Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

Elsharkawy, Alaa Eldin; Behne, F.; Oppel, F.; Pannek, H. W.; Schulz, Reinhard; Hoppe, Mathias; Pahs, Gerald; Gyimesi, Csilla; Nayel, Mohamed H.; Issa, Ahmed; Ebner, Alois

doi:10.3171/jns/2008/108/4/0676

Cited by 72 publications

(63 citation statements)

References 72 publications

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“…One large study revealed that at 2 years follow-up, 50.3% were reported to have complete seizure freedom (or auras only) (Engel's Class I), 18.3% have Class II outcome, 17.7% have Class III outcome. This is greater than 50% reduction in seizures in 86% of the patients at 2 years follow-up [12]. Similar results were seen in patients who had MST as the primary procedure for extra-temporal onset seizures [1,[3][4][5][6].…”

Section: Discussionsupporting

confidence: 71%

Efficacy of Vagus Nerve Stimulation (VNS) after Multiple Subpial Transections (MST) for Extra-Temporal Seizure Foci

Patil

Anthony²,

Andrews³

2013

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Background: The effect of Vagus nerve stimulation (VNS) therapy following major resective surgeries has been reported. However, the effect of VNS therapy following multiple-subpial-transections (MST) has not been reported. The objective of this paper is to examine the beneficial effect of VNS therapy following MST. Methods: There are 22 patients aged 10 -55 years. Male/female distribution is 11/11 and follow-up is 24 -148 months (median of 120 months). Seizure foci were bilateral in 9 patients, multi-lobar (unilateral) in 12 patients and single-lobar in 1 patient. MST was performed over broad areas in and around the seizure foci. VNS implantation was done when the response to MST procedure was poor (1 patients), or there was recurrence of seizures (21 patients). Interval between MST and VNS implanttation varied from one month to three years (median of 2 years). Results: Thirteen patients (59%) are seizure free (Engel' Class I), 8 (36.5%) have greater than 90% reduction in seizure frequency (Class II), and 1 (4.5%) has between 50% -90% reduction in seizure frequency (Class III). Conclusion: The results show that VNS therapy produced meaningful improvement in seizure outcome in all patients with extra-temporal seizures that had inadequate response to MST.

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Section: Discussionsupporting

confidence: 71%

Efficacy of Vagus Nerve Stimulation (VNS) after Multiple Subpial Transections (MST) for Extra-Temporal Seizure Foci

Patil

Anthony²,

Andrews³

2013

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“…1 Authors have suggested that the relative immaturity of the frontal cortex may render it more seizure prone and therefore promotes the development of multifocal seizures; this, in turn, may reduce the likelihood of achieving favorable surgical seizure outcome. 7 Additionally, the pathology that contributes to FLE is likely widespread in nature and is compounded by epileptic discharges spreading from other regions. Resection may therefore not be able to remove all possible causative foci.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical management of frontal lobe epilepsy in children

Vachhrajani¹,

Ribaupierre²,

Otsubo

et al. 2012

PED

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Object Pediatric frontal lobe epilepsy (FLE) remains a challenging condition for neurosurgeons and epileptologists to manage. Postoperative seizure outcomes remain far inferior to those observed in temporal lobe epilepsies, possibly due to inherent difficulties in delineating and subsequently completely resecting responsible epileptogenic regions. In this study, the authors review their institutional experience with the surgical management of FLE and attempt to find predictors that may help to improve seizure outcome in this population. Methods All surgically treated cases of intractable FLE from 1990 to 2008 were reviewed. Demographic information, preoperative and intraoperative imaging and electrophysiological investigations, and follow-up seizure outcome were assessed. Inferential statistics were performed to look for potential predictors of seizure outcome. Results Forty patients (20 male, 20 female) underwent surgical management of FLE during the study period. Patients were an average of 5.6 years old at the time of FLE onset and 11.7 years at the time of surgery; patients were followed for a mean of 40.25 months. Most patients displayed typical FLE semiology. Twenty-eight patients had discrete lesions identified on MRI. Eight patients underwent 2 operations. Cortical dysplasia was the most common pathological diagnosis. Engel Class I outcome was obtained in 25 patients (62.5%), while Engel Class II outcome was observed in 5 patients (12.5%). No statistically significant predictors of outcome were found. Conclusions Control of FLE remains a challenging problem. Favorable seizure outcome, obtained in 62% of patients in this series, is still not as easily obtained in FLE as it is in temporal lobe epilepsy. While no statistically significant predictors of seizure outcome were revealed in this study, patients with FLE continue to require extensive workup and investigation to arrive at a logical and comprehensive neurosurgical treatment plan. Future studies with improved neuroimaging and advanced invasive monitoring strategies may well help define factors for success in this form of epilepsy that is difficult to control.

