Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis

Background: Epilepsy is a common serious neurological condition and 30 to 40 % of people with epilepsy have seizures that are not controlled by medication. Patients are considered to have drug resistant epilepsy if disabling seizures continue despite appropriate trials of two anti-epileptic drugs. Most lesions causing drug resistant epilepsy can be detected by 3T MR Imaging using dedicated epilepsy protocol which is crucial for diagnostic and subsequent therapeutic planning with benefit from surgery. We present a review of the major abnormalities related to drug resistant epilepsy, highlighting the key findings of 3 T MRI.Methods: A Cross-sectional Observational study was done in 30 patients. Patients less than 60 yrs of age of either sex, diagnosed with DRE as per ILAE criteria, were included in the study. 3T MRI was performed using dedicated epilepsy protocol, with additional 3D imaging for manual hippocampal volumetric evaluation.Results: About 77% cases showed an MRI abnormality on visual assessment, with additional 16% cases showing abnormal MRI findings on manual hippocampal volumetry. Nearly 50% of the abnormal MRI cases showed Mesial Temporal Sclerosis, followed by neoplasms as etiology of DRE.Conclusions: MR imaging has significantly improved detection of pathologies related to epilepsy, especially with the advent of epilepsy protocol. The total percentage of MRI abnormalities increased after incorporating manual hippocampal volumetry.

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Graph theory for EEG: can we learn to trust another black box?

Brain ◽

10.1093/brain/awz369 ◽

2019 ◽

Vol 142 (12) ◽

pp. 3663-3666

Author(s):

Garnett C Smith ◽

William C Stacey

Keyword(s):

Graph Theory ◽

Surgical Outcome ◽

Black Box ◽

Drug Resistant ◽

Drug Resistant Epilepsy

This scientific commentary refers to ‘Virtual resection predicts surgical outcome for drug-resistant epilepsy’ by Kini et al. (doi:10.1093/brain/awz303).

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Drug resistant epilepsy with mesial temporal sclerosis as possible late neurological complication in two AML survivors after stem cell transplantation

Epilepsy & Behavior Case Reports ◽

10.1016/j.ebcr.2018.05.001 ◽

2018 ◽

Vol 10 ◽

pp. 71-77

Author(s):

Kwan-Ming Karen Yam ◽

Wing-Kwan Alex Leung ◽

Xian-Lun Zhu ◽

Lai-Wah Eva Fung

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Neurological Complication ◽

Mesial Temporal Sclerosis ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Resection of ictal high frequency oscillations is associated with favorable surgical outcome in pediatric drug resistant epilepsy secondary to tuberous sclerosis complex

Epilepsy Research ◽

10.1016/j.eplepsyres.2016.07.005 ◽

2016 ◽

Vol 126 ◽

pp. 90-97 ◽

Cited By ~ 12

Author(s):

Hisako Fujiwara ◽

James L. Leach ◽

Hansel M. Greiner ◽

Katherine D. Holland-Bouley ◽

Douglas F. Rose ◽

...

Keyword(s):

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Surgical Outcome ◽

High Frequency ◽

Drug Resistant ◽

Pediatric Drug ◽

High Frequency Oscillations ◽

Drug Resistant Epilepsy

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Categorizing cortical dysplasia lesions for surgical outcome using network functional connectivity

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds20990 ◽

2021 ◽

pp. 1-9

Author(s):

Abdullah S. Bdaiwi ◽

Hansel M. Greiner ◽

James Leach ◽

Francesco T. Mangano ◽

Mark W. DiFrancesco

Keyword(s):

Functional Connectivity ◽

Surgical Outcomes ◽

Surgical Outcome ◽

Network Connectivity ◽

Cortical Dysplasia ◽

Lesion Volume ◽

Healthy Children ◽

Drug Resistant ◽

Drug Resistant Epilepsy ◽

The Impact

OBJECTIVE Focal cortical dysplasia (FCD) is often associated with drug-resistant epilepsy, leading to a recommendation to surgically remove the seizure focus. Predicting outcome for resection of FCD is challenging, requiring a new approach. Lesion-symptom mapping is a powerful and broadly applicable method for linking neurological symptoms or outcomes to damage to particular brain regions. In this work, the authors applied lesion network mapping, an expansion of the traditional approach, to search for the association of lesion network connectivity with surgical outcomes. They hypothesized that connectivity of lesion volumes, preoperatively identified by MRI, would associate with seizure outcomes after surgery in a pediatric cohort with FCD. METHODS This retrospective study included 21 patients spanning the ages of 3 months to 17.7 years with FCD lesions who underwent surgery for drug-resistant epilepsy. The mean brain-wide functional connectivity map of each lesion volume was assessed across a database of resting-state functional MRI data from healthy children (spanning approximately 2.9 to 18.9 years old) compiled at the authors’ institution. Lesion connectivity maps were averaged across age and sex groupings from the database and matched to each patient. The authors sought to associate voxel-wise differences in these maps with subject-specific surgical outcome (seizure free vs persistent seizures). RESULTS Lesion volumes with persistent seizures after surgery tended to have stronger connectivity to attention and motor networks and weaker connectivity to the default mode network compared with lesion volumes with seizure-free surgical outcome. CONCLUSIONS Network connectivity–based lesion-outcome mapping may offer new insight for determining the impact of lesion volumes discerned according to both size and specific location. The results of this pilot study could be validated with a larger set of data, with the ultimate goal of allowing examination of lesions in patients with FCD and predicting their surgical outcomes.

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