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Palmini A. More versus less: the unresolved debate on the best surgical approach to temporal lobe epilepsy with hippocampal sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:613-615. [PMID: 37494947 PMCID: PMC10371413 DOI: 10.1055/s-0043-1771265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- André Palmini
- Pontificia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Núcleo de Neurociências Clínicas, Porto Alegre RS, Brazil
- Pontificia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia & Programa de Cirurgia da Epilepsia, Porto Alegre RS, Brazil
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Wang G, Wu W, Xu Y, Yang Z, Xiao B, Long L. Imaging Genetics in Epilepsy: Current Knowledge and New Perspectives. Front Mol Neurosci 2022; 15:891621. [PMID: 35706428 PMCID: PMC9189397 DOI: 10.3389/fnmol.2022.891621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/06/2022] [Indexed: 12/11/2022] Open
Abstract
Epilepsy is a neurological network disease with genetics playing a much greater role than was previously appreciated. Unfortunately, the relationship between genetic basis and imaging phenotype is by no means simple. Imaging genetics integrates multidimensional datasets within a unified framework, providing a unique opportunity to pursue a global vision for epilepsy. This review delineates the current knowledge of underlying genetic mechanisms for brain networks in different epilepsy syndromes, particularly from a neural developmental perspective. Further, endophenotypes and their potential value are discussed. Finally, we highlight current challenges and provide perspectives for the future development of imaging genetics in epilepsy.
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Affiliation(s)
- Ge Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Wenyue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yuchen Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhuanyi Yang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
- *Correspondence: Lili Long
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Mo J, Zhang J, Hu W, Shao X, Sang L, Zheng Z, Zhang C, Wang Y, Wang X, Liu C, Zhao B, Zhang K. Neuroimaging gradient alterations and epileptogenic prediction in focal cortical dysplasia Ⅲa. J Neural Eng 2022; 19. [PMID: 35405671 DOI: 10.1088/1741-2552/ac6628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/10/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Focal cortical dysplasia Type Ⅲa (FCD Ⅲa) is a highly prevalent temporal lobe epilepsy but the seizure outcomes are not satisfactory after epilepsy surgery. Hence, quantitative neuroimaging, epileptogenic alterations, as well as their values in guiding surgery are worth exploring. METHODS We examined 69 patients with pathologically verified FCD Ⅲa using multimodal neuroimaging and stereoelectroencephalography (SEEG). Among them, 18 received postoperative imaging which showed the extent of surgical resection and 9 underwent SEEG implantation. We also explored neuroimaging gradient alterations along with the distance to the temporal pole. Subsequently, the machine learning regression model was employed to predict whole-brain epileptogenicity. Lastly, the correlation between neuroimaging or epileptogenicity and surgical cavities was assessed. RESULTS FCD Ⅲa displayed neuroimaging gradient alterations on the temporal neocortex, morphology-signal intensity decoupling, low similarity of intra-morphological features and high similarity of intra-signal intensity features. The support vector regression model was successfully applied at the whole-brain level to calculate the continuous epileptogenic value at each vertex (mean-squared error = 13.8 ± 9.8). CONCLUSION Our study investigated the neuroimaging gradient alterations and epileptogenicity of FCD Ⅲa, along with their potential values in guiding suitable resection range and in predicting postoperative seizure outcomes. The conclusions from this study may facilitate an accurate presurgical examination of FCD Ⅲa. However, further investigation including a larger cohort is necessary to confirm the results.
