Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood

Benifla, Mony; Rutka, James T.; Otsubo, Hiroshi; Lamberti-Pasculli, Maria; Elliott, Irene; Sell, Eric; RamachandranNair, Rajesh; Ochi, Ayako; Weiss, Shelly K.; Snead, O. Carter; Donner, Elizabeth

doi:10.1016/j.eplepsyres.2008.07.012

Cited by 69 publications

(80 citation statements)

References 24 publications

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“…37,51,64,81,82,84,85 In the remaining one-third of patients, seizures usually recur during the first postoperative year, 37,48,97 although the percentage of patients who remain seizure free may decline with longer follow-up, with reported rates as low as 53% for patients with at least 5 years of follow-up and 41% for 10 years. 3,7,28,30,48,64,90 Recent data suggest that the histopathological abnormalities underlying surgically treated drug-resistant MTLE are the main factor predictive of seizure outcome. 11,13,49,53,65,77,88,89,91 In the last few years the classification systems for the main histopathological abnormalities observed in MTLE patients-that is, hippocampal sclerosis, 9,11 GCP, 10 FCD, 12 and ELGT IIId).…”

Section: Discussionmentioning

confidence: 99%

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Giulioni¹,

Marucci

Martinoni³

et al. 2013

JNS

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D rug-resistant MTLE is the most common type of epilepsy requiring surgical treatment, with a favorable seizure outcome being achieved in about 60%-75% of patients. 50,51,64,82,89 Clinically, MTLE is often regarded as a relatively homogeneous syndromic entity, with seizures characterized by typical ictal semiology 32,96 and EEG findings. 29,96 However, a variety of MTLE subtypes have been described according to the underlying etiology, with different surgical prognoses. 47,89,92 Recent neuropathological classifications of epi lep to gen ic lesions, such as mesial temporal sclerosis (MTS), 11 granule cell pathology (GCP), 10 focal cortical dysplasia (FCD), 12 and epilepsy-associated low-grade tumor (ELGT) 1,54,55,73,74,91 Object. The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications of mesial temporal sclerosis (MTS), granule cell pathology (GCP), focal cortical dysplasia (FCD) and epilepsy-associated low-grade tumors (ELGT).Methods. The authors analyzed data obtained in 120 consecutive cases involving patients presenting with drugresistant MTLE, who underwent tailored anteromesial temporal lobe resection, and correlated seizure outcome with pathological findings. They identified 5 histopathological groups: Group 1-ELGT, alone or associated with other lesions (30 cases); Group 2-isolated FCD (17 cases); Group 3-MTS, with or without GCP (28 cases); Group 4-MTS associated with FCD, with or without GCP (37 cases); Group 5-other lesions (8 cases).Results. Engel Class I outcome was observed in 83% of patients with ELGT (Class IA in 63%); in 59% of patients with isolated FCD, with FCD Type II showing a better prognosis than FCD Type I; in 82% of patients with isolated MTS (Class IA in 50%), with MTS Type 1a and MTS Type 1b showing a better prognosis than MTS Type 2 and patients with MTS and GCP having better postsurgical results than those with MTS without GCP. Engel Class I outcome was also achieved in 84% of patients with FCD associated with MTS (Engel Class IA in 62%); also in this group MTS 1a and MTS 1b associated with FCD showed a better prognosis than FCD associated with MTS 2. Finally, Engel Class I was also achieved in 2 patients with vascular malformation and in 1 with a temporal pole encephalocele.Conclusions. Patients with MTLE and ELGT, MTS, or MTS associated with FCD showed the best postsurgical seizure outcome (Engel Class I in more than 80% of cases), whereas only 63% of patients with isolated FCD achieved the same type of outcome. Interestingly, the analysis of seizure outcome in histopathological subtypes of FCD and of MTS showed different prognoses in the different pathological subgroups, with worse outcomes for atypical MTS, absence of GCP, and isolated FCD Type I. 37Abbreviations used in this paper: EEG = electroencephalographic; ELGT = epilepsy-associated low-grade tumor; FCD = focal cortical dysplasia; GCP = granule cell ...

