Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program

Abstract

The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.

Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal Epilepsy

“…Clinical and demographic information was tabulated. Diagnosis was determined according to the International Center for Neurological Restoration Comprehensive Epilepsy Surgery Program, which included (a) prolonged video-electroencephalography (VEEG)monitoring with scalp electrodes and additional electrodes considering the epileptogenic zone presumed; (b) MRI scans with a 1.5 T or 3 T scanner (Siemens Magnetom Symphony); (c) neuropsychological testing (executive functions, attention and memory assessment, higher verbal and visual functions); (d) sensorial evoked potentials, (e) antiepileptic drugs blood levels determination; and (f) subtraction single-photon emission computed tomography coregistered to magnetic resonance imaging (MRI) (SISCOM) [ 9 , 27 ]. Patients were prospectively recruited for this study from December 2016 to February 2020 after providing informed consent.…”

Sequential Semiology of Seizures and Brain Perfusion Patterns in Patients with Drug-Resistant Focal Epilepsies: A Perspective from Neural Networks

“…Temporal lobe epilepsy is the most common type of focal epilepsy [7,[10][11][12]. It has been conceptualized as a neural network disease that can involve brain regions beyond the mesial temporal lobe [13,14].…”

A Novel Noninvasive Approach Based on SPECT and EEG for the Location of the Epileptogenic Zone in Pharmacoresistant Non-Lesional Epilepsy

“…This article illustrates the methodology follow up for the presurgical evaluation in the first Cuban comprehensive surgery program carried out at the International Center for Neurological Restoration in Havana, Cuba [9].…”