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Xu K, Yang X, Zhou J, Guan Y, Zhao M, Wang M, Wang J, Li T, Wang X, Luan G. SEEG-based reevaluation of epileptogenic networks and the predictive role for reoperation in MTLE patients with surgical failure. Epilepsia Open 2023; 8:846-857. [PMID: 37043173 PMCID: PMC10472362 DOI: 10.1002/epi4.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/08/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE Approximately 20%-30% of mesial temporal lobe epilepsy (MTLE) patients got unfavorable seizure control after surgery, and there was a discrepancy about the reasons for the surgical failure. The functional connectivity (FC) patterns obtained from stereo-electroencephalography (SEEG) reveal information about the dynamics of the epileptic brain and the added value of extracting information that was not identifiable in the SEEG data using FC analysis. This study aims to find out the patterns of the potential epileptogenic network of failure patients and the electrophysiological predictors of reoperation. METHODS From January 2012 to December 2019, the MTLE patients with surgical failure were reviewed, and all patients underwent SEEG-guided reoperation. The epileptogenic network was quantified by calculating FC indicators, including phase slope index (PSI), mutual information (MI) strength, imaginary coherence (icoh), and Granger causality. RESULTS Ten patients with 13 seizures were included in the analysis, and 7 of them achieved a favorable outcome after the SEEG-guided reoperation. The surgical zone (SZ) with a favorable prognosis showed greater outward information flow than the non-SZ, whereas the SZ with an unfavorable prognosis showed greater inward information flow. The recurrent patients with favorable prognosis had strong connectivity between the posterior hippocampus, temporal neocortex, and insula, whereas the patients with unfavorable prognosis showed strong functional connectivity between the insula and temporal-parietal-occipital junction. The power spectrum of patients with favorable prognosis was significantly lower than that of patients with unfavorable prognosis, especially showing a more oscillation power of low frequency. SIGNIFICANCE The SEEG-guided reoperation could achieve favorable seizure control outcomes for recurrent patients. The FCs were a potential indicator to help construct the temporal epileptic network and predictor for the reoperative prognosis in the recurrent patients.
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Affiliation(s)
- Ke Xu
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Xue Yang
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Jing Wang
- Department of Neurology, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Tianfu Li
- Department of Neurology, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
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2
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Feng T, Yang Y, Wei P, Wang C, Fan X, Wang K, Zhang H, Shan Y, Zhao G. The role of the orbitofrontal cortex and insula for prognosis of mesial temporal lobe epilepsy. Epilepsy Behav 2023; 138:109003. [PMID: 36470059 DOI: 10.1016/j.yebeh.2022.109003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE We investigated the network between the medial temporal lobe (MTL) and extratemporal structures in patients with mesial temporal lobe epilepsy (MTLE) in order to explain the recurrence of MTLE after surgery. This study contributes to our current understanding of MTLE with stereotactic electroencephalography (SEEG). METHODS We conducted a retrospective study of SEEG in 20 patients with MTLE in order to observe and analyze the intensity of interictal high-frequency oscillations (HFOs), as well as the dynamic course of coherence connectivity values of the MTL and extratemporal structures during the initial phase of the seizure. The results correlated with the patient prognosis. RESULTS First, the presence of HFOs was observed during the interictal period in all 20 patients; these were localized to the MTL in 17 patients and the orbitofrontal cortex in seven patients and the insula in six patients. The better the prognosis, the greater the localization of the HFOs concentration in the MTL structures (p < 0.05). Second, significantly enhanced connectivity of MTL structures with the orbitofrontal cortex and insula was observed in most patients with MTLE, before and after the seizure onset (p < 0.05). Finally, the connectivity between extratemporal structures, such as the orbitofrontal cortex and insula, and MTL structures was significantly stronger in patients who had a worse prognosis than in other patients, before and after seizure onset (p < 0.05). INTERPRETATION The epileptogenic network in recurrent MTLE is not limited to MTL structures but is also associated with the orbitofrontal cortex and insula. This can be used as a potential indicator for predicting the prognosis of patients after surgery, providing an important avenue for future clinical evaluation.
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Affiliation(s)
- Tao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yanfeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Changming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Huaqiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (CHINA-INI), Beijing, China; Institute for Brain Disorder, Beijing, China.
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3
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Morgan VL, Sainburg LE, Johnson GW, Janson A, Levine KK, Rogers BP, Chang C, Englot DJ. Presurgical temporal lobe epilepsy connectome fingerprint for seizure outcome prediction. Brain Commun 2022; 4:fcac128. [PMID: 35774185 PMCID: PMC9237708 DOI: 10.1093/braincomms/fcac128] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/02/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023] Open
Abstract
Temporal lobe epilepsy presents a unique situation where confident clinical localization of the seizure focus does not always result in a seizure-free or favourable outcome after mesial temporal surgery. In this work, magnetic resonance imaging derived functional and structural whole-brain connectivity was used to compute a network fingerprint that captures the connectivity profile characteristics that are common across a group of nine of these patients with seizure-free outcome. The connectivity profile was then computed for 38 left-out patients with the hypothesis that similarity to the fingerprint indicates seizure-free surgical outcome. Patient profile distance to the fingerprint was compared with 1-year seizure outcome and standard clinical parameters. Distance to the fingerprint was higher for patients with Engel III-IV 1-year outcome compared with those with Engel Ia, Ib-d, and II outcome (Kruskal-Wallis, P < 0.01; Wilcoxon rank-sum p corr <0.05 Bonferroni-corrected). Receiver operator characteristic analysis revealed 100% sensitivity and 90% specificity in identifying patients with Engel III-IV outcome based on distance to the fingerprint in the left-out patients. Furthermore, distance to the fingerprint was not related to any individual clinical parameter including age at scan, duration of disease, total seizure frequency, presence of mesial temporal sclerosis, lateralizing ictal, interictal scalp electroencephalography, invasive stereo-encephalography, or positron emission tomography. And two published algorithms utilizing multiple clinical measures for predicting seizure outcome were not related to distance to the fingerprint, nor predictive of seizure outcome in this cohort. The functional and structural connectome fingerprint provides quantitative, clinically interpretable and significant information not captured by standard clinical assessments alone or in combinations. This automated and simple method may improve patient-specific prediction of seizure outcome in patients with a clinically identified focus in the mesial temporal lobe.