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Affiliation(s)
- Jiajie Mo
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Jianguo Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Wenhan Hu
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Xiaoqiu Shao
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Lin Sang
- Peking University First Hospital Fengtai Hospital, No. 99 South 4th Fengtai Road, Fengtai District, Beijing, 100070, CHINA
| | - Zhong Zheng
- Peking University First Hospital Fengtai Hospital, No. 99 South 4th Fengtai Road, Fengtai District, Beijing, 100070, CHINA
| | - Chao Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Yao Wang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Xiu Wang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Chang Liu
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
| | - Baotian Zhao
- Beijing Tiantan Hospital, , Beijing, 100070, CHINA
| | - Kai Zhang
- Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, CHINA
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He C, Ye L, Chen C, Hu L, Jin B, Ding Y, Li H, Ding M, Wang S, Wang S. Hippocampal Malrotation Could Be Less Significant in Epilepsy Caused by Focal Cortical Dysplasia Type I and Type II. Front Neurol 2022; 13:755022. [PMID: 35237224 PMCID: PMC8882826 DOI: 10.3389/fneur.2022.755022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Debates over the relationship between hippocampal malrotation (HIMAL) and epilepsy continue without consensus. This study explores the role of HIMAL in a cohort of epilepsy caused by focal cortical dysplasia (FCD). Methods In this study, 90 patients with epilepsy caused by FCD type I and type II and 48 healthy adults underwent a 3 Tesla MRI following a dedicated epilepsy protocol for the analysis of the prevalence and morphologic features of HIMAL. In addition, numerous clinical characteristics and hippocampal volumes were evaluated. Results The cohort included a total of 90 patients (32 were HIMAL, 58 were non-HIMAL). Among these patients, 32 (35.6%) had HIMAL (22 left, four right, and six bilateral), which did not differ from the 48 controls, where 16 (33.3%) had HIMAL (12 left, two right, and two bilateral). Neither the quantitative features of HIMAL (diameter ratio, dominant inferior temporal sulcus height ratio, medial distance ratio, dominant inferior temporal sulcus angle, and parahippocampal angle), nor the accompanying characteristics of HIMAL (vertical dominant inferior temporal sulcus, enlarged temporal horn, and a low position of ipsilateral fornix) showed differences between patients with FCD and controls. No statistical difference in the clinical characteristics between FCD patients with HIMAL and those without was found. Neither the side nor the existence of HIMAL was correlated with the lateralization and location of FCD. As to the hippocampal volume, there was no difference between FCD patients with HIMAL and those without. Conclusion Hippocampal malrotation is a common morphologic variant in healthy controls as well as in patients with epilepsy caused by FCD type I and type II. Hippocampal malrotation could be less significant in epilepsy caused by FCD type I and type II.
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Affiliation(s)
- Chenmin He
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingqi Ye
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingli Hu
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Li
- Epilepsy Center, Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Shan Wang
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Shuang Wang
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Zhang L, Zhou H, Zhang W, Ling X, Zeng C, Tang Y, Gan J, Tan Q, Hu X, Li H, Cheng B, Xu H, Guo Q. Electroclinical and Multimodality Neuroimaging Characteristics and Predictors of Post-Surgical Outcome in Focal Cortical Dysplasia Type IIIa. Front Bioeng Biotechnol 2022; 9:810897. [PMID: 35083208 PMCID: PMC8784525 DOI: 10.3389/fbioe.2021.810897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Focal cortical dysplasia (FCD) type IIIa is an easily ignored cause of intractable temporal lobe epilepsy. This study aimed to analyze the clinical, electrophysiological, and imaging characteristics in FCD type IIIa and to search for predictors associated with postoperative outcome in order to identify potential candidates for epilepsy surgery. We performed a retrospective review including sixty-six patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. We evaluated the clinical, electrophysiological, and neuroimaging features for potential association with seizure outcome. Univariate and multivariate analyses were conducted to explore their predictive role on the seizure outcome. We demonstrated that thirty-nine (59.1%) patients had seizure freedom outcomes (Engel class Ia) with a median postsurgical follow-up lasting 29.5 months. By univariate analysis, duration of epilepsy (less than 12 years) (p = 0.044), absence of contralateral insular lobe hypometabolism on PET/MRI (pLog-rank = 0.025), and complete resection of epileptogenic area (pLog-rank = 0.004) were associated with seizure outcome. The incomplete resection of the epileptogenic area (hazard ratio = 2.977, 95% CI 1.218–7.277, p = 0.017) was the only independent predictor for seizure recurrence after surgery by multivariate analysis. The results of past history, semiology, electrophysiological, and MRI were not associated with seizure outcomes. Carefully included patients with FCD type IIIa through a comprehensive evaluation of their clinical, electrophysiological, and neuroimaging characteristics can be good candidates for resection. Several preoperative factors appear to be predictive of the postoperative outcome and may help in optimizing the selection of ideal candidates to benefit from epilepsy surgery.
