Intractable Epilepsy and Structural Lesions of the Brain: Mapping, Resection Strategies, and Seizure Outcome

Awad, Issam A.; Rosenfeld, Jeffrey V.; Ahl, Jennifer; Hahn, Joseph F.; Lüders, Hans

doi:10.1111/j.1528-1157.1991.tb05242.x

Cited by 350 publications

(202 citation statements)

References 27 publications

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“…Whereas favorable results and percentages of seizure-free patients as high as 82% have been reported after lesionectomy alone (28,29), improved seizure control after exact delineation and resection of the epileptogenic zone has been emphasized by other investigators (30-33). These data indicate that in patients with solitary circumscribed intracerebral lesions, such as solitary cavernomas, gangliogliomas or gliomas, or localized trauma, the zone of seizure origin very probably is either contiguous with or in close proximity to the lesion (30,34). Awad et al (30) reported that in patients with complete resection of the lesion, the extent of the epileptogenic zone resection did not affect outcome.…”

Section: Discussionmentioning

confidence: 95%

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Hufnagel¹,

Zentner²,

Fernández³

et al. 1997

Epilepsia

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Summary:Purpose: To assess the efficacy and safety of multiple subpial transection (MST), a new technique in epilepsy surgery, alone and in combination with resection.Methods: MST was performed in 22 patients with intractable epilepsy, 10 of whom were treated with a combination of a resection and MST in functionally important cortex, 6 of whom were treated with a combination of a resection and MST performed outside functionally important cortex, and 6 of whom were treated with MST alone.Results: Of the 6 patients who received MST alone, none became seizure free and 4 showed >50% reduction of all seizure types. In 2 patients, including 1 with Rasmussen's encephalitis, no change in seizure frequency or intensity occurred. Of the 16 patients in whom MST was combined with a resection, 9 (56%) became seizure free. Six of the remaining 7 patients showed >95% reduction of all seizure types. Disappearance of epileptiform potentials in the postoperative EEG correlated significantly with complete relief from seizures.Subtle, permanent neurological deficits remained in 5 of 14 patients who received MST in functionally important brain areas.Conclusions: Reduction of the seizure frequency was substantial in 4 of 6 patients who received MST alone, but complete seizure control was not observed. MST surrounding a lesionectomy may be a new surgical approach which would minimize the excised volume and improve seizure control. Key Words: Epilepsy surgery-Epileptogenic zone-Multiple subpial transection-Electrocorticography-Seizure outcome.In multiple subpial transection (MST), a new technique in epilepsy surgery (l), the main objective is to extend the surgical procedure into epileptogenic brain areas of high functional importance, such as the primary motor or speech areas, while avoiding unacceptable neurological deficits. In theory, MST disrupts horizontal neuronal interconnections essential for seizure spread, while preserving the descending vertical neuronal colstructural abnormality detected by magnetic resonance imaging (MRI) or intraoperatively. We wished to evaluate whether seizure control achieved by this method is similar to that achieved by a more extensive resection of a lesion and the perilesional epileptogenic cortex. If so, MST may prove to be a new approach to epilepsy surgery of circumscribed epileptogenic lesions. umns largely responsible for the underlying neuronal function. Recent studies have demonstrated efficacy of MST in seizure control without producing major neurological dysfunction (2-6). However, few patients have been treated exclusively with MST and separate data concerning this subgroup are frequently lacking (2,6). In the present study, we assessed seizure control and safety aspects in patients treated with MST alone or in combination with a resection. In a subgroup of patients, MST was performed outside functionally important brain areas surrounding a lesionectomy limited to the extent of a PATIENTS AND METHODSMST was performed in 22 patients (12 men, 10 women) aged 7 to 45 years (mean, 26 years) wi...

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Section: Discussionmentioning

confidence: 95%

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Hufnagel¹,

Zentner²,

Fernández³

et al. 1997

Epilepsia

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“…This prevalence of bitemporal abnorm a l i t i e s i n c reases as the duration of the EEG re c o rdings increased. Other studies have also shown that surface EEG findings consisting of bilateral independent temporal foci, did not correlate with the effect of surgery in seizure's control 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Ganglioglioma: comparison with other low-grade brain tumors

Brainer-Lima

Filho

2006

Arq. Neuro-Psiquiatr.

