Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy

Jeha, Lara E.; Najm, Imad; Bingaman, William; Khandwala, Farah; Widdess‐Walsh, Peter; Morris, Harold H.; Dinner, Dudley S.; Nair, Dileep; Foldvary-Schaeffer, N.; Prayson, Richard A.; Comair, Youssef G.; OʼBrien, Ralph G.; Bulacio, Juan; Gupta, Ajay; Lüders, Hans

doi:10.1212/01.wnl.0000219810.71010.9b

Cited by 216 publications

(226 citation statements)

References 10 publications

Supporting

Mentioning

191

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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 ...

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Resective epilepsy surgery is far from a cure: 30–40% of patients undergoing a resection for frontal lobe epilepsy (FLE) are seizure free a decade after surgery,43, 44 whereas only 50–60% remain seizure free 10 years after TLE surgery 43, 45, 46. Seizure recurrence is a complex, multifactorial, and dynamic phenomenon.…”

Section: Surgical Outcomesmentioning

confidence: 99%

“…No clinical predictors could a priori predict patients whose seizures will recur during AED reduction as opposed to those whose seizures will recur after complete AED discontinuation 63. Similarly, although low seizure frequency, lack of secondary generalization, unilateral preoperative EEG and MRI findings, and lack of need for invasive EEG recordings correlate with early seizure freedom after surgery for TLE,46, 53 only the presence of a specific pathological diagnosis predicts long‐term seizure freedom: 40% of patients with gliosis or nonspecific pathology were seizure free 10 years after TLE surgery in the one series that investigated early versus late outcomes independently, as opposed to 80% of those with a specific pathological abnormality 46. Overall, a lot remains to be understood about the determinants of cure (defined by seizure freedom off AEDs) or long‐term seizure remission after epilepsy surgery.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Not all that glitters is gold: A guide to surgical trials in epilepsy

Jehi

2016

Epilepsia Open

View full text Add to dashboard Cite

SummaryEpilepsy surgery is often the only effective treatment in appropriately selected patients with drug‐resistant epilepsy, a disease affecting about 30% of those with epilepsy. We review the evidence supporting the use of epilepsy surgery, with a focus on randomized controlled trials (RCTs). Second, we identify gaps in knowledge about the benefits of epilepsy surgery for certain populations, the challenges of individualizing the choice of surgery, and our lack of understanding of the mechanisms of surgical outcomes. We conducted a search (MEDLINE, Embase, Cochrane, Clinicaltrials.gov) on March 2, 2016, to identify epilepsy surgery RCTs, systematic reviews, or health technology assessments (HTAs). Abstracts were screened to identify resective, palliative (e.g., corpus callosotomy, multiple subpial transection [MST]), ablative (e.g., Laser interstitial thermal therapy [LITT], gamma knife radiosurgery [RS]), and neuromodulation (e.g., cerebellar stimulation [CS], hippocampal stimulation [HS], repetitive transcranial magnetic stimulation [rTMS], responsive neurostimulation [RNS], thalamic stimulation [TS], trigeminal nerve stimulation [TNS], and vagal nerve stimulation [VNS]) RCTs. Study characteristics and outcomes were extracted. Knowledge gaps were identified. Of 1,205 abstracts, 20 RCTs were identified (resective surgery including corpus callosotomy [n = 7], MST [n = 0], RS [n = 1, 3 papers], LITT [n = 0], CS [n = 1], HS [n = 2], RNS [n = 1], rTMS [n = 1], TNS [n = 1], TS [n = 1], and VNS [n = 5]). Most studies targeted patients with temporal lobe epilepsy (TLE) and none examined the effectiveness of resective surgical therapies in patients with extra‐TLE (ETLE) or with specific lesions aside from mesial temporal lobe sclerosis. No pediatric surgical RCTs were identified except for VNS. Few RCTs address the effectiveness of surgery in epilepsy and most are of limited generalizability. Future studies are needed to compare the effectiveness of different surgical strategies, better understand the mechanisms of surgical outcomes, and define the ideal surgical approaches, particularly for patients with high or very low cognitive function, normal imaging, or ETLE.

show abstract

“…The reasons for failure are not well known and there are no data available on the clinical predictors of failed surgery. 1,3,21 Previous studies have demonstrated that late recurrence after initial seizure freedom is not a rare event, but risk factors specific to the event remain elusive. Therefore, the purpose of this study is to discuss the electrophysiology and pathological substrate behind failed temporal lobe resection in patients with unilateral radiographic MTS.…”

mentioning

confidence: 99%

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Vale¹,

Pollock²,

Benbadis

2012

FOC

View full text Add to dashboard Cite

Object The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis. Methods A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates. Results Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings. Conclusions The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.

show abstract

Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy

Cited by 216 publications

References 10 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

Not all that glitters is gold: A guide to surgical trials in epilepsy

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Contact Info

Product

Resources

About