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Affiliation(s)
- Lingling Zhang
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hailing Zhou
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei Zhang
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xueying Ling
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chunyuan Zeng
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiefeng Gan
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qinghua Tan
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xiangshu Hu
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Hainan Li
- Department of Pathology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Baijie Cheng
- Department of Pathology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiang Guo
- Epilepsy Center, Guangdong 999 Brain Hospital, Guangzhou, China
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Expression Profile of miRs in Mesial Temporal Lobe Epilepsy: Systematic Review. Int J Mol Sci 2022; 23:ijms23020951. [PMID: 35055144 PMCID: PMC8781102 DOI: 10.3390/ijms23020951] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is one of the most common forms of focal epilepsy in children and adults. TLE is characterized by variable onset and seizures. Moreover, this form of epilepsy is often resistant to pharmacotherapy. The search for new mechanisms for the development of TLE may provide us with a key to the development of new diagnostic methods and a personalized approach to the treatment. In recent years, the role of non-coding ribonucleic acids (RNA) has been actively studied, among which microRNA (miR) is of the greatest interest. (1) Background: The purpose of the systematic review is to analyze the studies carried out on the role of miRs in the development of mesial TLE (mTLE) and update the existing knowledge about the biomarkers of this disease. (2) Methods: The search for publications was carried out in the databases PubMed, Springer, Web of Science, Clinicalkeys, Scopus, OxfordPress, Cochrane. The search was carried out using keywords and combinations. We analyzed publications for 2016–2021, including original studies in an animal model of TLE and with the participation of patients with TLE, thematic and systemic reviews, and Cochrane reviews. (3) Results: this thematic review showed that miR‒155, miR‒153, miR‒361‒5p, miR‒4668‒5p, miR‒8071, miR‒197‒5p, miR‒145, miR‒181, miR‒199a, miR‒1183, miR‒129‒2‒3p, miR‒143‒3p (upregulation), miR–134, miR‒0067835, and miR‒153 (downregulation) can be considered as biomarkers of mTLE. However, the roles of miR‒146a, miR‒142, miR‒106b, and miR‒223 are questionable and need further study. (4) Conclusion: In the future, it will be possible to consider previously studied miRs, which have high specificity and sensitivity in mTLE, as prognostic biomarkers (predictors) of the risk of developing this disease in patients with potentially epileptogenic structural damage to the mesial regions of the temporal lobe of the brain (congenital disorders of the neuronal migration and neurogenesis, brain injury, neuro-inflammation, tumor, impaired blood supply, neurodegeneration, etc.).
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Pitskhelauri D, Kudieva E, Kamenetskaya M, Kozlova A, Vlasov P, Dombaanai B, Eliseeva N, Shishkina L, Sanikidze A, Shults E, Moshev D, Pronin I, Melikyan A. Multiple hippocampal transections for mesial temporal lobe epilepsy. Surg Neurol Int 2021; 12:372. [PMID: 34513139 PMCID: PMC8422472 DOI: 10.25259/sni_350_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.
