Cognitive features and surgical outcome of patients with long-term epilepsy-associated tumors (LEATs) within the temporal lobe

Vogt, Viola Lara; Delev, Daniel; Grote, Alexander; Lehe, Marec von; Becker, Albert; Schramm, Johannes; Elger, Christian E.; Helmstaedter, Christoph

doi:10.1016/j.yebeh.2018.08.028

Cited by 34 publications

(41 citation statements)

References 41 publications

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“…A previous study found that tumor type was the significant predictor for postsurgical seizure freedom, with the lowest rate (56.6%) in pilocytic astrocytoma, a slightly higher rate in pleomorphic xanthoastrocytoma (62.5%), and the highest rates in diffuse astrocytoma (77.8%), ganglioglioma (81.3%), and dysembryoplastic neuroepithelial tumor (89.3%); however, the scope of that study was limited to temporal lobe epilepsy only. 28 Other studies including only partial low‐grade tumors found no relationship between tumor type and seizure outcome. 9 , 21 , 24 Our study found that patients with WHO grade II tumors had worse outcomes than those with WHO grade I tumors (76.60% vs. 88.06%), but not to a statistically significant extent.…”

Section: Discussionmentioning

confidence: 97%

Clinical characteristics of low‐grade tumor‐related epilepsy and its predictors for surgical outcome

Chen

et al. 2021

Ann Clin Transl Neurol

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Objectives: Low-grade tumors are the most common neoplasms inducing focal epilepsy; however, the short-and medium-term efficacy of surgery in epilepsy patients with low-grade tumors remains underappreciated. This study aims to summarize the clinical characteristics of epilepsy patients with low-grade tumors and to identify factors associated with postsurgical seizure-free outcomes. Methods: We retrospectively reviewed consecutive patients with lowgrade tumors who underwent subsequent epilepsy surgery in our epilepsy center, between 2012 and 2018 with a minimum follow-up of 1 year. Using Engel's classification and Kaplan-Meier survival analysis, we assessed postoperative seizure freedom over time. Demographical, electroclinical, and other presurgical evaluations were then evaluated for association with postoperative seizure outcome. Results: The cohort included a total of 132 patients: 79 males and 53 females. Among them, 110 (83.33%) were seizure-free through their last followup. The Engel class I outcomes were 90.15%, 87.76%, 85.53%, 82.46%, and 73.17% at the end of the 1st, 2nd, 3rd, 4th, and 5th postoperative years, respectively. Multivariate logistic analysis revealed that longer epilepsy duration (p < 0.001, OR 1.091, 95% CI 1.040-1.144) and incomplete resection (p = 0.009, OR 3.673, 95% CI 1.393-9.684) were independently associated with seizure recurrence through the last follow-up. Conclusions: Surgical treatment for seizure control in patients with low-grade tumors provides excellent shortand median-term outcomes.

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Section: Discussionmentioning

confidence: 97%

Clinical characteristics of low‐grade tumor‐related epilepsy and its predictors for surgical outcome

Chen

et al. 2021

Ann Clin Transl Neurol

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“…It should be emphasised that in most of these patients, epilepsy control is the main goal of surgery because most are benign tumours of glioneuronal or glial origin [19]. However, in those with a diffuse low-grade glioma (WHO GII), the oncological aspects of treatment should prevail according to the progressive course of these tumours.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Class I epilepsy surgery outcome in tumour-related chronic temporal lobe epilepsy in adults

Nowak

Rysz

Dziedzic

et al. 2019

Neurol Neurochir Pol.

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Objective. Temporal lobe tumours, especially low-grade gliomas and glioneuronal tumours, are common causes of seizures in patients referred for epilepsy surgery. We here present our experience of surgical treatment of patients with intractable chronic epilepsy associated with temporal lobe tumours, focusing on the long-term surgical outcomes and the features associated with better seizure control.Methods. In this study, we retrospectively analysed 44 consecutive patients from a total of 182 with refractory temporal lobe epilepsy presenting with long-term intractable epilepsy due to a temporal lobe tumour who were surgically treated at our institution between 2005 and 2015 with post-surgical follow-up of at least two years. All patients underwent a standard presurgical evaluation that included: history and physical examination with a description of the seizure semiology, serial scalp EEG recording, brain MR imaging, and a detailed neuropsychological evaluation. Our surgical strategy comprised tumour resection, and combined mesial temporal and neocortical resection in most cases. Results.No patient died during surgery or the postoperative course. Seven patients had postoperative complications, of whom two had permanent hemiparesis due to ischaemic stroke. At the final follow-up, a favourable seizure outcome (Engel Class I) was found in 37 patients (84%), including 31 (70.5%) in Engel Class IA (excellent result). Two (4.5%) patients presented with an Engel Class II outcome (unfavourable outcome). Five patients (11.5%) were in Engel Classes III or IV (surgical failure). We found that complete resection of the hippocampus along with tumour and temporal pole removal was strongly associated with seizure freedom (p = 0.015). Pathological diagnosis was also a significant prognostic indicator of tumour-related seizure freedom. Patients with a diagnosis of a glioneuronal tumour benefited from more seizure freedom after resection compared to those who had a low-grade glioma (p = 0.024). Conclusion.The most appropriate management of tumour-related chronic temporal lobe epilepsy in adults appears to be tailored temporal lobe resection including tumour and hippocampal complex removal. Surgical treatment of tumoural temporal lobe epilepsy demonstrates excellent results in terms of seizure improvement, especially in patients with glioneuronal tumours.

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“… 145 VNS is also approved for refractory depression and might be useful for patients DRE and comorbid depression. 146 Mindfulness therapy is also associated with greater benefits than short-term psychotherapy in QOL, mood, seizure frequency, and verbal memory. 147 …”

Section: Comprehensive Care Adaptationsmentioning

confidence: 99%

Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

Guéry

Rheims

2021

NDT

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Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients' quality of life.

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Cognitive features and surgical outcome of patients with long-term epilepsy-associated tumors (LEATs) within the temporal lobe

Cited by 34 publications

References 41 publications

Clinical characteristics of low‐grade tumor‐related epilepsy and its predictors for surgical outcome

Clinical characteristics of low‐grade tumor‐related epilepsy and its predictors for surgical outcome

Predictors of Class I epilepsy surgery outcome in tumour-related chronic temporal lobe epilepsy in adults

Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

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