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-Method: F o rty-two patients with low-grade brain tumor and re f r a c t o ry epilepsy were studied. The mean age was 22.3 years. They were divided into two groups: Group A, patients with ganglioglioma (n=19) and group B, patients with other low-grade tumors (n=23) (14 astrocytoma, 6 oligodend roglioma, 2 dysembryoplastic neuroepithelial tumor, and 1 xanthoastro c y t o m a ) . Results: Age at seizure 's onset was 7 years or less in 73% of the patients in group A and in 30.4% of the patients in group B (p=0.045). Complex partial occurred frequently in group A and B (94.7% versus 82%, respectively). Seizure 's fre q u e ncy was higher in group B (p=0.002).Computerized tomography (CT) was normal in 36.8% of group A patients and abnormal in all group B patients. Magnetic resonance imaging (MRI) was abnormal in all patients. S u rgical removal was complete in 89.5% of the patients in group A and in 78.2% of the patients in gro u p B . Conclusion: The association of re f r a c t o ry epilepsy and complex partial seizures, at a relatively low freq u e n c y, in young patients potentially normal CT and a MRI hypointense temporal lobe lesion in T1-weighed slices were habitual image findings in ganglioglioma, rather than other low-grade tumor.KEY WORDS: ganglioglioma, refractory epilepsy, low-grade brain tumors.Ganglioglioma: estudo comparativo com outros tumores cerebrais primarios de baixo grau RESUMO -Método: Foram estudados 42 pacientes com tumor cerebral primário de baixo grau e epilepsia refratária. A idade média foi 22,3 anos. Eles foram divididos em dois grupos: no grupo A os pacientes com ganglioglioma (n=19) e no grupo B os pacientes com outros tumores primários de crescimento lento (n=23) (14 astrocitomas, 6 oligodendrogliomas, 2 tumores desembrioblástico neuroepitelial e um xantoastro c i t om a ) . Resultados: A idade de início das crises convulsivas foi 7 anos ou menos em 73% dos pacientes no g rupo A e 30,4% dos pacientes no grupo B (p=0,045). A crise convulsiva do tipo parcial complexa foi a mais identificada nos grupos A e B (94,7% versus 82%, respectivamente). A freqüência de crise foi mais alta no g rupo B (p=0,002). A tomografia computadorizada foi normal em 36,8% dos pacientes no grupo A e anormal em todos no grupo B. A ressonância magnética foi anormal em todos os pacientes. A remoção cirúr-gica foi completa em 89.5% dos pacientes no grupo A e 78,2% no grupo B. Conclusão: A associação de epilepsia refratária e crise parcial complexa, principalmente quando a freqüência não é muito alta, em pacientes jovens, mesmo com tomografia computadorizada normal e alteração hipointensa na seqüência de T1 da ressonância magnética é sugestiva de ganglioglioma mais que outros tipos de tumor cere b r a l primário de baixo grau. PALAVRAS-CHAVE: ganglioglioma, epilepsia refratária, tumor cerebral de baixo grau.Ganglioglioma (GG) is one of the commonest causes of tumor-related re f r a c t o ryepilepsy in young pat i e n t s 1 , and together with other low-grade brain neop l a s m 's, comprises 10-30% of the ...

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“…In some series as ours the inclusion of the mesial temporal structures didn't promote a better prognosis 7,14,15 while in others extensive resections implied in control of the seizures 3,16,17 . Studies have identified incomplete tumor resections or tumor recurrences as a important cause of a poor postoperative seizure control 8,[18][19][20] . In this series two patients with partial resection of the tumor still presented seizures; after total remotion of the lesion they became seizure free.…”

Section: Discussion Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy

Jorge

Marie

Pedreira

et al. 2000

Arq. Neuro-Psiquiatr.

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-This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and postsurgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.KEY WORDS: epilepsy, temporal tumor, clinical aspects, surgical outcome, MRI.Características clínicas, de neuroimagem estrutural e prognóstico cirúrgico de pacientes com tumor do lobo temporal e epilepsia RESUMO -Este é um estudo retrospectivo de 21 pacientes com epilepsia e tumores do lobo temporal tratados cirurgicamente. A avaliação incluiu dados clínicos, eletrencefalográficos, de neuroimagem, anatomia patológica e seguimento pós-operatório. Eram 9 casos de ganglioglioma, 5 de astrocitoma pilocítico, 3 de ganglioneuroma, 2 de tumor neuroectodérmico disembrioplástico, 1 de xantoastrocitoma pleomórfico e 1 de meningoangiomatose. A média de tempo de seguimento pós-operatório foi 22 meses e o prognóstico foi avaliado de acordo com a classificação de Engel; 76,2% encontravam-se na classe I e o restante nas classes II e III. Todos os pacientes que se encontravam nas classes II e III haviam sido submetidos a ressecção do tumor e de estruturas mesiais temporais. Não encontramos diferenças entre os grupos quanto as características clínicas, histológicas e tempo de seguimento. Dez pacientes apresentavam TC normal; os achados na RM foram comparados ao diagnóstico patológico, mas não encontramos características específicas relacionadas ao tipo de tumor. O estudo por RM foi essencial para o diagnóstico e localização precisa da lesão. Ganglioglioma foi o tumor mais freqüente e lesionectomia associada a ressecção mesial não proporcionou melhor prognóstico. PALAVRAS-CHAVE: epilepsia, tumor do lobo temporal, clínica, prognóstico cirúrgico e ressonância magnética.New neuroimaging techniques, especially MRI, have allowed more frequent detection of structural abnormalities, such as discrete neuronal migration disorders, gliosis and slow growing tumors in patients with medically refractory epilepsy 1 . Small growing tumors ...

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Intractable Epilepsy and Structural Lesions of the Brain: Mapping, Resection Strategies, and Seizure Outcome

Cited by 350 publications

References 27 publications

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Ganglioglioma: comparison with other low-grade brain tumors

Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy

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