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Affiliation(s)
- David Pitskhelauri
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Elina Kudieva
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Maria Kamenetskaya
- Department of Neuropsychiatric Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Antonina Kozlova
- Department of Neurophysiological Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Pavel Vlasov
- Department of Pediatric Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Baiyr Dombaanai
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Natalia Eliseeva
- Department of Neuroophthalmological Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Lyudmila Shishkina
- Department of Neuropathology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexander Sanikidze
- Department of Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Evgeniy Shults
- Department of X-ray and Radioisotope Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Dmitriy Moshev
- Department of Neuroanesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Igor Pronin
- Department of X-ray and Radioisotope Research, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Armen Melikyan
- Department of Pediatric Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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Neuropathological spectrum of drug resistant epilepsy: 15-years-experience from a tertiary care centre. J Clin Neurosci 2021; 91:226-236. [PMID: 34373032 DOI: 10.1016/j.jocn.2021.07.014] [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: 01/29/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Neuropathology of drug resistant epilepsy (DRE) has direct bearing on the clinical outcome. Classification of the most common pathologies, hippocampal sclerosis (HS) and focal cortical dysplasia (FCD) have undergone several revisions and studies on the surgical pathology of DRE employing the updated ILAE classification are scarce. Here, we report the neuropathological spectrum of 482 surgically treated cases of DRE from a single institute using the latest ILAE classifications along with clinicoradiologic correlation. Majority of the cases (324, 67.2%) had temporal lobe epilepsy (TLE), with 158 (32.8%) having extratemporal seizure focus. Among TLE, HS was most common (n = 208, 64.2%), followed by neoplasms (42, 13%), FCD (26, 8%) and dual pathology (23, 7%). Less frequent were vascular malformations (cavernoma-3, arteriovenous malformation-1), mild malformation of cortical development (mMCD, 3), gliotic lesions (5), cysticercosis (2), double pathology (2) and polymicrogyria (1). Among extratemporal epilepsies, FCD was most common (46, 29.1%), followed by neoplasms (29, 18.3%), gliotic lesions (27, 17.1%), Rasmussen encephalitis (18, 11.4%), hypothalamic hamartoma (12, 7.6%), malformations of cortical development (10, 6.3%) and vascular malformations (6, 3.8%). Less frequent were double pathology (2, cysticercosis + FCD type IIb, DNET + FCD type IIb), mMCD (2), cysticercosis (1) and dual pathology (1). No underlying pathology was detected in 12 cases (2.5%). Radiopathological concordance was noted in 83%. In 36 cases (7.5%), histopathology detected an unsuspected second pathology that included FCD type III (n = 16) dual pathology (n = 18) and double pathology (n = 2). Further, in four MRI negative cases, histopathology was required for a conclusive diagnosis.
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Xu K, Wang X, Guan Y, Zhao M, Tang C, Zhou J, Zhai F, Wang M, Duan Z, Qi X, Li T, Luan G. Prognostic value of histopathologic pattern for long-term surgical outcomes of 198 patients with confirmed mesial temporal lobe epilepsy. Hum Pathol 2021; 115:47-55. [PMID: 34119513 DOI: 10.1016/j.humpath.2021.05.011] [Citation(s) in RCA: 3] [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: 03/16/2021] [Accepted: 05/06/2021] [Indexed: 11/20/2022]
Abstract
Hippocampal sclerosis (HS) is the most common neuropathologic findings in patients with intractable temporal lobe epilepsy (TLE). The international league against epilepsy has proposed a new classification of HS based on pyramidal cell loss on different subfields to facilitate the study of HS pathology in patients after anterior temporal lobectomy (ATL), and the influence of these HS patterns on the prognosis of patients with TLE is contradictory. This study aims to investigate the relationship between different HS subtypes and postoperative seizure outcomes for intractable patients with TLE. From January 2008 to December 2018, we retrospectively reviewed 198 TLE patients with ATL surgery, and all patients had a complete preoperative evaluation, a specimen of hippocampal tissue after surgery, cognitive test after surgery, and more than 2 years of postoperative follow-up. The main findings were as follows: 1) temporal neocortical gray matter heterotopia were more common in the no-HS group; 2) HS type 1 was associated with a longer duration of epilepsy; 3) history of meningitis was the independent predictor of HS type 1; 4) no-HS patients experienced worse postoperative seizure outcomes than those with HS type1 and type 2, whereas no difference in seizure outcomes was obtained between HS type 1 and type 2; 5) no-HS patients were at increased risk for verbal memory decline after left hippocampal resection. The HS subtypes were associated with the prognosis of patients with TLE, and other variables were the predictors of different HS types. `Further study was to identify the HS subtypes by noninvasive evaluation to approve better postoperative outcomes.
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Affiliation(s)
- Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | | | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Zejun Duan
- Department of Pathlogy, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Xueling Qi
- Department of Pathlogy, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China.