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Affiliation(s)
- Victoria L Morgan
- Correspondence to: Victoria L. Morgan, PhD 1161 21st Avenue South, R0102 MCN Nashville, TN 37232 USA E-mail:
| | - Lucas E Sainburg
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Graham W Johnson
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Andrew Janson
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
| | - Kaela K Levine
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
| | - Baxter P Rogers
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Catie Chang
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Dario J Englot
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
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Hussein H, Kokkinos V, Sisterson ND, Modo M, Richardson RM. Extrapial Hippocampal Resection in Anterior Temporal Lobectomy: Technical Description and Clinical Outcomes in a 62-Patient Case Series. Oper Neurosurg (Hagerstown) 2021; 21:312-323. [PMID: 34333663 DOI: 10.1093/ons/opab262] [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: 11/10/2020] [Accepted: 05/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anterior temporal lobectomy (ATL) is the most effective treatment for drug-resistant mesial temporal lobe epilepsy. Extrapial en bloc hippocampal resection facilitates complete removal of the hippocampus. With increasing use of minimally invasive treatments, considering open resection techniques that optimize the integrity of tissue specimens is important both for obtaining the correct histopathological diagnosis and for further study. OBJECTIVE To describe the operative strategy and clinical outcomes associated with an extrapial approach to hippocampal resection during ATL. METHODS A database of epilepsy surgeries performed by a single surgeon between October 2011 and February 2019 was reviewed to identify all patients who underwent ATL using an extrapial approach to hippocampal resection. To reduce confounding variables for outcome analysis, subjects with prior resections, tumors, and cavernous malformations were excluded. Seizure outcomes were classified using the Engel scale. RESULTS The surgical technique is described and illustrated with intraoperative images. A total of 62 patients met inclusion criteria (31 females) for outcome analysis. Patients with most recent follow-up <3 yr (n = 33) and >3 yr (n = 29) exhibited 79% and 52% class I outcomes, respectively. An infarct was observed on postoperative magnetic resonance imaging in 3 patients (1 asymptomatic and 2 temporarily symptomatic). An en bloc specimen in which the subiculum and all hippocampal subfields were preserved was obtained in each case. Examples of innovative research opportunities resulting from this approach are presented. CONCLUSION Extrapial resection of the hippocampus can be performed safely with seizure freedom and complication rates at least as good as those reported with the use of subpial techniques.
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Affiliation(s)
- Helweh Hussein
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel D Sisterson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michel Modo
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Ivanović J, Alfstad KÅ, Marthinsen PB, Olsen KB, Larsson PG, Pripp AH, Stanišić M. Seizure Outcome After Ipsitemporal Reoperation in Pharmacoresistant Temporal Lobe Epilepsy Patients With Hippocampal Sclerosis and Nonspecific Pathology. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Wu K, Wang Z, Zhang Y, Yao J, Zhang Z. Transcutaneous vagus nerve stimulation for the treatment of drug‐resistant epilepsy: a meta‐analysis and systematic review. ANZ J Surg 2020; 90:467-471. [DOI: 10.1111/ans.15681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Kaymin Wu
- Department of Neurosurgery, Guangxing HospitalZhejiang Chinese Medical University Hangzhou China
| | - Zipu Wang
- Department of NeurosurgeryBengbu Medical College Bengbu China
| | - Yunxiao Zhang
- Department of Neurosurgery, Guangxing HospitalZhejiang Chinese Medical University Hangzhou China
| | - Jiahui Yao
- Department of Emergency StatisticsYuhang First People's Hospital Hangzhou China
| | - Zuyong Zhang
- Department of Neurosurgery, Guangxing HospitalZhejiang Chinese Medical University Hangzhou China
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Schoenberg MR, Clifton WE, Sever RW, Vale FL. Neuropsychology Outcomes Following Trephine Epilepsy Surgery: The Inferior Temporal Gyrus Approach for Amygdalohippocampectomy in Medically Refractory Mesial Temporal Lobe Epilepsy. Neurosurgery 2019; 82:833-841. [PMID: 28595352 PMCID: PMC5952931 DOI: 10.1093/neuros/nyx302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE) that are refractory to medical management. The inferior temporal gyrus (ITG) approach provides access to the mesial temporal lobe (MTL) structures with minimal tissue disruption. Reported neuropsychology outcomes following this approach are limited. OBJECTIVE To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospective design. METHODS Fifty-four participants had Engel class I/II outcome following resection of MTL using the ITG approach. All participants had localization-related epilepsy confirmed by long-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, and neuropsychology assessment. RESULTS Clinical semiology/video-electroencephalography indicated that of the 54 patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) had pathology-confirmed mesial temporal sclerosis (MTS). Group level analyses found declines in verbal memory for patients with language-dominant resections (P < .05). No significant decline in neuropsychological measures occurred for patients with MTS. Participants without MTS who underwent a language-dominant lobe resection exhibited a significant decline in verbal and visual memory (P < .05). Nondominant resection participants did not exhibit significant change in neuropsychology scores (P > .05). CONCLUSION Neuropsychology outcomes of an ITG approach for selective mesial temporal resection are comparable to other selective AH techniques showing minimal adverse cognitive effects. These data lend support to the ITG approach for selective AH as an option for MTLE.
