Prognosis after temporal lobe epilepsy surgery: The value of combining predictors

Uijl, Sabine G.; Leijten, Frans S.S.; Arends, Johan; Parra, Jaime; Huffelen, Alexander C. van; Moons, Karel G.M.

doi:10.1111/j.1528-1167.2008.01695.x

Cited by 55 publications

(36 citation statements)

References 34 publications

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“…Surprisingly, in a recent study by Uijl et al [10], the combination of previously established predictors including absence of tonic-clonic seizures, absence of status epilepticus, presence of mesial temporal sclerosis (MTS) on MRI, absence of ictal dystonic posturing, concordance between MRI and ictal EEG as well as unilateral temporal abnormalities in FDG-PET did not yield additional significant predictive value, particularly not for predicting unfavorable outcome. Notably, the presence of depression and other psychiatric comorbidities was not taken into account in this study [10]. Thus, the set of prognostic factors might not be complete, leading to a lack of presurgical information, which challenges the appropriate selection of surgical candidates.…”

Section: Introductionmentioning

confidence: 88%

Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Lackmayer¹,

Lehner-Baumgartner²,

Pirker³

et al. 2013

Epilepsy & Behavior

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Section: Introductionmentioning

confidence: 88%

Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Lackmayer¹,

Lehner-Baumgartner²,

Pirker³

et al. 2013

Epilepsy & Behavior

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“…[1][2][3]5,7,[10][11][12]14,15,19,28,29,31,32,37,[46][47][48]50,52,56,57,63,64,66,73,74 Studies varied with inclusion of imaging-defined and/or pathologically diagnosed MTS, the type and timing of the seizure outcome analyses, and the definitions used for seizure freedom. Rates of seizure freedom decrease with longer follow-up.…”

Section: Seizure Freedom Over Time After Surgery For Mtsmentioning

confidence: 99%

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

Elliott¹,

Bollo

Berliner³

et al. 2013

JNS

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Object In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH). Methods The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom. Results The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures. Conclusions Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.

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“…None of the routine neuronal and glial markers distinguishes epileptic from nonepileptic cerebral tissue. Such neuropathological information could better define completeness of resection of epileptic foci and provide another predictor of outcome [1][2][3] .…”

mentioning

confidence: 99%

α-B-Crystallin as a Tissue Marker of Epileptic Foci in Paediatric Resections

Sarnat

Flores‐Sarnat²

2009

Can. j. neurol. sci.

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Background:We studied α-B-crystallin, a small heat shock chaperone protein upregulated by various "stresses", as an immunocytochemical tissue marker of epileptic foci. Methods: We examined 45 resected brain tissues of epileptic patients, 16 months to 23 years. Postmortem brains of 2 epileptic children and 20 normal fetuses and neonates of 10-41 weeks gestation similarly were studied. Immunocytochemical demonstration of α-B-crystallin was supplemented by neuronal, glial and inflammatory cell markers and electron microscopy (EM) in surgical cases. Autopsy brain tissue of children without epilepsy or neurological disease served as controls. Results: In all resections, α-B-crystallin was overexpressed in astrocytes and oligodendrocytes, including satellite cells adherent to neurons, and occasionally in neurons of neocortex, hippocampus and amygdala. In six cases, reactivity was most intense at or near the epileptic focus, with a diminishing gradient of intensity for 2-3 cm; similar focal expression was seen in autopsy cases. Presence or absence of histological structural lesions was independent of α-B-crystallin expression. Balloon cells and giant atypical cells in tuberous sclerosis were intensely reactive. Reactivity was present in DNETs. No correlation occurred with microglial activation, inflammation or gliosis; no ultrastructural alterations were seen. No expression was seen in fetal brains at any age. Conclusions: Immunoreactive α-B-crystallin is a reliable tissue marker of epileptic foci, regardless of presence or absence of structural lesions; at times it maps the extent of a focus.

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Prognosis after temporal lobe epilepsy surgery: The value of combining predictors

Cited by 55 publications

References 34 publications

Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

α-B-Crystallin as a Tissue Marker of Epileptic Foci in Paediatric Resections

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