Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy

Jobst, Barbara C.; Cascino, Gregory D.

doi:10.1001/jama.2014.17426

Cited by 522 publications

(373 citation statements)

References 64 publications

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“…A recent review found that extratemporal versus temporal surgery was inconsistently associated with outcome 30. Overall, it appears that extratemporal surgery is associated with less chance of long-term remission than is temporal lobe surgery.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting seizure outcome after epilepsy surgery: an observational series

Bell

Tisi

Gonzalez-Fraile

et al. 2017

J Neurol Neurosurg Psychiatry

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Section: Discussionmentioning

confidence: 99%

Factors affecting seizure outcome after epilepsy surgery: an observational series

Bell

Tisi

Gonzalez-Fraile

et al. 2017

J Neurol Neurosurg Psychiatry

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“…3 Though the overall risk of morbidity has been low (8%-10.8%), TLE surgery has been associated with medical and neurologic complications. Medical complications include CSF leak (5.8%), aseptic meningitis (2.7%), pneumonia (0.7%), intracranial hematomas (1.5%), deep vein thrombosis/pulmonary embolism (0.7%), and hydrocephalus (1.4%).…”

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Symptomatic cerebral vasospasm on conventional angiography following temporal lobe epilepsy surgery

et al. 2017

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Pearls & Oy-sters: Symptomatic cerebral vasospasm on conventional angiography following temporal lobe epilepsy surgery PEARLS• Cerebral vasospasm is a complication of temporal lobe epilepsy (TLE) surgery.• Cerebral vasospasm is associated with increased incidence of reversible and permanent neurologic deficit after TLE surgery. OY-STERS• Cerebral vasospasm after TLE can be demonstrated as focal stenosis on conventional angiography. Triple-H therapy (hypertension, hypervolemia, and hemodilution), intra-arterial vasodilator administration, and angioplasty should be considered in clinically significant cases.CASE REPORT We present a case of a 39-year-old right-handed woman with longstanding pharmacoresistant left TLE who developed new-onset neurologic deficits 2 weeks after a left anteromedial temporal lobe resection. The patient started having seizures at 26 years of age. Seizures manifested as déjà vu sensation followed by staring and unresponsiveness and right upper extremity jerking lasting 2-3 minutes. These occurred daily with occasional evolution to bilateral convulsions. She was on multiple antiepileptic medications including levetiracetam, carbamazepine, and gabapentin and had previously failed valproic acid and phenytoin. MRI brain was consistent with left mesial temporal sclerosis, and FDG-PET showed hypometabolism of the left temporal lobe. Neuropsychology evaluation revealed congruent findings. After presentation at the interdisciplinary epilepsy surgery conference, she underwent a left anteromedial temporal lobe resection. Initial postoperative course was uneventful, and examination revealed expected deficits consisting of a new right superior quadrantanopsia and mild dysnomia. MRI obtained on postoperative day 1 showed expected postsurgical changes following a partial left temporal lobectomy with minimal amount of blood products along the posteromedial resection edge.On postoperative day 14, the patient developed acute right upper motor neuron facial weakness and global aphasia. No other new weakness, numbness, or visual disturbances were identified. MRI revealed a subacute left middle cerebral artery (MCA) infarct, and conventional angiography showed multifocal, critical vasospasm in proximal and distal left M1 and the M2-3 segments (figure). The proximal inferior division of the left MCA was nearly occluded. In addition, moderate to severe focal stenosis was present in the distal supraclinoid left internal carotid artery (LICA) and left P2-3 segments. Milrinone 10 mg was infused intra-arterially in the left internal carotid artery, followed by balloon angioplasty throughout the left M1 and LICA. An IV milrinone infusion was continued for 72 hours. She was also given oral nimodipine. Systolic blood pressures were maintained between 140 and 160 mm Hg with IV fluids and vasopressors. Daily transcranial Doppler (TCD) monitoring initially showed elevated left MCA mean flow velocities.CT angiogram repeated after 3 days showed substantial improvement in vasospasm, and TCD velocities normalized. On clinica...

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“…Definitions such as the ILAE definition are necessary, but drug-resistant severe generalized tonic-clonic seizures certainly call for more treatment than drug-resistant focal seizures without objective manifestations. Epilepsy remains a dynamic disease with spontaneous fluctuations in seizure occurrence, which makes it so difficult to determine outcomes (5). The desire to consider just a one-time intervention and report the associated outcome may not fit the nature of the disease (6).…”

Section: Consensus Over Individualism: Validation Of the Ilae Definitmentioning

confidence: 99%

Consensus over Individualism: Validation of the ILAE Definition for Drug Resistant Epilepsy

Jobst¹

2015

Epilepsy Curr

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In Clinical Science Commentary Consensus in Merriam-Webster's dictionary is defined as "a general agreement about something." However, since the introduction of classifications of seizures, epilepsy syndromes, and surgical outcome scales, there seems to be an inability to reach agreement in the epilepsy community about details and wording. To alleviate some of the controversial items, the International League Against Epilepsy (ILAE) has called task forces and published statements to standardize classifications and definitions (1-3). One such statement is the definition for drug-resistant epilepsy (2). However, definitions are of value only if they are practical, usable, and generally accepted. A possible way to assess whether a published medical definition is valid is to evaluate the definition for repeatability, consistency, and practicability in daily medical care. The above study by Tellez-Zenteno et al. attempts to validate the ILAE definition for drug-resistant epilepsy and compares the ILAE definition to previously published definitions by individual authors. In short, the ILAE defines drug-resistant as "failure of adequate trials of two tolerated and appropriately chosen AED schedules (whether as monotherapies or in combination) to achieve seizure freedom" (2). The authors find that the ILAE

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Resective Epilepsy Surgery for Drug-Resistant Focal Epilepsy

Cited by 522 publications

References 64 publications

Factors affecting seizure outcome after epilepsy surgery: an observational series

Factors affecting seizure outcome after epilepsy surgery: an observational series

Pearls & Oy-sters: Symptomatic cerebral vasospasm on conventional angiography following temporal lobe epilepsy surgery

Consensus over Individualism: Validation of the ILAE Definition for Drug Resistant Epilepsy

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