Prognostic factors in the surgical treatment of temporal lobe epileptics

Bengzon, A. R. A.; Rasmussen, T; Gloor, P.; Dussault, Jean H.; Stephens, Michael M.

doi:10.1212/wnl.18.8.717

Cited by 213 publications

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“…This latter contrasts the 26 seizure-free (SF) patients with the 27 patients whose disorders remained the same or worsened, similar to the analysis of Bengzon et al (19).…”

Section: Resultssupporting

confidence: 67%

“…Eight of these (3,4,6,(9)(10)(11)(12)15) agreed with Penfield (17,18) that the presence of a specific epileptogenic lesion usually augurs a favorable postsurgical outcome (Table 1). Additionally, Bengzon et al (19), compiling the Montreal experience, found a higher proportion of patients with lesions in the favorable-outcome group than among those in whom resective surgery was unhelpful. However, six of these 14 reports (5,7,8,13,14,16) found no correlation between the presence of a specific, causative lesion and outcome.…”

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confidence: 99%

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Indices of Resective Surgery Effectiveness for Intractable Nonlesional Focal Epilepsy

et al. 2003

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Summary: Among 70 patients with intractable focal epilepsy and no specific lesion, as determined by both MRI (magnetic resonance imaging) and histopathology, outcome after resective surgery was polarized: 26 (37%) became seizure free (SF), and 27 (39%) were not helped. Eighteen (42%) of 43 standard temporal resections rendered patients SF, somewhat more than eight (30%) of 27 other procedures. To seek reliable prognostic factors, the subsequent correlative data compared features of the 26 SF patients with those of the 27 not helped. Although ictal semiology guided the site of surgical resection, it and other aspects of seizure and neurologic history failed to predict surgical outcome. However, two aspects of preoperative scalp EEGs correlated with SF outcomes: (a) among 25 patients in whom >50% of clinical seizures arose from the later resected lobe and no other origins, 18 (72%) became SF compared with seven (28%) of 25 with other ictal profiles; (b) 13 (93%) of 14 temporal lobe patients whose interictal and ictal EEGs lacked features indicative of multifocal epileptogenesis became SF compared with five (33%) of 15 with such components. The considered need for subdural (SD) EEG reduced SF outcome from 18 (90%) of 20 patients without SD to eight (24%) of 33 with SD; this likely reflected an insufficient congruity of ictal semiology and interictal and ictal scalp EEG for localizing epileptogenesis. Within this SD group, >50% of clinical seizure origins from a later resected lobe increased SF outcome somewhat: from two (14%) of 14 without this attribute to six (40%) of 15 with it; 100% of such origins increased SF outcome from two (12%) of 16 to six (46%) of 13.

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“…This latter contrasts the 26 seizure-free (SF) patients with the 27 patients whose disorders remained the same or worsened, similar to the analysis of Bengzon et al (19).…”

Section: Resultssupporting

confidence: 67%

mentioning

confidence: 99%

Indices of Resective Surgery Effectiveness for Intractable Nonlesional Focal Epilepsy

et al. 2003

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“…Awad et al (30) reported that in patients with complete resection of the lesion, the extent of the epileptogenic zone resection did not affect outcome. In contrast, epileptiform abnormalities in postexcision ECoG have been shown to originate mainly from the site of surgery and to correlate with a poorer surgical outcome (35)(36)(37). These data indicate that in patients with MRI-detected circumscribed lesions, the resection may be limited to the lesion and a small (<0.5 cm) margin of tissue surrounding it.…”