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Affiliation(s)
- Mike R Schoenberg
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - William E Clifton
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida
| | - Ryan W Sever
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida.,Florida School of Professional Psychology, Tampa, Florida
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
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8
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Morgan VL, Rogers BP, Anderson AW, Landman BA, Englot DJ. Divergent network properties that predict early surgical failure versus late recurrence in temporal lobe epilepsy. J Neurosurg 2019; 132:1324-1333. [PMID: 30952126 DOI: 10.3171/2019.1.jns182875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objectives of this study were to identify functional and structural network properties that are associated with early versus long-term seizure outcomes after mesial temporal lobe epilepsy (mTLE) surgery and to determine how these compare to current clinically used methods for seizure outcome prediction. METHODS In this case-control study, 26 presurgical mTLE patients and 44 healthy controls were enrolled to undergo 3-T MRI for functional and structural connectivity mapping across an 8-region network of mTLE seizure propagation, including the hippocampus (left and right), insula (left and right), thalamus (left and right), one midline precuneus, and one midline mid-cingulate. Seizure outcome was assessed annually for up to 3 years. Network properties and current outcome prediction methods related to early and long-term seizure outcome were investigated. RESULTS A network model was previously identified across 8 patients with seizure-free mTLE. Results confirmed that whole-network propagation connectivity patterns inconsistent with the mTLE model predict early surgical failure. In those patients with networks consistent with the mTLE network, specific bilateral within-network hippocampal to precuneus impairment (rather than unilateral impairment ipsilateral to the seizure focus) was associated with mild seizure recurrence. No currently used clinical variables offered the same ability to predict long-term outcome. CONCLUSIONS It is known that there are important clinical differences between early surgical failure that lead to frequent disabling seizures and late recurrence of less frequent mild seizures. This study demonstrated that divergent network connectivity variability, whole-network versus within-network properties, were uniquely associated with these disparate outcomes.
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Affiliation(s)
- Victoria L Morgan
- 1Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center.,Departments of2Biomedical Engineering and
| | - Baxter P Rogers
- 1Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | - Adam W Anderson
- 1Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center.,Departments of2Biomedical Engineering and
| | - Bennett A Landman
- 1Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center.,3Electrical Engineering and Computer Science, Vanderbilt University; and
| | - Dario J Englot
- 1Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg 2018; 32:663-670. [PMID: 30317876 DOI: 10.1080/02688697.2018.1506095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
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Vaugier L, Lagarde S, McGonigal A, Trébuchon A, Milh M, Lépine A, Scavarda D, Carron R, Bartolomei F. The role of stereoelectroencephalography (SEEG) in reevaluation of epilepsy surgery failures. Epilepsy Behav 2018. [PMID: 29526579 DOI: 10.1016/j.yebeh.2018.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Management of patients after initial epilepsy surgical failure is challenging. In this study, we report our experience in using the stereoelectroencephalography (SEEG) method in the reevaluation of patients after initial epilepsy surgical failure. We selected 28 patients examined through SEEG in our department for drug-resistant focal epilepsy following initial epilepsy surgical failure. For each patient, the residual seizure onset zone (rSOZ) as defined by SEEG was classified as either contiguous if the seizure onset zone (SOZ) was focal and close to the surgical cavity (same lobe) or noncontiguous in cases where the SOZ included site(s) distant from the surgical cavity. The rSOZ was defined according to visual analysis of SEEG traces completed by an estimation of the epileptogenicity index (EI). A second surgical procedure was performed in 12 patients (45%). A favorable outcome (Engel class I or II) was obtained in 9/12 patients (6 in Engel class I, 50%). The proportion of patients that had reoperation was higher in the contiguous group (80%) than in the noncontiguous group (22%) (p=0.02). A rSOZ localized in close relation to the initial surgical resection zone (contiguous group) was found in 10 patients (35%). Among them, 8 have since undergone reoperation, and a good outcome (Engel class I) was achieved in 5/8 (63%). A rSOZ involving a distant region from the first surgery was observed in 18 patients (65%) (noncontiguous group). Among them, only 4 have undergone reoperation, leading to a failure in 2 (Engel class III or IV) and a good outcome in 2 (IA). Ten patients had a first standard temporal lobectomy, and in 50% of these cases, the insula was involved in the rSOZ. Stereoelectroencephalography offers a unique way to evaluate the rSOZ at the individual level and thus guide further surgical decision-making. The best results are observed in patients having a focal rSOZ close to the site of the surgical resection in the first surgery.
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Affiliation(s)
- Lisa Vaugier
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Aileen McGonigal
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Agnès Trébuchon
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Mathieu Milh
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Anne Lépine
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Didier Scavarda
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France; APHM, Timone Hospital, Paediatric Neurosurgery Department, Marseille, France
| | - Romain Carron
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France; APHM, Timone Hospital, Functional and Stereotactical Neurosurgery Department, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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11
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Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ. Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia 2017; 58:2133-2142. [PMID: 28994113 DOI: 10.1111/epi.13920] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series and reviews. Therefore, our group performed the first quantitative meta-analysis of the literature from the past 30 years to assess for rates and predictors of successful reoperations. METHODS A PubMed search was conducted for studies reporting outcomes of repeat epilepsy surgery. Studies were excluded if they reported fewer than five eligible patients or had average follow-ups < 1 year, and patients were excluded from analysis if they received a nonresective intervention. Outcomes were stratified by each variable of interest, and quantitative meta-analysis was performed to generate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Seven hundred eighty-two patients who received repeat resective epilepsy surgery from 36 studies were included. Engel I outcome was observed in 47% (n = 369) of patients. Significant predictors of seizure freedom included congruent over noncongruent electrophysiology data (OR = 3.6, 95% CI = 1.6-8.2), lesional over nonlesional epilepsy (OR = 3.2, 95% CI = 1.9-5.3), and surgical limitations over disease-related factors associated with failure of the first surgery (OR = 2.6, 95% CI = 1.3-5.3). Among patients with at least one of these predictors, seizure freedom was achieved in 58%. Conversely, the use of invasive monitoring was associated with worse outcome (OR = 0.4, 95% CI = 0.2-0.9). Temporal lobe over extratemporal/multilobe resection (OR = 1.5, 95% CI = 0.8-3.0) and abnormal over normal preoperative magnetic resonance imaging (OR = 1.9, 95% CI = 0.6-5.4) showed nonsignificant trends toward seizure freedom. SIGNIFICANCE This analysis supports considering further resection in patients with intractable epilepsy who continue to have debilitating seizures after an initial surgery, especially in the context of factors predictive of a favorable outcome.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Alvin Y Chan
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Stephen C Harward
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Carrie Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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12
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Schmeiser B, Zentner J, Steinhoff B, Brandt A, Schulze-Bonhage A, Kogias E, Hammen T. The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy. Seizure 2017; 51:174-179. [DOI: 10.1016/j.seizure.2017.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/13/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022] Open
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13
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El Tahry R, Wang IZ. Failed epilepsy surgery: is this the end? Acta Neurol Belg 2017; 117:433-440. [PMID: 28303525 DOI: 10.1007/s13760-017-0769-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/07/2017] [Indexed: 12/14/2022]
Abstract
Resective epilepsy surgery can lead to sustained seizure control in 70-80% of patients evaluated for epilepsy surgery, indicating that up to 30% of patients still have recurrent seizures after surgery. Definitions of failed epilepsy surgery vary amongst studies. This review focuses on seizure outcome predictors after reoperation, possible mechanisms of failure and best management for this difficult patient population.
