Surgical Treatment of Extratemporal Epilepsy: Clinical, Radiologic, and Histopathologic Findings in 60 Patients

Zentner, Josef; Hufnagel, A.; Ostertun, B.; Wolf, Helmut K.; Behrens, Elga; Campos, Manuel; Solymosi, L.; Elger, Christian E.; Wiestler, Otmar D.; Schramm, Johannes

doi:10.1111/j.1528-1157.1996.tb01027.x

Cited by 168 publications

(121 citation statements)

References 26 publications

(12 reference statements)

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“…Conversely, in cases of extra-TLE, the degree of clinical correlations was clearly better with MRI than EEG, and EEG-MRI correlation provided another basis for the syndromic diagnosis, also superior to the clinical-EEG correlation. Thus MRI seemed to be an invaluable addition to ICEES for the topographic diagnosis of extra-TLE, a finding in good agreement with the results of presurgical evaluations of intractable neocortical epilepsies (16,27,28). However, the topographic diagnosis of extra-TLE was still problematic, even with the incorporation of MRI, as evidenced by the absence of any concordance among the three correlations in 42% of patients and a <50% detection rate of lesions by MRI.…”

Section: Discussionsupporting

confidence: 52%

“…Over the past decade, magnetic resonance imaging (MRI) has exerted a great impact on the practice of epilepsy management. MRI may detect lesions in 50% to 74% of patients with LE attending an epilepsy clinic (17,18), and the presence of lesions in MRI may provide reliable evidence of seizure origin as well as other important clinical information such as etiology, surgical accessibility and outcome, prognosis, or responses to drug therapy (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). However, no attempt to incorporate MRI features into the current ICEES has yet been systematically undertaken.…”

mentioning

confidence: 99%

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Syndromic Diagnosis at the Epilepsy Clinic: Role of MRI in Lobar Epilepsies

Lee¹,

Heo²,

Kim

et al. 2002

Epilepsia

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Summary:Purpose: Magnetic resonance imaging (MRI) is an essential diagnostic tool for the management of epilepsy at modern epilepsy clinics. This study was conducted to incorporate MRI features into the international classification of epilepsies and epilepsy syndromes (ICEES) proposed by the International League Against Epilepsy (ILAE).Methods: Three hundred consecutive patients newly registered in the Yonsei Epilepsy Clinic underwent stepwise classifications based on clinical features, clinical EEG, and clinical EEG-MRI correlations. The patients were required to have epilepsy and have undergone both EEG and MRI for inclusion in the study. Interictal epileptiform discharges (IEDs) in the EEG were divided into lobar, multilobar, and generalized. MRI lesions were divided into lobar and multilobar lesions. Lobar epilepsies (LEs) were divided into temporal, frontal, parietal, occipital, rolandic, temporoparietooccipital junctional, multilobar, and nonlocalized LEs.Results: Two hundred forty-nine patients satisfied the inclusion criteria. In the first-step diagnosis, 190 patients were classified as having localization-related epilepsy; 24 patients, generalized epilepsy; 34 patients, undetermined epilepsy; and one patient, a special syndrome. EEG revealed IEDs in 124 (50%) patients, and the second-step diagnosis changed the diagnostic categories of 79 (32%) patients. MRI detected lesions in 106 (43%) patients, and the third-step diagnosis changed the diagnostic categories of 30 (12%) patients. The nonspecific diagnostic categories of ICEES decreased from 49% to 37% and then to 29%, as diagnosis progressed from steps one to three. In cases of LE, MRI was superior to EEG in its clinical correlation. Additionally, the diagnostic precision in temporal lobe epilepsy was far better than that for other LEs.Conclusions: The impact of MRI on ICEES was only modest in terms of changing diagnostic categories, although MRI provided a structural substrate for epilepsy in 38% of patients with negative EEGs. In LE, MRI was as sensitive as EEG, and its clinical correlation was superior to that of EEG, which strongly supports the rationale of incorporating MRI into ICEES.

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Section: Discussionsupporting

confidence: 52%

mentioning

confidence: 99%

Syndromic Diagnosis at the Epilepsy Clinic: Role of MRI in Lobar Epilepsies

Lee¹,

Heo²,

Kim

et al. 2002

Epilepsia

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“…The proportion of our patients without demonstrated specific lesions (10%) is lower than that in most epilepsy surgical series, possibly because of the strict inclusion criteria of our study and its more recent time span (3)(4)(5)(6)(7)(8)(9)(11)(12)(13)15,16,28,29). Eleven of these reports specifically described pathology; of these, the proportion of all patients with normal or nonspecific pathology ranged from 6 to 58% (median, 20%; average, 25%).…”

Section: Nonlesional Incidence In Surgical Seriesmentioning

confidence: 82%

“…Fourteen epilepsy surgery series (3-16) used MRI and/or histopathology to disclose specific lesions. 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.…”

mentioning

confidence: 83%

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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“…The resection of an epileptogenic lesion within an ictal onset zone (IOZ) is recognized as among the most important factors linked to a favorable surgical outcome [3]. The majority of surgical series have suggested that the presence of a specific lesion usually leads to a favorable surgical outcome [24]. The presence of a lesion increases the likelihood of seizure freedom and thus, brain MRI is relatively good at predicting the prognosis of neocortical epilepsy.…”

Section: Neuropathology In Neocortical Epilepsy: Does Nonlesional Neomentioning

confidence: 99%