Outcome of Extratemporal Epilepsy Surgery Experience of a Single Center

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

doi:10.1227/01.neu.0000324732.36396.e9

Cited by 48 publications

(39 citation statements)

References 49 publications

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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.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The pathology of magnetic-resonance-imaging-negative epilepsy

et al. 2013

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“…Presently, about half of these patients become suitable candidates for epilepsy surgery [6]. Surgery achieves long-term control in 50–80% of patients [7,8,9]. The gap between the patients who are suitable candidates for epilepsy surgery and those with drug-resistant epilepsy is becoming narrower, especially with the development of better imaging modalities (both structural and functional), brain-mapping techniques, microneurosurgical techniques and a better understanding of neurobiology of epilepsy [10,11].…”

Section: Introductionmentioning

confidence: 99%

Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Dagar¹,

Chandra²,

Chaudhary³

et al. 2011

Pediatr Neurosurg

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Purpose: To assess the outcome of a pediatric population operated for drug-resistant epilepsy from a large tertiary care center in India. Methods: Retrospectively: quality of life (QOL); prospectively: preoperative assessment included interictal EEG, MRI (as per epilepsy protocol), video-EEG. Ictal SPECT (with subtraction) and PET were performed when required. QOL scores were assessed using the HASS or SSQ for seizure severity, Quality of Life in Childhood Epilepsy (QOLCE) for QOL, and Child Behavior Check List (CBCL) for behavior. Results: 142 were operated from January 2000 to June 2011 by the senior author. 118 patients with at least 1 year of follow-up were included in the study. Mean age at surgery was 9.8 ± 4.3 years. In addition, 40 patients underwent QOL assessment prospectively both before and after surgery. Mean duration of epilepsy was 5.3 ± 3.3 years. A class I outcome (Engel’s) was seen in 79.5% patients, class II in 8.6%, class III in 10.7%, and class IV in 1 patient. As per surgical procedures, class I outcome in patients who underwent temporal resection, hemispherotomy and extratemporal resection was 76, 87 and 72%, respectively. QOL scores correlated with duration of seizures, epileptic encephalopathy and outcome of surgery, but not with side of surgery, age and sex. Conclusions: This study, the largest reported from India, has demonstrated satisfactory results for epilepsy surgery in children.

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“…Although improvements in surgical outcome of patients with extratemporal epilepsy have been reported in recent years -mostly due to refinements in patient selection, seizure recurrence following this procedure is still high in comparison to patients operated for temporal epilepsy 22,23 . Pragmatically speaking, thus, we did not find differences in the occurrence of SUDEP in connection with post-surgical seizure status, neither in patients with temporal lobe nor in those with extratemporal lobe epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

Almeida

Nunes

Palmini

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. Method: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. Results: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2% of the 166 patients of the non operated group and in 3.7% of the 384 patients who were operated (OR=3.02, 95% CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). Conclusion: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP. Key words: SUDEP, refractory epilepsy, epilepsy surgery, extratemporal epilepsy.Incidência de SUDEP numa coorte de pacientes com epilepsia refratária: papel da cirurgia e da localização da lesão RESUMO Objetivo: O objetivo deste estudo é avaliar a incidência e características de morte súbita em pacientes com epilepsia refratária (SUDEP) e sua relação com cirurgia prévia e localização da lesão. Método: Estudo de Coorte realizado com 550 pacientes com epilepsia refratária seguidos no Programa de Epilepsia do Hospital Universitário da PUCRS, Porto Alegre, Brasil, entre Janeiro, 1992 e Julho, 2002. Os pacientes foram distribuídos em dois grupos (operados e não operados). Tipo de epilepsia, distribuição das descargas interictais e achados em RNM foram correlacionados com SUDEP. Resultados: A incidência estimada de SUDEP foi 29:1000 indivíduos. A incidência de provável SUDEP nos 166 pacientes do grupo de não operados foi 1,2% e nos 384 pacientes no grupo operado 3,7% (OR=3,02, 95% IC 0,69-13,16) (p=0,11). Comparando os pacientes que morreram com os sobreviventes do grupo operado houve diferença significativa nas seguintes variáveis: pacientes com SUDEP apresentam uma predominância de crises epilépticas generalizadas (p=0,002), lesões extratemporais na RNM (p<0,001) e atividade epileptiforme na região extratemporal (p=0,001). Conclusão: A localização da lesão e as descargas extratemporais em pacientes tratados cirurgicamente com epilepsia refratária correlacionaram-se significativamente com SUDEP. Então, é possível que nestes pacientes uma doença sobrejacent...

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Outcome of Extratemporal Epilepsy Surgery Experience of a Single Center

Cited by 48 publications

References 49 publications

The pathology of magnetic-resonance-imaging-negative epilepsy

The pathology of magnetic-resonance-imaging-negative epilepsy

Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

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