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Affiliation(s)
- Riëm El Tahry
- Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.
- Department of Pneumology, Sleep Laboratory, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av Hippocrate 10, 1200, Brussels, Belgium.
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Kubota Y, Ochiai T, Hori T, Kawamata T. Usefulness of StereoEEG-based tailored surgery for medial temporal lobe epilepsy. Preliminary results in 11 patients. Clin Neurol Neurosurg 2017; 158:67-71. [PMID: 28482271 DOI: 10.1016/j.clineuro.2017.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/22/2017] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach. PATIENTS AND METHODS Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone. RESULTS Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%). CONCLUSION Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases.
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Affiliation(s)
- Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
| | - Taku Ochiai
- Ochiai Brain Clinic, Saitama, Saitama, Japan
| | | | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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15
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Morgan VL, Englot DJ, Rogers BP, Landman BA, Cakir A, Abou-Khalil BW, Anderson AW. Magnetic resonance imaging connectivity for the prediction of seizure outcome in temporal lobe epilepsy. Epilepsia 2017; 58:1251-1260. [PMID: 28448683 DOI: 10.1111/epi.13762] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Currently, approximately 60-70% of patients with unilateral temporal lobe epilepsy (TLE) remain seizure-free 3 years after surgery. The goal of this work was to develop a presurgical connectivity-based biomarker to identify those patients who will have an unfavorable seizure outcome 1-year postsurgery. METHODS Resting-state functional and diffusion-weighted 3T magnetic resonance imaging (MRI) was acquired from 22 unilateral (15 right, 7 left) patients with TLE and 35 healthy controls. A seizure propagation network was identified including ipsilateral (to seizure focus) and contralateral hippocampus, thalamus, and insula, with bilateral midcingulate and precuneus. Between each pair of regions, functional connectivity based on correlations of low frequency functional MRI signals, and structural connectivity based on streamline density of diffusion MRI data were computed and transformed to metrics related to healthy controls of the same age. RESULTS A consistent connectivity pattern representing the network expected in patients with seizure-free outcome was identified using eight patients who were seizure-free at 1-year postsurgery. The hypothesis that increased similarity to the model would be associated with better seizure outcome was tested in 14 other patients (Engel class IA, seizure-free: n = 5; Engel class IB-II, favorable: n = 4; Engel class III-IV, unfavorable: n = 5) using two similarity metrics: Pearson correlation and Euclidean distance. The seizure-free connectivity model successfully separated all the patients with unfavorable outcome from the seizure-free and favorable outcome patients (p = 0.0005, two-tailed Fisher's exact test) through the combination of the two similarity metrics with 100% accuracy. No other clinical and demographic predictors were successful in this regard. SIGNIFICANCE This work introduces a methodologic framework to assess individual patients, and demonstrates the ability to use network connectivity as a potential clinical tool for epilepsy surgery outcome prediction after more comprehensive validation.
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Affiliation(s)
- Victoria L Morgan
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Dario J Englot
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Baxter P Rogers
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bennett A Landman
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Ahmet Cakir
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Bassel W Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Adam W Anderson
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, U.S.A
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16
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Lim SN, Lee CY, Lee ST, Tu PH, Chang BL, Lee CH, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Chiang HI, Wu T. Low and High Frequency Hippocampal Stimulation for Drug-Resistant Mesial Temporal Lobe Epilepsy. Neuromodulation 2016; 19:365-72. [PMID: 27072376 PMCID: PMC5074270 DOI: 10.1111/ner.12435] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/23/2015] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
Abstract
Objective Electrical stimulation of the hippocampus offers the possibility to treat patients with mesial temporal lobe epilepsy (MTLE) who are not surgical candidates. We report long‐term follow‐up results in five patients receiving low or high frequency hippocampal stimulation for drug‐resistant MTLE. Materials and Methods The patients underwent stereotactic implantation of quadripolar stimulating electrodes in the hippocampus. Two of the patients received unilateral electrode implantation, while the other three received bilateral implantation. Stimulation of the hippocampal electrodes was turned ON immediately after the implantation of an implantable pulse generator, with initial stimulation parameters: 1 V, 90–150 μs, 5 or 145 Hz. The frequency of seizures was monitored and compared with preimplantation baseline data. Results Two men and three women, aged 27–61 years were studied, with a mean follow‐up period of 38.4 months (range, 30–42 months). The baseline seizure frequency was 2.0–15.3/month. The five patients had an average 45% (range 22–72%) reduction in the frequency of seizures after hippocampal stimulation over the study period. Low frequency hippocampal stimulation decreased the frequency of seizures in two patients (by 54% and 72%, respectively). No implantation‐ or stimulation‐related side effects were reported. Conclusions Electrical stimulation of the hippocampus is a minimally invasive and reversible method that can improve seizure outcomes in patients with drug‐resistant MTLE. The optimal frequency of stimulation varied from patient to patient and therefore required individual setting. These experimental results warrant further controlled studies with a large patient population to evaluate the long‐term effect of hippocampal stimulation with different stimulation parameters.
