Long-term seizure outcome for international consensus classification of hippocampal sclerosis: A survival analysis

Meng, Na; Ge, Haitao; Chen, Shi; Shen, Hong; Wang, Yu; Pu, Song; Liu, Li; Wang, Haiyang; Xie, Chuncheng; Zhu, Minwei; Wang, Jiabin; Shi, Changbin; Lin, Zhiguo

doi:10.1016/j.seizure.2014.10.006

Cited by 68 publications

(45 citation statements)

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“…25 (17-34) 36 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) 186 (88) 145 ( Most published studies aimed at identifying the factors predicting outcomes are mainly based on electroclinical parameters, but it has been pointed that etiology may play a role in influencing the long-term efficacy of TLE surgery. 21 We therefore evaluated outcomes in relation to the pathologic categories of IHS and HS associated with other pathologies (FCD IIIa or DP).…”

Section: (4-15)mentioning

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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Section: (4-15)mentioning

confidence: 99%

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

et al. 2015

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“…Postoperative outcome has been shown to be superior in patients with TLE who, after resection, were retrospectively shown to have classical patterns of HS (ie, preservation of CA2 neurons) or total HS (ie, neuronal loss throughout the CA), whereas patients with circumscribed neuronal loss of CA1 or CA4 tend to have poorer outcomes 17, 18, 19, 20. Mathern et al (1996) had previously reported that patients with initial precipitating injuries were more likely to benefit from surgery and had neuronal cell loss in CA1 and presubiculum regions.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, these patterns of HS appear to be related to various clinical aspects of TLE and may have significance for postoperative prognosis. ILAE HS type 1 is more frequently associated with a history of initial precipitating injuries in early childhood, an early seizure onset and improved seizure outcome after temporal lobe surgery 17, 18, 19, 20. ILAE HS type 2 and 3 appear to be associated with a later age of onset and a less favorable postoperative outcome,17, 18, 19, 20 although there are some inconsistencies in these relationships 21.…”

Section: Introductionmentioning

confidence: 99%

“…ILAE HS type 1 is more frequently associated with a history of initial precipitating injuries in early childhood, an early seizure onset and improved seizure outcome after temporal lobe surgery 17, 18, 19, 20. ILAE HS type 2 and 3 appear to be associated with a later age of onset and a less favorable postoperative outcome,17, 18, 19, 20 although there are some inconsistencies in these relationships 21. Given the clinical relevance of regional hippocampal subfield pathology in TLE, it is important to develop and apply MRI approaches that permit assessment of hippocampal subfield structure and volume in this patient group, particularly if such non‐invasive imaging measures can be used to predict treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

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Hippocampal subfield segmentation in temporal lobe epilepsy: Relation to outcomes

et al. 2018

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ObjectiveTo investigate the clinical and surgical outcome correlates of preoperative hippocampal subfield volumes in patients with refractory temporal lobe epilepsy (TLE) using a new magnetic resonance imaging (MRI) multisequence segmentation technique.MethodsWe recruited 106 patients with TLE and hippocampal sclerosis (HS) who underwent conventional T1‐weighted and T2 short TI inversion recovery MRI. An automated hippocampal segmentation algorithm was used to identify twelve subfields in each hippocampus. A total of 76 patients underwent amygdalohippocampectomy and postoperative seizure outcome assessment using the standardized ILAE classification. Semiquantitative hippocampal internal architecture (HIA) ratings were correlated with hippocampal subfield volumes.ResultsPatients with left TLE had smaller volumes of the contralateral presubiculum and hippocampus‐amygdala transition area compared to those with right TLE. Patients with right TLE had reduced contralateral hippocampal tail volumes and improved outcomes. In all patients, there were no significant relationships between hippocampal subfield volumes and clinical variables such as duration and age at onset of epilepsy. There were no significant differences in any hippocampal subfield volumes between patients who were rendered seizure free and those with persistent postoperative seizure symptoms. Ipsilateral but not contralateral HIA ratings were significantly correlated with gross hippocampal and subfield volumes.ConclusionsOur results suggest that ipsilateral hippocampal subfield volumes are not related to the chronicity/severity of TLE. We did not find any hippocampal subfield volume or HIA rating differences in patients with optimal and unfavorable outcomes. In patients with TLE and HS, sophisticated analysis of hippocampal architecture on MRI may have limited value for prediction of postoperative outcome.

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Hippocampal Sclerosis, Granule Cell Dispersion, and Cortical Dysplasia

Thom¹

2018

Developmental Neuropathology

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Long-term seizure outcome for international consensus classification of hippocampal sclerosis: A survival analysis

Abstract: Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery.

Cited by 68 publications

References 36 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

Hippocampal subfield segmentation in temporal lobe epilepsy: Relation to outcomes

Hippocampal Sclerosis, Granule Cell Dispersion, and Cortical Dysplasia

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