Surgery for epilepsy

West, Siobhan; Nolan, Sarah J; Cotton, Jennifer; Gandhi, Sacha E; Weston, Jennifer; Sudan, Ajay; Ramírez, Roberto; Newton, Richard

doi:10.1002/14651858.cd010541.pub2

Cited by 146 publications

(127 citation statements)

References 271 publications

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“…A review17 reported that ‘55%–70% of individuals undergoing temporal resection and 30%–50% undergoing extratemporal resection become completely seizure-free’, although the difference was less marked in their own analysis (62% ‘good’ outcome—which includes >1 year seizure free—for extratemporal resection and 69% for temporal). In contrast, using survival analysis, we found that at 5 years 33% remained seizure free in the extratemporal group compared with 52% in the temporal group (table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Other studies using outcome at specific time points found no effect of lesional versus non-lesional epilepsy (largely HS)15 or of pathology (normal, gliosis or atrophy, hamartomas, arteriovenous malformations, non-specific) almost 30 years postsurgery 16. A review of surgery for epilepsy found that an abnormal MRI was associated with better outcome 17. In conclusion, the weight of evidence is that if a discrete MRI-visible pathology, particularly HS, is resected, the chances of long-term remission is better than if the MRI is normal.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Comparing epilepsy surgery outcome between studies is challenging, because different outcome measures have been used 1 25. We only counted patients completely seizure free since surgery (Engel class IA).…”

Section: Discussionmentioning

confidence: 99%

“…For this study, outcome data 24 months after operation were used because changes in seizure frequency before this time-period occur frequently 24. Seizure freedom was rigorously defined as ‘no seizures and no auras since discharge from the hospital after surgery’, that is, Engel class IA23 for reasons detailed recently10 and to avoid inconsistencies across studies due to different outcome scores 1 25…”

Section: Methodsmentioning

confidence: 99%

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Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes

Cloppenborg

May

Blümcke³

et al. 2016

J Neurol Neurosurg Psychiatry

120

116

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Introduction Despite the success of epilepsy surgery, recent reports suggest a decline in surgical numbers. We tested these trends in our cohort to elucidate potential reasons. Patients and methods Presurgical, surgical and postsurgical data of all patients undergoing presurgical evaluation in between 1990 and 2013 were retrospectively analysed. Patients were grouped according to the underlying pathology. Results A total of 3060 patients were presurgically studied, and resective surgery was performed in 66.8% (n=2044) of them: medial temporal sclerosis (MTS): n=675, 33.0%; benign tumour (BT): n=408, 20.0%; and focal cortical dysplasia (FCD): n=284, 13.9%. Of these, 1929 patients (94.4%) had a follow-up of 2 years, and 50.8% were completely seizure free (Engel IA). Seizure freedom rate slightly improved over time. Presurgical evaluations continuously increased, whereas surgical interventions did not. Numbers for MTS, BT and temporal lobe resections decreased since 2009. The number of non-lesional patients and the need for intracranial recordings increased. More evaluated patients did not undergo surgery (more than 50% in 2010-2013) because patients were not suitable (mainly due to missing hypothesis:

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Association of Seizure Spread With Surgical Failure in Epilepsy

et al. 2019

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IMPORTANCE Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. OBJECTIVE To characterize features of surgically refractory TLE. DESIGN, SETTING, AND PARTICIPANTS Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015. Thirteen patients were excluded for having less than 1 year of follow-up. Patients at the highest risk for seizure recurrence were identified. Intracranial electroencephalogram (iEEG) analyses generated 3-dimensional seizure spread representations and quantified rapid seizure spread. The final analyses of seizure outcome and follow-up data were performed in June 2017. MAIN OUTCOMES AND MEASURES The Engel class seizure outcome following surgery was evaluated for all patients, defining seizure recurrence as Engel class II or greater. Intracranial recordings of neocortical grids/strips and depth electrodes were analyzed visually for seizure spread. Fast β power was projected onto reconstructions of patients' brain magnetic resonance imaging scans to visualize spread patterns and was quantified to compare power within vs outside resective margins. RESULTS Of 118 patients with 1 year of follow-up or more (mean [SD], 6.5 [4.6] years), 66 (55.9%) were women and 52 (44.1%) were men (median age, 39 years [range, 4-66 years]). The cumulative probability of continuous Engel class I seizure freedom since surgery at postoperative year 10 and afterward was 65.6%, with 92% of recurrences in years 1 to 3. Multivariable statistical analyses found that the selection for iEEG study was the most reliable predictor of seizure recurrence, with a mixed-effects model estimating that the Engel score in the iEEG cohort was higher by a mean (SD) of 1.1 (0.33) (P = .001). In patients with iEEG results, rapid seizure spread in less than 10 seconds was associated with recurrence (hazard ratio, 5.99; 95% CI, 1.7-21.1; P < .01). In the first 10 seconds of seizures, fast β power activity outside the resective margins in the lateral temporal cortex was significantly greater in patients whose seizures recurred compared with patients who were seizure-free (mean [SEM], 137.5% [16.8%] vs 93.4% [4.6%]; P < .05). CONCLUSIONS AND SIGNIFICANCE Rapid seizure spread outside anteromedial temporal resection resective margins plays a significant role in the surgical failure of drug-resistant TLE. Seizure control after epilepsy surgery might be improved by investigating areas of early spread as candidates for resection or neuromodulation.

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Surgery for epilepsy

Cited by 146 publications

References 271 publications

Factors affecting seizure outcome after epilepsy surgery: an observational series

Factors affecting seizure outcome after epilepsy surgery: an observational series

Trends in epilepsy surgery: stable surgical numbers despite increasing presurgical volumes

Association of Seizure Spread With Surgical Failure in Epilepsy

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