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Affiliation(s)
- Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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17
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Ryzí M, Ošlejšková H, Rektor I, Novák Z, Hemza J, Chrastina J, Svoboda M, Hermanová M, Brázdil M. Long-term approach to patients with postsurgical seizures. Epilepsia 2016; 57:597-604. [DOI: 10.1111/epi.13343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michal Ryzí
- Department of Child Neurology; Brno Epilepsy Center; Brno University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Hana Ošlejšková
- Department of Child Neurology; Brno Epilepsy Center; Brno University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Ivan Rektor
- First Department of Neurology; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
- Central European Institute of Technology (CEITEC); Masaryk University; Brno Czech Republic
| | - Zdeněk Novák
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Jan Hemza
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Jan Chrastina
- Department of Neurosurgery; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses; Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Markéta Hermanová
- First Department of Pathological Anatomy; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Milan Brázdil
- First Department of Neurology; Brno Epilepsy Center; St. Anne's University Hospital and Faculty of Medicine; Masaryk University; Brno Czech Republic
- Central European Institute of Technology (CEITEC); Masaryk University; Brno Czech Republic
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18
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Gales JM, Prayson RA. Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy. Hum Pathol 2016; 48:111-6. [DOI: 10.1016/j.humpath.2015.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
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Abstract
PURPOSE To describe a delayed severe complication of temporal lobectomy for intractable epilepsy. METHOD A case of amnesia occurring 24 years after surgery is described and five similar cases from the literature reviewed. RESULTS Mean age at surgery (5 right) was 40 years (19-62 years), 3 female. Four of five tested had impaired visual and verbal memory preoperatively but not sufficient to contraindicate surgery. Pathology was mesial temporal sclerosis in 3, 1 cavernoma, 1 dysembryoplastic neuroepithelial tumor (DNET) and 1 normal. Postoperatively, four were seizure free 3-12 years off medication and two continued with seizures. There was no unexpected postoperative memory change until incapacitating anterograde amnesia developed 1-24 years after surgery. In five patients, including ours, this followed definite or possible status epilepticus with new mesial temporal sclerosis on the opposite side in the four that were investigated by MRI. One patient developed a glioblastoma in the opposite temporal lobe. CONCLUSION Continuing or late recurrence of seizures from the remaining temporal lobe after temporal lobectomy can result in incapacitating amnesia if status epilepticus occurs. Other new lesions on the opposite side to surgery can have the same effect.
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20
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Temporal lobe surgery in medically refractory epilepsy: A comparison between populations based on MRI findings. Seizure 2014; 23:20-4. [DOI: 10.1016/j.seizure.2013.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/12/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
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21
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Neuroprotective effects of vagus nerve stimulation on hippocampal neurons in intractable epilepsy. Med Hypotheses 2013; 81:1066-8. [DOI: 10.1016/j.mehy.2013.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/28/2013] [Accepted: 10/04/2013] [Indexed: 11/18/2022]
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Zhang J, Liu W, Chen H, Xia H, Zhou Z, Mei S, Liu Q, Li Y. Identification of common predictors of surgical outcomes for epilepsy surgery. Neuropsychiatr Dis Treat 2013; 9:1673-82. [PMID: 24235833 PMCID: PMC3825696 DOI: 10.2147/ndt.s53802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although epilepsy surgery is an effective treatment for patients with drug-resistant epilepsy, surgical outcomes vary across patient groups and studies. Identification of reliable prognostic factors for surgical outcome is important for outcome research. In this study, recent systematic reviews and meta-analyses on prediction of seizure outcome have been analyzed, and common predictors of seizure outcome or unrelated factors for temporal lobe epilepsy (TLE), lesional extratemporal lobe epilepsy (ETLE), and tuberous sclerosis complex have been identified. Clinical factors such as lesional epilepsy, abnormal magnetic resonance imaging, partial seizures, and complete resection were found to be common positive predictors, and factors such as nonlesional epilepsy, poorly defined and localized epileptic focus, generalized seizures, and incomplete resection are common negative predictors, while factors such as age at surgery and side of surgery are unrelated to seizure outcome for TLE and lesional ETLE. In addition, diagnostic neuroimaging and resection are among the most important predictors of seizure outcome. However, common predictors of seizure outcome could not be identified in nonlesional ETLE because no predictors were found to be significant in adult patients (by meta-analysis), and outcome prediction is difficult in this case. Meta-analysis of other outcomes, such as neuropsychologic outcomes, is rare due to lack of evaluation standards. Further studies on identification of reliable predictors of surgical outcomes are needed.
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Affiliation(s)
- Jing Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
| | - Weifang Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
| | - Hong Xia
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
| | - Zhen Zhou
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
| | - Shanshan Mei
- Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People’s Republic of China
| | - Qingzhu Liu
- Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People’s Republic of China
| | - Yunlin Li
- Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People’s Republic of China
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23
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Reoperation after failed resective epilepsy surgery. Seizure 2013; 22:493-501. [DOI: 10.1016/j.seizure.2013.04.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/20/2022] Open
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24
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Elliott RE, Bollo RJ, Berliner JL, Silverberg A, Carlson C, Geller EB, Barr WB, Devinsky O, Doyle WK. Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control. J Neurosurg 2013; 119:261-72. [DOI: 10.3171/2013.4.jns121829] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH).
Methods
The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom.
Results
The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures.
Conclusions
Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.