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“…Pathological findings are typically reported in small-scale studies from individual centers, [13][14][15][16] or buried in larger series containing a full spectrum of patients among which only a small number was MRI-negative. 17,18 A few attempts at meta-analysis have been performed to better understand surgical outcome and factors such as pathology, surgery type, and seizure semiology in MRI-negative patients. Ansari et al 24 reported 95 pediatric extratemporal nonlesional epilepsy patients from 17 studies, and classified surgical pathology into three categories: cortical dysplasia, gliosis, and others (neuronal loss, encephalitis, polymicrogyria, ulegyria, chronic inflammation, and normal).…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Studies specifically on the surgical pathology of MRI-negative patients, however, are limited to small-scale experiences of individual centers, [13][14][15][16] or cases buried in larger series containing both MRI-positive and -negative patients. 17,18 Moreover, with the advance in MRI technology over the last decade and the establishment of more uniform epilepsy MRI protocols, the definition of 'MRInegative' cases in recent studies may not be equivalent to earlier ones. The purpose of this study is to systematically review one institution's recent experience with the pathological substrates underlying strictly defined MRI-negative epilepsies.…”

mentioning

confidence: 99%

The pathology of magnetic-resonance-imaging-negative epilepsy

et al. 2013

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Patients with magnetic-resonance-imaging (MRI)-negative (or 'nonlesional') pharmacoresistant focal epilepsy are the most challenging group undergoing presurgical evaluation. Few large-scale studies have systematically reviewed the pathological substrates underlying MRI-negative epilepsies. In the current study, histopathological specimens were retrospectively reviewed from MRI-negative epilepsy patients (n ¼ 95, mean age ¼ 30 years, 50% female subjects). Focal cortical dysplasia cases were classified according to the International League Against Epilepsy (ILAE) and Palmini et al classifications. The most common pathologies found in this MRI-negative cohort included: focal cortical dysplasia (n ¼ 43, 45%), gliosis (n ¼ 21, 22%), hamartia þ gliosis (n ¼ 12, 13%), and hippocampal sclerosis (n ¼ 9, 9%). The majority of focal cortical dysplasia were ILAE type I (n ¼ 37) or Palmini type I (n ¼ 39). Seven patients had no identifiable pathological abnormalities. The existence of positive pathology was not significantly associated with age or temporal/extratemporal resection. Follow-up data post surgery was available in 90 patients; 63 (70%) and 57 (63%) attained seizure freedom at 6 and 12 months, respectively. The finding of positive pathology was significantly associated with seizure-free outcome at 6 months (P ¼ 0.035), but not at 12 months. In subgroup analysis, the focal cortical dysplasia group was not significantly correlated with seizure-free outcome, as compared with the negative-pathology groups at either 6 or 12 months. Of note, the finding of hippocampal sclerosis had a significant positive correlation with seizurefree outcome when compared with the negative-pathology group (P ¼ 0.009 and 0.004 for 6-and 12-month outcome, respectively). Absence of a significant histopathology in the resected surgical specimen did not preclude seizure freedom. In conclusion, our study highlights the heterogeneity of epileptic pathologies in MRInegative epilepsies, with focal cortical dysplasia being the most common finding. The existence of positive pathology in surgical specimen may be a good indication for short-term good seizure outcome. There is a small subset of cases in which no pathological abnormalities are identified.

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Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

Abstract: Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.

Cited by 72 publications

References 72 publications

Efficacy of Vagus Nerve Stimulation (VNS) after Multiple Subpial Transections (MST) for Extra-Temporal Seizure Foci

Efficacy of Vagus Nerve Stimulation (VNS) after Multiple Subpial Transections (MST) for Extra-Temporal Seizure Foci

Neurosurgical management of frontal lobe epilepsy in children

The pathology of magnetic-resonance-imaging-negative epilepsy

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