Section: Discussionmentioning

confidence: 93%

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Hufnagel¹,

Zentner²,

Fernández³

et al. 1997

Epilepsia

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Summary:Purpose: To assess the efficacy and safety of multiple subpial transection (MST), a new technique in epilepsy surgery, alone and in combination with resection.Methods: MST was performed in 22 patients with intractable epilepsy, 10 of whom were treated with a combination of a resection and MST in functionally important cortex, 6 of whom were treated with a combination of a resection and MST performed outside functionally important cortex, and 6 of whom were treated with MST alone.Results: Of the 6 patients who received MST alone, none became seizure free and 4 showed >50% reduction of all seizure types. In 2 patients, including 1 with Rasmussen's encephalitis, no change in seizure frequency or intensity occurred. Of the 16 patients in whom MST was combined with a resection, 9 (56%) became seizure free. Six of the remaining 7 patients showed >95% reduction of all seizure types. Disappearance of epileptiform potentials in the postoperative EEG correlated significantly with complete relief from seizures.Subtle, permanent neurological deficits remained in 5 of 14 patients who received MST in functionally important brain areas.Conclusions: Reduction of the seizure frequency was substantial in 4 of 6 patients who received MST alone, but complete seizure control was not observed. MST surrounding a lesionectomy may be a new surgical approach which would minimize the excised volume and improve seizure control. Key Words: Epilepsy surgery-Epileptogenic zone-Multiple subpial transection-Electrocorticography-Seizure outcome.In multiple subpial transection (MST), a new technique in epilepsy surgery (l), the main objective is to extend the surgical procedure into epileptogenic brain areas of high functional importance, such as the primary motor or speech areas, while avoiding unacceptable neurological deficits. In theory, MST disrupts horizontal neuronal interconnections essential for seizure spread, while preserving the descending vertical neuronal colstructural abnormality detected by magnetic resonance imaging (MRI) or intraoperatively. We wished to evaluate whether seizure control achieved by this method is similar to that achieved by a more extensive resection of a lesion and the perilesional epileptogenic cortex. If so, MST may prove to be a new approach to epilepsy surgery of circumscribed epileptogenic lesions. umns largely responsible for the underlying neuronal function. Recent studies have demonstrated efficacy of MST in seizure control without producing major neurological dysfunction (2-6). However, few patients have been treated exclusively with MST and separate data concerning this subgroup are frequently lacking (2,6). In the present study, we assessed seizure control and safety aspects in patients treated with MST alone or in combination with a resection. In a subgroup of patients, MST was performed outside functionally important brain areas surrounding a lesionectomy limited to the extent of a PATIENTS AND METHODSMST was performed in 22 patients (12 men, 10 women) aged 7 to 45 years (mean, 26 years) wi...

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“…A recent epidemiologic study found a prevalence among seniors of 10.8/1,000 and an estimated yearly incidence of new-onset epilepsy of 2.4/1,000 [8]. There is skepticism about outcomes in older patients treated with surgery related to the presence of multiple comorbidities, preexisting cognitive decline and longer seizure duration [2,13]. Few studies report postsurgical outcomes in older adults and the available data are based on small number heterogeneous samples.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of epilepsy surgery for medically refractory temporal lobe epilepsy in older patients

Mihaylova¹,

Khan²,

Buchtel³

et al. 2015

MRAJ

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Purpose-Resective epilepsy surgery for temporal lobe epilepsy (TLE) remains underutilized in elderly patients and only few studies report postsurgical seizure and neurocognitive outcomes in this group. The aim of this study was to investigate the tolerability and efficacy of surgery in older epileptics.Methods-We conducted a retrospective analysis of 18 patients aged 55 or older to assess the efficacy and tolerability of the procedure. Mean disease duration was 34 years.Results-Fourteen patients (78%) achieved Engel class I outcome over a mean follow-up period of 4.2 years. Thirteen patients had neuroimaging and histopathology consistent with mesial temporal sclerosis (MTS). We did not find a measurable effect of disease duration on postsurgical outcome. We confirmed Medical Research Archives 2015Issue 2Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 2 that the MRI evidence of MTS can be used as a predictor for postsurgical outcome. Postsurgical neuropsychological evaluation completed in 13 patients between three months and two and a half years post resection showed decline in verbal abilities most significantly in those who had undergone dominant temporal lobe surgery.Discussion/Conclusion-Our results indicate that epilepsy surgery is well tolerated, safe and effective in older patients with refractory TLE. Postsurgical neuropsychological evaluation showed expected decline in verbal abilities in patients who had undergone dominant resection.

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Prognostic factors in the surgical treatment of temporal lobe epileptics

Cited by 213 publications

References 0 publications

Indices of Resective Surgery Effectiveness for Intractable Nonlesional Focal Epilepsy

Indices of Resective Surgery Effectiveness for Intractable Nonlesional Focal Epilepsy

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

Outcomes of epilepsy surgery for medically refractory temporal lobe epilepsy in older patients

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