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Affiliation(s)
| | - Robert J. Bollo
- 2Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Alyson Silverberg
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
| | | | - Eric B. Geller
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
| | - William B. Barr
- 4Neurology, Comprehensive Epilepsy Center, and
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Orrin Devinsky
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
- 6Psychiatry, New York University Langone Medical Center, New York, New York; and
| | - Werner K. Doyle
- 3Departments of Neurosurgery,
- 4Neurology, Comprehensive Epilepsy Center, and
- 5Institute of Neurology & Neurosurgery, Saint Barnabas Medical Center, Livingston, New Jersey
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25
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Vale FL, Reintjes S, Garcia HG. Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach. Neurosurg Focus 2013; 34:E2. [DOI: 10.3171/2013.3.focus1354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to identify the complications associated with the inferior temporal gyrus approach to anterior mesial temporal lobe resection for temporal lobe epilepsy.
Methods
This retrospective study examined complications experienced by 483 patients during the 3 months after surgery. All surgeries were performed during 1998–2012 by the senior author (F.L.V.).
Results
A total of 13 complications (2.7%) were reported. Complications were 8 delayed subdural hematomas (1.6%), 2 superficial wound infections (0.4%), 1 delayed intracranial hemorrhage (0.2%), 1 small lacunar stroke (0.2%), and 1 transient frontalis nerve palsy (0.2%). Three patients with subdural hematoma (0.6%) required readmission and surgical intervention. One patient (0.2%) with delayed intracranial hemorrhage required readmission to the neuroscience intensive care unit for observation. No deaths or severe neurological impairments were reported. Among the 8 patients with subdural hematoma, 7 were older than 40 years (87.5%); however, this finding was not statistically significant (p = 0.198).
Conclusions
The inferior temporal gyrus approach to mesial temporal lobe resection is a safe and effective method for treating temporal lobe epilepsy. Morbidity and mortality rates associated with this procedure are lower than those associated with other neurosurgical procedures. The finding that surgical complications seem to be more common among older patients emphasizes the need for early surgical referral of patients with medically refractory epilepsy.
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Affiliation(s)
- Fernando L. Vale
- 1Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and
| | - Stephen Reintjes
- 1Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and
| | - Hermes G. Garcia
- 2Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico
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Jung R, Aull-Watschinger S, Moser D, Czech T, Baumgartner C, Bonelli-Nauer S, Pataraia E. Is reoperation an option for patients with temporal lobe epilepsy after failure of surgery? Seizure 2012; 22:502-6. [PMID: 23273881 DOI: 10.1016/j.seizure.2012.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 11/18/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Epilepsy surgery is the most efficacious therapeutic modality for patients with medically refractory focal epilepsies, but surgical failures remain a challenge to the epilepsy treatment team. The aim of present study was to evaluate the postoperative outcome of patients who underwent reoperation after a failed epilepsy surgery on the temporal lobe. METHODS We systematically analyzed the results of comprehensive preoperative evaluations before the first surgery, and before and after reoperation in 17 patients with drug resistant temporal lobe epilepsies. RESULTS Overall, 13 of 17 patients (76.5%) improved after reoperation: five patients (29.4%) were completely seizure free after reoperation (median duration 60months, range 12-72); six patients (35.3%) were seizure free at least 12month before observation points (median duration 120.5months, range 35-155) and two patients (11.8%) had a decrease in seizure frequency. Four patients (23.5%) remained unchanged with respect to seizure frequency and severity. There was no correlation between the improvement in seizure outcome after reoperation and other clinical data except of the history of traumatic brain injury (TBI). The patients who had no history of TBI improved after reoperation, compared to patients with TBI (p=0.044). The postoperative seizure outcome of patients with incongruent Video-EEG results before the first surgery (p=0.116) and before reoperation (p=0.622) was not poorer compared to patients with congruent Video-EEG results. CONCLUSIONS Reoperation can considerably improve the operative outcome of the first failed epilepsy surgery in patients with drug resistant temporal lobe epilepsies. Epilepsy centres should be encouraged to report the results of failed epilepsy surgeries.
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Affiliation(s)
- Rebekka Jung
- Department of Neurology, Medical University Vienna, Austria
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27
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Blümcke I, Coras R, Miyata H, Ozkara C. Defining clinico-neuropathological subtypes of mesial temporal lobe epilepsy with hippocampal sclerosis. Brain Pathol 2012; 22:402-11. [PMID: 22497612 DOI: 10.1111/j.1750-3639.2012.00583.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hippocampal sclerosis (HS) is the most frequent cause of drug-resistant focal epilepsies (ie, mesial temporal lobe epilepsy with hippocampal sclerosis; mTLE-HS), and presents a broad spectrum of electroclinical, structural and molecular pathology patterns. Many patients become drug resistant during the course of the disease, and surgical treatment was proven helpful to achieve seizure control. Hence, up to 40% of patients suffer from early or late surgical failures. Different patterns of hippocampal cell loss, involvement of other mesial temporal structures, as well as temporal neocortex including focal cortical dysplasia, may contribute to the extent of the epileptogenic network and will be discussed. An international consensus is mandatory to clarify terminology use and to reliably distinguish mTLE-HS subtypes. High-resolution imaging with confirmed histopathologic diagnosis, as well as advanced neurophysiologic and molecular genetic measures, will be a powerful tool in the future to address these issues and help to predict each patient's probability to control their epilepsy in mTLE-HS conditions.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany.
