients (31%), 3 of whom were from the seizure-free group (3/17, 18%); 5 had seizure recurrence (5/9, 56%) (p=0.078). IEAs in postoperative EEGs were less frequently demonstrated in patients who were seizure free, but the presence of postoperative IEAs does not preclude successful surgical outcome.
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Affiliation(s)
- Svetlana Kipervasser
- EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel
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Persistent seizures following left temporal lobe surgery are associated with posterior and bilateral structural and functional brain abnormalities. Epilepsy Res 2007; 74:131-9. [PMID: 17412561 DOI: 10.1016/j.eplepsyres.2007.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 02/16/2007] [Accepted: 02/19/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE To perform a quantitative MRI and retrospective electrophysiological study to investigate whether persistent post-surgical seizures may be due to brain structural and functional abnormalities in temporal lobe cortex beyond the margins of resection and/or bilateral abnormalities in patients with temporal lobe epilepsy (TLE). METHODS In 22 patients with left TLE and histopathological evidence of hippocampal sclerosis, we compared pre-surgical brain morphology between patients surgically remedied (Engel's I) and patients with persistent post-surgical seizures (PPS, Engel's II-IV) using voxel-based morphometry (VBM). Routine pre-surgical EEG and invasive and non-invasive telemetry investigations were additionally compared between patient groups. RESULTS Results indicated widespread structural and functional abnormalities in patients with PPS relative to surgically remedied patients. In particular, patients with PPS had significantly reduced volume of the ipsilateral posterior medial temporal lobe and contralateral medial temporal lobe relative to surgically remedied patients. Furthermore, successful surgery was associated with clear anterior (89%) and unilateral (100%) temporal lobe EEG abnormalities, whilst PPS were associated with widespread ipsilateral (91%) and bilateral (82%) temporal lobe abnormalities. DISCUSSION We suggest that these preliminary data support the hypothesis that PPS after temporal lobe surgery are due to functionally connected epileptogenic cortex remaining in the ipsilateral posterior temporal lobe and/or in temporal lobe contralateral to resection.
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Blümcke I, Pauli E, Clusmann H, Schramm J, Becker A, Elger C, Merschhemke M, Meencke HJ, Lehmann T, von Deimling A, Scheiwe C, Zentner J, Volk B, Romstöck J, Stefan H, Hildebrandt M. A new clinico-pathological classification system for mesial temporal sclerosis. Acta Neuropathol 2007; 113:235-44. [PMID: 17221203 PMCID: PMC1794628 DOI: 10.1007/s00401-006-0187-0] [Citation(s) in RCA: 282] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/14/2006] [Accepted: 12/14/2006] [Indexed: 12/17/2022]
Abstract
We propose a histopathological classification system for hippocampal cell loss in patients suffering from mesial temporal lobe epilepsies (MTLE). One hundred and seventy-eight surgically resected specimens were microscopically examined with respect to neuronal cell loss in hippocampal subfields CA1–CA4 and dentate gyrus. Five distinct patterns were recognized within a consecutive cohort of anatomically well-preserved surgical specimens. The first group comprised hippocampi with neuronal cell densities not significantly different from age matched autopsy controls [no mesial temporal sclerosis (no MTS); n = 34, 19%]. A classical pattern with severe cell loss in CA1 and moderate neuronal loss in all other subfields excluding CA2 was observed in 33 cases (19%), whereas the vast majority of cases showed extensive neuronal cell loss in all hippocampal subfields (n = 94, 53%). Due to considerable similarities of neuronal cell loss patterns and clinical histories, we designated these two groups as MTS type 1a and 1b, respectively. We further distinguished two atypical variants characterized either by severe neuronal loss restricted to sector CA1 (MTS type 2; n = 10, 6%) or to the hilar region (MTS type 3, n = 7, 4%). Correlation with clinical data pointed to an early age of initial precipitating injury (IPI < 3 years) as important predictor of hippocampal pathology, i.e. MTS type 1a and 1b. In MTS type 2, IPIs were documented at a later age (mean 6 years), whereas in MTS type 3 and normal appearing hippocampus (no MTS) the first event appeared beyond the age of 13 and 16 years, respectively. In addition, postsurgical outcome was significantly worse in atypical MTS, especially MTS type 3 with only 28% of patients having seizure relief after 1-year follow-up period, compared to successful seizure control in MTS types 1a and 1b (72 and 73%). Our classification system appears suitable for stratifying the clinically heterogeneous group of MTLE patients also with respect to postsurgical outcome studies.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 8-10, 91054, Erlangen, Germany.
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Abstract
PURPOSE OF REVIEW The sequence of febrile seizures followed by intractable temporal lobe epilepsy is rarely seen from a population perspective. However, several studies have shown a significant relationship between a history of prolonged febrile seizures in early childhood and mesial temporal sclerosis. The interpretation of these observations remains quite controversial. One possibility is that the early febrile seizure damages the hippocampus and is therefore a cause of mesial temporal sclerosis. Another possibility is that the child has a prolonged febrile seizure because the hippocampus was previously damaged by a prenatal or perinatal insult or by genetic predisposition. RECENT FINDINGS Imaging studies have shown that prolonged and focal febrile seizures can produce acute hippocampal injury that evolves to hippocampal atrophy, and that complex febrile seizures can originate in the temporal lobes in some children. Several lines of evidence now indicate that genetic predisposition is an important causal factor of febrile seizures and mesial temporal sclerosis. From recent clinical and molecular genetic studies, it appears that the relationship between febrile seizures and later epilepsy is frequently genetic, and there are several syndrome-specific genes for febrile seizures. SUMMARY Mesial temporal sclerosis probably has different causes. A number of retrospective studies showed that complex febrile seizures are a causative factor for the later development of mesial temporal sclerosis and temporal lobe epilepsy. However, contradictory results have come from several prospective and retrospective studies. The association between febrile seizures and temporal lobe epilepsy probably results from complex interactions between several genetic and environmental factors.
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Affiliation(s)
- Fernando Cendes
- Department of Neurology, FCM, UNICAMP, Campinas, Sao Paulo, Brazil.
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