The concept of temporal ‘plus’ epilepsy

Kahane, Philippe; Barba, Carmen; Rheims, Sylvain; Job-Chapron, A.S.; Minotti, Lorella; Ryvlin, Philippe

doi:10.1016/j.neurol.2015.01.562

Cited by 39 publications

(33 citation statements)

References 44 publications

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“…IEEG is unwarranted when it is not expected to change the surgical plan such as in typical cases of hypothalamic hamartoma or hemispheric syndromes with no hemispheric functions. The temporal lobe cases are usually related to differentiating mesial from neocortical involvement, or they extend beyond the temporal lobe, 30 or the side of seizure onset in patients with bilateral temporal epilepsy. The need to obtain the added information must be weighed against the limitations, risks, and costs associated with IEEG studies.…”

Section: General Indicationsmentioning

confidence: 99%

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

et al. 2016

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Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.

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Section: General Indicationsmentioning

confidence: 99%

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

et al. 2016

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“…Although patients with TLE and neuroradiological evidence of hippocampal sclerosis have improved postsurgical outcomes relative to patients with TLE and no MRI lesion (Berkovic et al , 1995; McIntosh et al , 2004), between two-thirds and one-half of patients with hippocampal sclerosis will experience postoperative seizures (Berkovic et al , 1995; Janszky et al , 2005). Current suggestions for why these persistent postoperative seizures occur include a combination of insufficient resection of mesial temporal lobe tissue (Bonilha et al , 2004; Bonilha and Keller, 2015), mesial temporal lobe pathology existing outside the margins of resection (Babb et al , 1984; Holmes et al , 2000; Prasad et al , 2003; Keller et al , 2007), contralateral temporal lobe seizure involvement (Hennessy et al , 2000; Lin et al , 2005; Keller et al , 2007), occult extra-temporal lobe involvement, including temporal-plus epilepsy (Sisodiya et al , 1997; Ryvlin and Kahane, 2005; Kahane et al , 2015; Barba et al , 2016), structural network alterations (Bonilha et al , 2015; Keller et al , 2015 b ), and atypical subtypes of TLE that may be particularly resistant to conventional temporal lobe surgery (Blumcke et al , 2007; Thom et al , 2010; Bonilha et al , 2012). The development of predictive biomarkers for the future success of surgical intervention in epilepsy represents an important research endeavour, particularly as a reliable prognostic marker could inform patient clinical management and surgical decision-making.…”

Section: Introductionmentioning

confidence: 99%

Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy

Keller

Glenn

Weber

et al. 2016

Brain

105

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“…It is clear that the notion of focality is too simplistic to suit the variety of temporal lobe seizure generators, and the concept of 'epileptogenic network' has been developed to account for the complex spatial organization of several distinct cortical areas generating seizures [5]. On this basis, we aim to analyze anatomoelectrical features of IOPs and extratemporal EPs in atypical TLE, and to evaluate their impact on the seizure status and cognitive outcomes after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…They used TPE to indicate both an ictal discharges originating simultaneously from the temporal lobe and the neighboured extratemporal structures, or two coexisting seizure types in the same patient, with temporal and extratemporal ictal onset, respectively [5].…”

Section: Grouping Methodsmentioning

confidence: 99%

“…The spectrum of TLE includes many subdivisions, from the focal mesiotemporal subtype, the temporopolar subtype, the mesiolateral subtype, the lateral subtype to the widely extended temporal plus epilepsy (TPE) subtype [5]. The patients with the EZs localized in the anterior temporal lobe may have better clinical outcomes after ALT, but those with TPE may not have [6].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Prognosis of Surgical Treatment in Atypical Temporal Lobe Epilepsy-A Study Based on Ictal Onset Patterns and Extratemporal Early Propagations on Stereo-Electroencephalography

Wang¹,

Li²,

Wang³

et al. 2017

Neuropsychiatry

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Purpose:Our aim is to examine ictal onset patterns (IOPs), extratemporal early propagations (EPs) and inner relationship between them based on stereo-electroencephalography recordings in the patients with atypical temporal lobe epilepsy, and to evaluate their impact on seizure prognosis and cognitive outcomes after epilepsy surgery. Methods:Forty-three patients were included in this retrospective study. Five to sixteen multilead electrodes were implanted per patient. All of them underwent a standard craniotomy for tailored resection of the hypothetical epileptogenic zone. Post-operative seizure status and cognitive outcomes were evaluated by Engle's classification, Wechsler intelligence and Wechsler memory scale. Results:Four types of IOPs were identified in the 43 patients. The patients with low frequency highamplitude periodic spikes (LFPS) and spike or poly-spike fast discharges (SpFD) had better seizure outcomes. There were ten patients with extratemporal EPs, who had worse clinical outcomes than those without extratemporal EPs (Engel's class I: χ2 =10.689, p=0.001; Engel's class Ia: χ2 =4.251, p=0.039). Three conditions related to IOPs and extratemporal EPs were combined to predict the seizure prognosis after operation. The sensitivity and specificity were 90.0% and 78.6% for Engel's class I, and were 87.0% and 55.0% for Engel's class Ia. The patients with LFPS showed more significant improvement in memory quotient (MQ) but not in full intelligence quotient (FIQ) than those with other IOPs. Conclusions:IOPs and extratemporal EPs are closely related to seizure status and cognitive outcomes after epilepsy surgery in atypical TLE patients.

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The concept of temporal ‘plus’ epilepsy

Cited by 39 publications

References 44 publications

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy

Evaluating the Prognosis of Surgical Treatment in Atypical Temporal Lobe Epilepsy-A Study Based on Ictal Onset Patterns and Extratemporal Early Propagations on Stereo-Electroencephalography

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