Is it worth pursuing surgery for epilepsy in patients with normal neuroimaging?

Alarcón, Gonzalo; Valentin, Antonio; Watt, Charles H.; Selway, Richard; Lacruz, María Elena; Elwes, Robert; Jarosz, Józef; Honavar, Mrinalini; Brunhuber, F.; Mullatti, Nandini; Bódi, István; Salinas, María Jezabel Haye; Binnie, C.D.; Polkey, Charles E.

doi:10.1136/jnnp.2005.077289

Cited by 113 publications

(95 citation statements)

References 12 publications

(18 reference statements)

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“…6 FCD and, less often, gliosis are the most common findings. [6][7][8][9][10][11][12] Four of the six 7T MRI-positive patients in this study underwent epilepsy surgery. In all of them, the epileptogenic lesions that were supposed to be FCD at 7T were histologically confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…1 Absence of a structural lesion on MRI still represents a challenge for surgical management, as it entails a poorer prognosis in both children and adults. [2][3][4][5] Although epileptogenic lesions, mainly focal cortical dysplasia (FCD), have been demonstrated in 30-50% of histopathology specimens of MRI-negative patients, [6][7][8][9][10][11][12] 16-43% of patients referred for presurgical assessment have negative brain MRI. 9,10,13,14 The diagnostic yield of MRI in detecting subtle lesions is influenced by reader expertise and the accuracy with which the suspected epileptogenic zone is indicated, but it is also strongly dependent on technical considerations such as the field strength, use of phased array head coils, dedicated epilepsy MRI protocols, and novel quantitative analyses.…”

Section: Gre and Flair Imagesmentioning

confidence: 99%

See 1 more Smart Citation

7TMRIin focal epilepsy with unrevealing conventional field strength imaging

Ciantis

Barba

Tassi³

et al. 2016

Epilepsia

133

127

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SUMMARYObjective: To assess the diagnostic yield of 7T magnetic resonance imaging (MRI) in detecting and characterizing structural lesions in patients with intractable focal epilepsy and unrevealing conventional (1.5 or 3T) MRI. Methods: We conducted an observational clinical imaging study on 21 patients (17 adults and 4 children) with intractable focal epilepsy, exhibiting clinical and electroencephalographic features consistent with a single seizure-onset zone (SOZ) and unrevealing conventional MRI. Patients were enrolled at two tertiary epilepsy surgery centers and imaged at 7T, including whole brain (three-dimensional [3D] T 1 -weighted [T1W] fast-spoiled gradient echo (FSPGR), 3D susceptibility-weighted angiography [SWAN], 3D fluid-attenuated inversion recovery [FLAIR]) and targeted imaging (2D T 2 *-weighted dual-echo gradient-recalled echo [GRE] and 2D gray-white matter tissue border enhancement [TBE] fast spin echo inversion recovery [FSE-IR]). MRI studies at 1.5 or 3T deemed unrevealing at the referral center were reviewed by three experts in epilepsy imaging. Reviewers were provided information regarding the suspected localization of the SOZ. The same team subsequently reviewed 7T images. Agreement in imaging interpretation was reached through consensus-based discussions based on visual identification of structural abnormalities and their likely correlation with clinical and electrographic data. Results: 7T MRI revealed structural lesions in 6 (29%) of 21 patients. The diagnostic gain in detection was obtained using GRE and FLAIR images. Four of the six patients with abnormal 7T underwent epilepsy surgery. Histopathology revealed focal cortical dysplasia (FCD) in all. In the remaining 15 patients (71%), 7T MRI remained unrevealing; 4 of the patients underwent epilepsy surgery and histopathologic evaluation revealed gliosis. Significance: 7T MRI improves detection of epileptogenic FCD that is not visible at conventional field strengths. A dedicated protocol including whole brain FLAIR and GRE images at 7T targeted at the suspected SOZ increases the diagnostic yield.

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Section: Discussionmentioning

confidence: 99%

Section: Gre and Flair Imagesmentioning

confidence: 99%

7TMRIin focal epilepsy with unrevealing conventional field strength imaging

Ciantis

Barba

Tassi³

et al. 2016

Epilepsia

133

127

View full text Add to dashboard Cite

show abstract

“…16 Epidural haematoma formation following subdural grid implantations are reported to occur in 1.6-4.7% of cases, 25,26 while subdural haematomas and collections are reported in 1.1-4.7%. [25][26][27][28] Clinically significant cerebral oedema is reported in 1.1-1.5% of cases. 7,25 Other complications following subdural grid implantation are reported as follows: permanent hemiplegia from haematoma, 1%; 28 apahasia, 1.1%; 16,25 transient leg weakness, 1%, 28 Infection following subdural grid implantation is reported at 0.85-22%.…”

Section: Discussionmentioning

confidence: 98%

Tailored cortical resection following image guided subdural grid implantation for medically refractory epilepsy

Liubinas

Cassidy

Roten

et al. 2009

Journal of Clinical Neuroscience

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“…The selection criteria and implantation procedures have been described in detail elsewhere (Alarcon et al, 2006;Alarcon, 2012).…”

Section: Electrode Placementmentioning

confidence: 99%

“…Approximately 30% of patients assessed for surgery require assessment with intracranial electrodes for the identification of the epileptogenic zone (Alarcon et al, 2006;Kumar et al, 2013). Although intracranial recordings can show a wide variety of interictal abnormalities (Alarcon et al, 1994(Alarcon et al, , 1995Fernandez Torre et al, 1999a,b;Kutsy et al, 1999;Kissani et al, 2001;Flanagan et al, 2009) with various degrees of localising value (Valentin et al, 2014), ictal findings are still the gold standard in the interpretation of the intracranial recordings.…”

Section: Introductionmentioning

confidence: 98%