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Mo J, Wei W, Liu Z, Zhang J, Ma Y, Sang L, Hu W, Zhang C, Wang Y, Wang X, Liu C, Zhao B, Gao D, Tian J, Zhang K. Neuroimaging Phenotyping and Assessment of Structural-Metabolic-Electrophysiological Alterations in the Temporal Neocortex of Focal Cortical Dysplasia IIIa. J Magn Reson Imaging 2021; 54:925-935. [PMID: 33891371 DOI: 10.1002/jmri.27615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Focal cortical dysplasia IIIa (FCD IIIa) is a common histopathological finding in temporal lobe epilepsy. However, subtle alterations in the temporal neocortex of FCD IIIa renders presurgical diagnosis and definition of the resective range challenging. PURPOSE To explore neuroimaging phenotyping and structural-metabolic-electrophysiological alterations in FCD IIIa. STUDY TYPE Retrospective. SUBJECTS One hundred and sixty-seven subjects aged 4-39 years, including 64 FCD IIIa patients, 89 healthy controls and 14 FCD I patients as disease controls. FIELD STRENGTH/SEQUENCE 3 T, fast-spin-echo T2 -weighted fluid-attenuated inversion recovery (FLAIR), synthetic T1 -weighted magnetization prepared rapid acquisition gradient echo (MPRAGE). ASSESSMENT Surface-based linear model was applied to reveal neuroimaging phenotyping in FCD IIIa and assess its relationship with clinical variables. Logistic regression was implemented to identify FCD IIIa patients. Epileptogenicity mapping (EM) was conducted to explore the structural-metabolic-electrophysiological alterations in temporal neocortex of FCD IIIa. STATISTICAL TESTS Student's t-test was applied to determine the significance of paired differences. Calibration curves were plotted to assess the goodness-of-fit (GOF) of the models, combined with the Hosmer-Lemeshow test. RESULTS FCD IIIa exhibited widespread hyperintensities in temporal neocortex, and these alterations correlated with disease duration (Puncorrected < 0.01). Machine learning model accurately identified 84.4% of FCD IIIa patients, 92.1% of healthy controls and 92.9% of FCD I patients. Cross-modality analysis showed a significant negative correlation between FLAIR hyperintensity and positron emission tomography hypometabolism P < 0.01). Furthermore, epileptogenic cortices were located predominantly in brain regions with FLAIR hyperintensity and hypometabolism. DATA CONCLUSION FCD IIIa exhibited widespread temporal neocortex FLAIR hyperintensity. Automated machine learning of neuroimaging patterns is conducive for accurate identification of FCD IIIa. The degree and distribution of morphological alterations related to the extent of metabolic and epileptogenic abnormalities, lending support to its potential value for reduction of the radiative and invasive approaches during presurgical workup. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wei Wei
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yanshan Ma
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dongmei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Ayub MA, Soman S. Editorial for "Neuroimaging Phenotyping and Structural-Metabolic-Epileptogenic Correlations in the Temporal Neocortex of Focal Cortical Dysplasia IIIa". J Magn Reson Imaging 2021; 54:936-937. [PMID: 33890322 DOI: 10.1002/jmri.27644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Muhammad A Ayub
- Department of Radiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts, USA
| | - Salil Soman
- Department of Radiology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts, USA
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Cossu M, d'Orio P, Barba C, Asioli S, Cardinale F, Casciato S, Caulo M, Colicchio G, Consales A, D'Aniello A, De Benedictis A, De Palma L, Didato G, Di Gennaro G, Di Giacomo R, Esposito V, Guerrini R, Nichelatti M, Revay M, Rizzi M, Vatti G, Villani F, Zamponi N, Tassi L, Marras CE. Focal Cortical Dysplasia IIIa in Hippocampal Sclerosis-Associated Epilepsy: Anatomo-Electro-Clinical Profile and Surgical Results From a Multicentric Retrospective Study. Neurosurgery 2021; 88:384-393. [PMID: 32860416 DOI: 10.1093/neuros/nyaa369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE). OBJECTIVE To investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa. METHODS A total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa). RESULTS At last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS. CONCLUSION Coexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.