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Section: Discussionmentioning

confidence: 99%

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Giulioni¹,

Marucci

Martinoni³

et al. 2013

JNS

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“…Temporal lobe epilepsy is the most common type of epilepsy, and mesial temporal sclerosis (MTS) is the most common temporal lobe epilepsy [65]. MTS, which can be readily identified on MRI with hippocampal atrophy and increased signal, is known to be medically refractory, but does respond well to anterior temporal lobectomy with better postoperative outcomes than other forms of temporal lobe epilepsy [10,[43][44][45][46][47][48]50,61,63]. When MRI fails to detect a potentially epileptogenic lesion, the chances of an excellent surgical outcome are significantly lower, ranging from 20-65% [40][41][42][43][44].…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

“…In addition, various neuro-radiological imaging techniques are employed to further identify the structural or functional epileptogenic lesion(s). Multiple studies have shown that the prognosis of epilepsy surgery varies depending on the etiology and location of the epileptogenic zone [43][44][45][46][47][48][49][50][51][60][61][62][63][64]. Radiographically identifiable epileptogenic lesions provide information about the etiology and localization of epilepsy, and can provide prognostic information for focal respective epilepsy surgery.…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

“…Epilepsy surgery is an effective and safe alternative form of therapy for those patients with focal onset epilepsy [32,[42][43][44][45][46][47][48][49][50][51]. Major complications from epilepsy surgery and subdural electrode evaluation have an incidence of less than 7% and long term permanent deficits have an incidence of less than 2% [52][53][54][55][56][57][58].…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

“…Radiographically identifiable epileptogenic lesions provide information about the etiology and localization of epilepsy, and can provide prognostic information for focal respective epilepsy surgery. Identifying a structural lesion on MRI provides an excellent prognosis from epilepsy surgery, with 60-90% freedom from disabling seizures [43][44][45][46][47][48][49][50][51][60][61][62][63][64]. Temporal lobe epilepsy is the most common type of epilepsy, and mesial temporal sclerosis (MTS) is the most common temporal lobe epilepsy [65].…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

Shin¹,

Jewells²,

Hadar³

et al. 2014

Int J Neurorehabilitation Eng

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Epilepsy is the fourth most common neurological disorder in the US, affecting nearly 2.5 million Americans. The economic impact of epilepsy represents estimated direct and indirect costs of 12.5 billion dollars per year. Patients with this disorder experience increased morbidity and mortality with long term fatality rates of 24%. Multiple diagnostic tools are used to identify and classify the seizure type/syndrome, etiology and localization of seizures, including electroencephalogram (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), magneto encephalogram (MEG), and neuropsychiatric testing. Despite 29 different antiepileptic medications that are available in the US, one third of patients remain refractory to pharmacological treatment. In these intractable epilepsy patients, non-pharmacological treatments can be considered. Commonly used non-pharmacological treatment options for epilepsy include epilepsy surgery, neurostimulation therapy, and diet therapy. Review of Epilepsy -Etiology, Diagnostic Evaluation and Treatment

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How are they doing as adults? Psychosocial and socioeconomic outcomes 11‐30 years after pediatric epilepsy surgery

et al. 2023

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ObjectivePediatric epilepsy surgery yields cure from epilepsy or complete seizure control with continued medication in many patients early in life. This study aimed to evaluate the long‐term (>10 years) psychosocial and socioeconomic outcomes of pediatric epilepsy surgery and examine the role of comorbid disability, type of surgery, seizure freedom, and age at surgery.MethodsA novel ad hoc parent/patient questionnaire was used to assess educational and occupational attainment, marital/familial status, mobility, and other outcomes in patients who underwent unilobar or multilobar surgery for drug‐refractory epilepsy during their childhood. The questionnaire also captured information on comorbid disability.ResultsOf the 353 eligible patients, 203 could still be contacted and 101 of these (50%) returned appropriately filled‐in questionnaires (follow‐up intervals: 11‐30 [mean: 19.6] years). The cure from epilepsy rate was 53%. Type of surgery was strongly confounded by comorbid disability. Patients with comorbid disabilities had significantly lower rates of regular school degrees, gainful employment, marriage, and driving license (N = 29; 12%, 4%, 0%, 3%) compared with non‐disabled patients (N = 69; 89%, 80%, 43%, and 67%, respectively). Patients achieved lower school degrees than their siblings and parents. Non‐disabled seizure‐free patients had better employment and mobility outcomes compared with non‐seizure‐free patients. Age at surgery (<10 vs. ≥10 years of age) did not have any effect on any outcome in patients with preschool seizure onset.SignificancePediatric epilepsy surgery can lead to permanent relief from epilepsy in many patients, but comorbid disability strongly impacts adult life achievement. In non‐disabled patients, favorable outcomes in academic, occupational, marital, and mobility domains were achieved, approaching respective rates in the German population. Complete seizure freedom had additional positive effects on employment and mobility in this group. However, in case of chronic comorbid disability the overall life prospects may be limited despite favorable seizure outcomes.

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Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood

Cited by 69 publications

References 24 publications

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

How are they doing as adults? Psychosocial and socioeconomic outcomes 11‐30 years after pediatric epilepsy surgery

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