Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients

Elsharkawy, Alaa Eldin; Alabbasi, Abdel Hamid; Pannek, H. W.; Oppel, F.; Schulz, Reinhard; Hoppe, Mathias; Hamad, Ana Paula Andrade; Nayel, Mohamed H.; Issa, Ahmed; Ebner, Alois

doi:10.3171/2008.6.jns17613

Cited by 133 publications

(131 citation statements)

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“…26 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) 36 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) 85 (91) 62 (67) Type 1 70 (74) 33 (47) 38 (54) 27 (39) 13 (19) 6 (3-10) (25) 7 (30) 11 (48) 5 (22) 7 ( 42 (43) 58 (60) 22 (23) 19 (20) 8 (4-13)…”

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“…26 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) 38 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) 61 (85) 49 (68) Type 2 24 (25) 8 (33) 16 (67) 7 (29) 6 (25) 7 ( 44-45% of the selected population, but only 11% were affected by DP. The distribution of HS types (74% type 1, 25% type 2, and only one patient with type 3) is slightly different from that reported in some studies, 12,14,15,22 but similar to the recent findings of Savitr Sastri et al, 25 and confirms that type 1 is the most frequent, whereas CA4-predominant type 3 is rare, accounting for no more than approximately 4% of the patients in some cohorts, 4,14,15 and none at all in others.…”

Section: (4-12)mentioning

confidence: 99%

“…21 We therefore evaluated outcomes in relation to the pathologic categories of IHS and HS associated with other pathologies (FCD IIIa or DP). The incidence of IHS and FCD IIIa was similar in our cohort, with each accounting for 40 (43) 49 (53) 32 (34) 20 (22) 6 (3-10)…”

Section: (4-15)mentioning

confidence: 99%

“…It has been established that surgery leads to short-term seizure control, 15,17 but the published long-term outcome data are contradictory. [18][19][20][21] Furthermore, very few reports have considered outcomes in relation to the different HS types, and then only in the short term. 12,14,15,[22][23][24][25] The aim of this study was to investigate the relationships between the different ILAE HS types, their etiologic factors, and short-and long-term postsurgical seizure outcomes in a large cohort of HS patients undergoing surgery for drugresistant TLE because a greater understanding of the factors predicting surgical outcomes, including histopathology, may improve the selection of surgical candidates and their postsurgical clinical management.…”

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confidence: 99%

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Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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SUMMARYObjective: Hippocampal sclerosis (HS) is the most frequent neuropathologic finding in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). The International League Against Epilepsy (ILAE) has recently proposed a new classification of HS based on specific patterns of cell loss. The aim of this study was to investigate the relationships between HS types, their etiologic factors, and the short-and long-term postsurgical outcomes of patients undergoing surgery because of drug-resistant TLE with HS. Methods: Two hundred thirteen patients with a neuropathologic diagnosis of HS and a minimum follow-up of 2 years were divided on the basis of their ILAE HS type and further classified into: (1) isolated HS, (2) HS associated with focal cortical dysplasia (FCD IIIa), or (3) HS associated with other lesions. Their clinical and neuropathologic data were correlated with their Engel class postsurgical outcomes. Results: The main findings were the following: (1) HS type 1 was associated with a longer duration of epilepsy; (2) >80% of the patients had an Engel class I short-and long-term outcomes, regardless of HS type and associated pathology; (3) short-and long-term postsurgical outcomes were less satisfactory in the patients who were completely seizure-free (Engel class Ia), and patients with HS type 2 had better long-term seizure outcomes than those with type 1; (4) the concomitant presence of FCD contributed to a worse outcome, regardless of HS type; and (5) a shorter duration of epilepsy significantly correlated with an Engel class Ia outcome. Significance: These data suggest that HS type and associated pathologies may predict the risk of recurrence, but other variables such as the duration of epilepsy need to be considered. A common neuropathologic classification system may help to identify preoperative predictive factors and improve the selection of patients who may benefit from epilepsy surgery.

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confidence: 99%

Section: (4-15)mentioning

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Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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“…37) Furthermore, long-term followup studies of more than 5 years reported that the seizure-free rate after temporal lobe surgery was approximately 50-70%. 7,12,17,34) Both anterior temporal lobectomy and selective amygdalohippocampectomy for MTLE lead to almost same seizure outcomes. 27,33) Resective surgery for MTLE has shown favorable outcome and safety, but is not free from failure of seizure control, morbidity, and relapse of seizure.…”

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confidence: 99%

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

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Evidence on Use of Neuroimaging for Surgical Treatment of Temporal Lobe Epilepsy

Jones

Cascino

2016

JAMA Neurol

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Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients

Abstract: These findings highlight the role of etiology in prediction of long-term outcome after TLE surgery.

Cited by 133 publications

References 75 publications

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Evidence on Use of Neuroimaging for Surgical Treatment of Temporal Lobe Epilepsy

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