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Affiliation(s)
- Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, National Research Council, Parma, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | | | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | | | - Luca De Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Giuseppe Didato
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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House PM, Kopelyan M, Braniewska N, Silski B, Chudzinska A, Holst B, Sauvigny T, Martens T, Stodieck S, Pelzl S. Automated detection and segmentation of focal cortical dysplasias (FCDs) with artificial intelligence: Presentation of a novel convolutional neural network and its prospective clinical validation. Epilepsy Res 2021; 172:106594. [PMID: 33677163 DOI: 10.1016/j.eplepsyres.2021.106594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/10/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Focal cortical dysplasias (FCDs) represent one of the most frequent causes of pharmaco-resistant focal epilepsies. Despite improved clinical imaging methods over the past years, FCD detection remains challenging, as FCDs vary in location, size, and shape and commonly blend into surrounding tissues without clear definable boundaries. We developed a novel convolutional neural network for FCD detection and segmentation and validated it prospectively on daily-routine MRIs. MATERIAL AND METHODS The neural network was trained on 201 T1 and FLAIR 3 T MRI volume sequences of 158 patients with mainly FCDs, regardless of type, and 7 focal PMG. Non-FCD/PMG MRIs, drawn from 100 normal MRIs and 50 MRIs with non-FCD/PMG pathologies, were added to the training. We applied the algorithm prospectively on 100 consecutive MRIs of patients with focal epilepsy from daily clinical practice. The results were compared with corresponding neuroradiological reports and morphometric MRI analyses evaluated by an experienced epileptologist. RESULTS Best training results reached a sensitivity (recall) of 70.1 % and a precision of 54.3 % for detecting FCDs. Applied on the daily-routine MRIs, 7 out of 9 FCDs were detected and segmented correctly with a sensitivity of 77.8 % and a specificity of 5.5 %. The results of conventional visual analyses were 33.3 % and 94.5 %, respectively (3/9 FCDs detected); the results of morphometric analyses with overall epileptologic evaluation were both 100 % (9/9 FCDs detected) and thus served as reference. CONCLUSION We developed a 3D convolutional neural network with autoencoder regularization for FCD detection and segmentation. Our algorithm employs the largest FCD training dataset to date with various types of FCDs and some focal PMG. It provided a higher sensitivity in detecting FCDs than conventional visual analyses. Despite its low specificity, the number of false positively predicted lesions per MRI was lower than with morphometric analysis. We consider our algorithm already useful for FCD pre-screening in everyday clinical practice.
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Affiliation(s)
- Patrick M House
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Department of Neurology and Epileptology, Hamburg, Germany.
| | | | | | | | | | - Brigitte Holst
- University Hospital Hamburg-Eppendorf, Department of Neuroradiology, Hamburg, Germany
| | - Thomas Sauvigny
- University Hospital Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Germany
| | - Tobias Martens
- University Hospital Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Germany; Asklepios Klinikum St. Georg, Department of Neurosurgery, Hamburg, Germany
| | - Stefan Stodieck
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Department of Neurology and Epileptology, Hamburg, Germany
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Roh H, Kim W, Kim J, Kim JH, Kim JH. Duration-dependent extensive volume and shape changes of mesolimbic structures in surgically treated unilateral patients with temporal lobe epilepsy. Epilepsy Behav 2021; 114:107517. [PMID: 33257292 DOI: 10.1016/j.yebeh.2020.107517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Although surgical treatment of drug-resistant mesial temporal lobe epilepsy (MTLE) has proven efficacy, surgical referrals are often delayed. Knowledge of the abnormalities of mesolimbic structures beyond the hippocampus may be important for patients with MTLE because of its usefulness in the understanding of progressive disabilities in affected structures. This study aimed to identify volume and shape changes of mesolimbic structures in surgically treated patients with unilateral MTLE and their correlation with various clinical parameters. METHODS Twenty-four patients with unilateral MTLE (12 with left MTLE [LMTLE] and 12 with right MTLE [RMTLE]) who were surgically treated with standard temporal lobectomy, including amygdalohippocampectomy, and 24 age- and sex-matched healthy individuals were enrolled. Preoperatively, volumetric analysis using magnetic resonance imaging (MRI) of 27 mesolimbic substructures (11 from each hemisphere and 5 from the midline) was performed. We also investigated the three-dimensional morphometric differences of the mesolimbic structures between the unilateral MTLE and control groups using shape analyses. RESULTS Patients with LMTLE showed significant volume reductions in various ipsilateral mesolimbic (72.7%, 8/11) and contralateral structures (27.3%, 3/11). Patients with RMTLE had also significant reduced volumes in ipsilateral (63.6%, 7/11) and contralateral structures (73.3%, 3/11). Among the clinical parameters, only the duration of epilepsy had a statistically significant inverse correlation with the volumes of the hippocampus, parahippocampus, entorhinal cortex, cingulate, and corpus callosum. In the shape analysis of the bilateral hippocampus, amygdala, parahippocampus, and entorhinal cortex, after accounting for the effects of age and total intracranial volume, significant shape changes in the anterolateral area of the ipsilateral hippocampus were noted, which corresponds to the cornu ammonis (CA)1 and subiculum of the hippocampus. CONCLUSIONS The extensive volume reductions in the multiple mesolimbic structures and the substantial inverse correlation between the duration of epilepsy and the volumes of the various mesolimbic structures in our study supports that MTLE is not restricted to the hippocampus, but it progressively involves extensive mesolimbic structures. The duration-dependent atrophic changes in multiple subcortical structures seen in this study also suggest a positive role of early surgical intervention for patients with drug-resistant TLE.
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Affiliation(s)
- Haewon Roh
- The Department of Neurosurgery, Guro Hospital, Korea University Medicine, Republic of Korea
| | - Won Kim
- The Department of Neurosurgery, Guro Hospital, Korea University Medicine, Republic of Korea
| | - Junwon Kim
- The Department of Neurosurgery, Guro Hospital, Korea University Medicine, Republic of Korea
| | - Ji Hyun Kim
- The Department of Neurology, Guro Hospital, Korea University Medicine, Republic of Korea
| | - Jong Hyun Kim
- The Department of Neurosurgery, Guro Hospital, Korea University Medicine, Republic of Korea.
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15
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He X, Liu D, Yang Z, Zhang J, Li S, Yang Z. Side of Lesions Predicts Surgical Outcomes in Patients With Drug-Resistant Temporal Lobe Epilepsy Secondary to Focal Cortical Dysplasia Type IIIa. Front Neurol 2020; 11:580221. [PMID: 33362691 PMCID: PMC7758315 DOI: 10.3389/fneur.2020.580221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate the surgical outcomes and analyze the predictors of surgical outcomes in patients undergoing anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) secondary to focal cortical dysplasia (FCD) type IIIa. Methods: Data on patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL at Xiangya Hospital, Central South University from January 2014 to April 2018, were collected retrospectively. International League Against Epilepsy (ILAE) classification was used to evaluate postoperative seizure outcomes. Predictors of surgical outcomes were identified by using univariate and multivariate analyses. Results: A total of 43 patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL were included in this study. Twenty patients had right ATL, and 23 patients had left ATL. With a follow-up of 2-6 years, 76.7% (33 of 43) of patients were seizure-free. Univariate and multivariate analysis results indicated that lesions on the right side independently predict postoperative seizure freedom (OR, 0.08; 95% CI, 0.01-0.72; P = 0.024). Conclusion: ATL is an effective therapy for patients with drug-resistant TLE secondary to FCD type IIIa. Patients with lesions on the right side are more likely to achieve postoperative seizure freedom.
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Affiliation(s)
- Xinghui He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junmei Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Sushan Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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16
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Effect of Temporal Neocortical Pathology on Seizure Freeness in Adult Patients with Temporal Lobe Epilepsy. World Neurosurg 2018; 116:e801-e805. [DOI: 10.1016/j.wneu.2018.05.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
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17
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de Souza JPSAS, Mullin J, Wathen C, Bulacio J, Chauvel P, Jehi L, Gonzalez-Martinez J. The usefulness of stereo-electroencephalography (SEEG) in the surgical management of focal epilepsy associated with “hidden” temporal pole encephalocele: a case report and literature review. Neurosurg Rev 2017; 41:347-354. [DOI: 10.1007/s10143-017-0922-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022]
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