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Morgan VL, Sonmezturk HH, Gore JC, Abou-Khalil B. Lateralization of temporal lobe epilepsy using resting functional magnetic resonance imaging connectivity of hippocampal networks. Epilepsia 2012; 53:1628-35. [PMID: 22779926 DOI: 10.1111/j.1528-1167.2012.03590.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Early surgical intervention can be advantageous in the treatment of refractory temporal lobe epilepsy (TLE). The success of TLE surgery relies on accurate lateralization of the seizure onset. The purpose of this study was to determine whether resting functional MRI (fMRI) connectivity mapping of the hippocampus has the potential to complement conventional presurgical evaluations in distinguishing left from right TLE. In addition, we sought to determine whether this same network might separate patients with favorable from unfavorable postoperative outcomes. METHODS Resting fMRI acquisitions were performed on 21 patients with TLE and 15 healthy controls. The patients included seven patients with left TLE and seven patients with right TLE with seizure-free postoperative outcome, and five patients with left TLE and two patients with right TLE with recurring seizures after surgery. Functional connectivity maps to each hippocampus were determined for each subject and were compared between the controls and the seizure-free patients with left TLE and with right TLE. The one network identified was then quantified in the patients with TLE and recurring seizures. KEY FINDINGS The resting functional connectivity between the right hippocampus and the ventral lateral nucleus of the right thalamus was the most statistically significant network to distinguish between seizure-free patients with left TLE and with right TLE with high sensitivity and specificity. This connectivity was also significantly greater in the seizure-free patients with left TLE than the healthy controls. Finally, six of the seven patients in whom seizures recurred after surgery had connectivity values in this network unlike those who were seizure-free. SIGNIFICANCE This study identified a region in the ventral lateral nucleus of the right thalamus whose connectivity to the hippocampi separates left from right TLE subjects. This suggests that the quantification of resting-state functional magnetic resonance imaging (MRI) connectivity across this network may be a potential indicator of lateralization of TLE that may be added to other presurgical MRI assessments. Further validation in a larger, independent cohort is required.
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Affiliation(s)
- Victoria L Morgan
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.
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Temporal lobe epilepsy surgery failures: a review. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:201651. [PMID: 22934162 PMCID: PMC3420575 DOI: 10.1155/2012/201651] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/17/2012] [Accepted: 02/01/2012] [Indexed: 11/23/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20–30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.
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Vale FL, Pollock G, Benbadis SR. Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology. Neurosurg Focus 2012; 32:E9. [DOI: 10.3171/2011.12.focus11318] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis.
Methods
A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates.
Results
Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings.
Conclusions
The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.
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Affiliation(s)
- Ciğdem Ozkara
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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32
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Vale FL, Effio E, Arredondo N, Bozorg A, Wong K, Martinez C, Downes K, Tatum WO, Benbadis SR. Efficacy of temporal lobe surgery for epilepsy in patients with negative MRI for mesial temporal lobe sclerosis. J Clin Neurosci 2012; 19:101-6. [DOI: 10.1016/j.jocn.2011.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/01/2011] [Accepted: 08/13/2011] [Indexed: 10/14/2022]
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KAWAMURA T, ONISHI H, KOHDA Y, HIROSE G. Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy. Neurol Med Chir (Tokyo) 2012; 52:892-8. [DOI: 10.2176/nmc.52.892] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nickels KC, Wong-Kisiel LC, Moseley BD, Wirrell EC. Temporal lobe epilepsy in children. EPILEPSY RESEARCH AND TREATMENT 2011; 2012:849540. [PMID: 22957247 PMCID: PMC3420576 DOI: 10.1155/2012/849540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/21/2011] [Indexed: 12/11/2022]
Abstract
The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome.
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Affiliation(s)
- Katherine C. Nickels
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Lily C. Wong-Kisiel
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Elaine C. Wirrell
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg 2011; 115:1248-55. [PMID: 21838505 DOI: 10.3171/2011.7.jns11977] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vagus nerve stimulation (VNS) was approved by the US FDA in 1997 as an adjunctive treatment for medically refractory epilepsy. It is considered for use in patients who are poor candidates for resection or those in whom resection has failed. However, disagreement regarding the utility of VNS in epilepsy continues because of the variability in benefit reported across clinical studies. Moreover, although VNS was approved only for adults and adolescents with partial epilepsy, its efficacy in children and in patients with generalized epilepsy remains unclear. The authors performed the first meta-analysis of VNS efficacy in epilepsy, identifying 74 clinical studies with 3321 patients suffering from intractable epilepsy. These studies included 3 blinded, randomized controlled trials (Class I evidence); 2 nonblinded, randomized controlled trials (Class II evidence); 10 prospective studies (Class III evidence); and numerous retrospective studies. After VNS, seizure frequency was reduced by an average of 45%, with a 36% reduction in seizures at 3-12 months after surgery and a 51% reduction after > 1 year of therapy. At the last follow-up, seizures were reduced by 50% or more in approximately 50% of the patients, and VNS predicted a ≥ 50% reduction in seizures with a main effects OR of 1.83 (95% CI 1.80-1.86). Patients with generalized epilepsy and children benefited significantly from VNS despite their exclusion from initial approval of the device. Furthermore, posttraumatic epilepsy and tuberous sclerosis were positive predictors of a favorable outcome. In conclusion, VNS is an effective and relatively safe adjunctive therapy in patients with medically refractory epilepsy not amenable to resection. However, it is important to recognize that complete seizure freedom is rarely achieved using VNS and that a quarter of patients do not receive any benefit from therapy.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
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Elliott RE, Morsi A, Geller EB, Carlson CC, Devinsky O, Doyle WK. Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation. Neurosurgery 2011; 69:1210-7. [DOI: 10.1227/neu.0b013e3182230ae3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Using the Cyberonics registry, Amar and colleagues reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES).
OBJECTIVE
To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE).
METHODS
We retrospectively reviewed 376 patients (188 female patients; 265 adults; mean age, 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed ≥1 prior craniotomies for TRE, and 266 (70.7%) had no history of IES.
RESULTS
The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types, and more commonly had focal or multifocal vs generalized seizures (P > .05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs 56.5%; P = .42). There was no correlation between type of failed IES (callosotomy vs resection) and seizure reduction with VNS therapy.
CONCLUSION
Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. For patients with TRE, including patients who failed cranial epilepsy surgeries, VNS should be considered a palliative treatment option.
