Diverse perspectives on developments in epilepsy surgery

Wilson, Sarah J.; Engel, Jerome

doi:10.1016/j.seizure.2010.10.028

Cited by 17 publications

(15 citation statements)

References 85 publications

(97 reference statements)

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“…The recommendations are focused broadly on the role of neuropsychological assessment in the routine care of children and adults with epilepsy across a diversity of health care settings. The long‐standing role that neuropsychology has played in the diagnostic work‐up of patients admitted for surgical characterization and associated specialized topics will be addressed in the second report in this series.…”

Section: Methodsmentioning

confidence: 99%

Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013–2017

et al. 2015

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SUMMARYThe International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of

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Section: Methodsmentioning

confidence: 99%

Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013–2017

et al. 2015

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“…Though common, drug-resistant focal epilepsies are potentially surgically remediable. Perspectives related to epilepsy surgery have progressed considerably over the past several decades, as recently summarized by Wilson and Engel [210], with a few notable developments in just the past year. With regard to palliative non-resective epilepsy surgery, the past 1–2 years have seen the approval of NeuroPace—a new implantable neurostimulation device for epilepsy [82]—as well as the 100,000th implantation of a vagus nerve stimulator [44].…”

Section: Introductionmentioning

confidence: 99%

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

2014

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Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world’s population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.

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“…Improvements in microsurgical technique and diagnostic technology have vastly improved the implementation and delivery of the surgical management of epilepsy over the past 30 years 12. Magnetoencephalography, functional MRI (fMRI) and simultaneous EEG-fMRI recordings with capability to capture localised changes in blood flow associated with interictal spikes and ictal EEG discharges,12 all of which were considered ‘experimental’ in the 20th century, are now commonplace in the work-up of paediatric epilepsy.…”

Section: Evolution Of Epilepsy Surgerymentioning

confidence: 99%

“…Magnetoencephalography, functional MRI (fMRI) and simultaneous EEG-fMRI recordings with capability to capture localised changes in blood flow associated with interictal spikes and ictal EEG discharges,12 all of which were considered ‘experimental’ in the 20th century, are now commonplace in the work-up of paediatric epilepsy. The advent of technology to further localise epileptogenic foci has resulted in improvements in targeted surgical therapy with hopes of minimising trauma to unaffected brain tissue.…”

Section: Evolution Of Epilepsy Surgerymentioning

confidence: 99%

“…Traditional surgical procedures to treat epilepsy, including temporal lobectomy and cortical and neocortical lesionectomy, have been improved as a result of improvement in MRI resolution in the 1990s, which allowed for definitive radiographic support for hippocampal sclerosis13 and, more recently, cortical dysplasia 14. This has allowed a proportion of patients who previously would have been thought to be poor surgical candidates to undergo surgery and afford improved functional outcomes 12. Thus, improvements in diagnostic techniques have been accompanied with improved surgical outcome and feasibility.…”

Section: Evolution Of Epilepsy Surgerymentioning

confidence: 99%

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Recent developments in the surgical management of paediatric epilepsy

2017

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Among the 1% of children affected by epilepsy, failure of pharmacological therapy and early age of seizure onset can lead to worse long-term cognitive outcomes, mental health disorders and impaired functional status. Surgical management often improves functional and cognitive outcomes in children with medically refractory epilepsy, especially when seizure remission is achieved. However, surgery remains underused in children with drug-resistant epilepsy, creating a large treatment gap. Several recent innovations have led to considerable improvement in surgical technique, including the recent development of minimally invasive diagnostic and therapeutic techniques such as stereotactic EEG, transcranial magnetic stimulation, MRI-guided laser ablation, as well as novel paradigms of neurostimulation. This article discusses the current landscape of surgical innovation in the management of paediatric epilepsy, leading to a paradigm shift towards minimally invasive therapy and closing the treatment gap in children suffering from drug-resistant seizures.

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Diverse perspectives on developments in epilepsy surgery

Cited by 17 publications

References 85 publications

Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013–2017

Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013–2017

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

Recent developments in the surgical management of paediatric epilepsy

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