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Affiliation(s)
- Robert E. Elliott
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Amr Morsi
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Eric B. Geller
- Department of Neurology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Chad C. Carlson
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Orrin Devinsky
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Werner K. Doyle
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
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Reoperation after selective amygdalohippocampectomy: an MRI analysis of the extent of temporomesial resection in ten cases. Acta Neurochir (Wien) 2011; 153:239-48. [PMID: 20853122 DOI: 10.1007/s00701-010-0802-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Selective amygdalohippocampectomy (SAHE) yields 60-80% of patients with medically refractory mesial temporal lobe epilepsy seizure-free and seems to be equally effective compared to the more extended temporal lobe resections. The resection of the entire entorhinal cortex (EC) is of crucial importance to warrant complete seizure control for those patients. Thus, evidence of residual EC could be a predictor of a potentially successful reoperation in patients with recurrent seizures after SAHE. We performed an analysis of preoperative and postoperative magnetic resonance imaging (MRI) in patients who underwent a reoperation after an unsuccessful transsylvian SAHE to assess the presence of residual EC before reoperation and to determine whether certain anatomical variants may dispose patients to incomplete resection of EC. MATERIALS AND METHODS Ten patients who underwent reoperation after SAHE for the recurrence of medically refractory seizures were studied. MRI after SAHE was assessed for the presence of residual EC using T2-weighted and inversion recovery sequences perpendicularly to the main axis of the hippocampus. The results were compared with a control group of ten patients who became seizure-free after SAHE. In the nine patients of the study group, the sulcal anatomy of the basal temporal lobe was graphically outlined and analysed on MRI scans performed before SAHE to characterise the sulcal boundaries of the EC. FINDINGS Residual EC was found in nine of ten patients and was absent in the control group. After reoperation (median follow-up of 36.5 months), eight out of ten patients were completely seizure-free. In seven out of nine patients, a discontinuous course of the lateral sulcal boundaries of the EC was determined. CONCLUSIONS Careful analysis of MRI verified residual mesiotemporal structures in the majority of patients who became seizure-free after reoperation. Certain temporobasal sulcal patterns might dispose for a higher risk of incomplete resection of the EC. The study confirms that reoperation is an effective treatment modality for patients with recurrent seizures after transsylvian SAHE.
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Goodman RR. AES 2009 Annual Course: Reoperation for medically refractory epilepsy. Epilepsy Behav 2011; 20:241-6. [PMID: 21288779 DOI: 10.1016/j.yebeh.2010.12.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 11/24/2022]
Abstract
A significant percentage of patients undergoing resective surgery for medically refractory epilepsy have persistent or recurrent disabling seizures. In these patients, the objective of seizure freedom justifies the consideration of repeat resective surgery. In this report, the available published experience with repeat resective surgery is analyzed. The reoperated patients are subdivided into three categories: patients with residual medial temporal structures, patients with an unresected or partially resected structural/mass (non-glioma) lesion and patients with non-lesional neocortical epilepsy. This analysis indicates that the chance of achieving seizure freedom is significant, although lower than with the initial surgery. The chance of significant morbidity (particularly significant neurologic deficit) is low, although higher than with the initial surgery. A proper evaluation can identify appropriate candidates for a resective reoperation. Palliative surgical options should be strongly considered for all patients, especially for those with lower chance of seizure freedom and/or elevated risk of morbidity.
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Affiliation(s)
- Robert R Goodman
- Neurological Surgery, Columbia University, New York, NY 10032, USA
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Vale FL, Ahmadian A, Youssef AS, Tatum WO, Benbadis SR. Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. Seizure 2010; 20:244-8. [PMID: 21196125 DOI: 10.1016/j.seizure.2010.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/27/2010] [Accepted: 12/03/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. METHODS All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. RESULTS Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). CONCLUSION VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.
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Affiliation(s)
- Fernando L Vale
- University of South Florida, Department of Neurosurgery, Tampa, FL 33606, United States.
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Jehi LE, Silveira DC, Bingaman W, Najm I. Temporal lobe epilepsy surgery failures: predictors of seizure recurrence, yield of reevaluation, and outcome following reoperation. J Neurosurg 2010; 113:1186-94. [DOI: 10.3171/2010.8.jns10180] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors provide a systematic analysis of electroclinical characteristics in patients with persistent seizures following temporal lobe epilepsy (TLE) surgery and identify ideal candidates for reoperation.
Methods
The authors retrospectively reviewed the records of 68 adult patients (mean follow-up 8.7 years) who underwent a video electroencephalography evaluation and high-resolution imaging after failed TLE surgery performed between 1990 and 2004 at The Cleveland Clinic. Multivariate logistic regression analyses were performed to identify predictors of the yield of a repeat evaluation, location of the recurrence focus, and outcome following reoperation.
Results
Although a focus of recurrence was identified in 44 patients, only 15 underwent reoperation, and only 6 of these became seizure free. Localized foci of recurrence were successfully identified in patients with early (within 1 postoperative year) and frequent (≥ 4 per month) recurrent seizures (yield of 100% if both conditions were fulfilled). Predictors of contiguity of the focus of recurrence to the initial surgical bed were variable depending on the type of the initial surgery: patients with baseline contralateral temporal spiking were 6 times (OR 6.34, p < 0.05) more likely to experience seizure recurrence from the contralateral temporal lobe after a “standard” temporal lobectomy, while the need to use subdural electrodes and the timing of recurrence were more significant following limited temporal resections. The focus of recurrence was distant to the original surgical bed when subdural electrodes were used prior to first surgery (OR 28.0, p = 0.01) or when seizures recurred early (within < 6 postoperative months; OR 12.5, p = 0.04). With reoperation, only patients with mesial and basal extension of the temporal resections became seizure free. Interestingly, seizure freedom was achieved with medical therapy alone in 42% of patients with a nonidentifiable recurrence focus as opposed to 4% of those with an unoperated identifiable focus.
Conclusions
The timing and frequency of recurrent seizures following unsuccessful TLE surgery provide useful guidelines for the yield of a surgical reevaluation, and potentially for the mechanisms of surgical failure.
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