Association between temporal lobe P-glycoprotein expression and seizure recurrence after surgery for pharmacoresistant temporal lobe epilepsy

Objective: To assess the seizure outcomes of stereotactic laser amygdalohippocampectomy (SLAH) in consecutive patients with mesial temporal lobe epilepsy (mTLE) in a single center and identify scalp EEG and imaging factors in the presurgical evaluation that correlate with post-surgical seizure recurrence.Methods: We retrospectively reviewed the medical and EEG records of 30 patients with drug-resistant mTLE who underwent SLAH and had at least 1 year of follow-up. Surgical outcomes were classified using the Engel scale. Univariate hazard ratios were used to evaluate the risk factors associated with seizure recurrence after SLAH.Results: The overall Engel class I outcome after SLAH was 13/30 (43%), with a mean postoperative follow-up of 48.9 ± 17.6 months. Scalp EEG findings of interictal regional slow activity (IRSA) on the side of surgery (HR = 4.05, p = 0.005) and non-lateralizing or contra-lateralizing seizure onset (HR = 4.31, p = 0.006) were negatively correlated with postsurgical seizure freedom. Scalp EEG with either one of the above features strongly predicted seizure recurrence after surgery (HR = 7.13, p < 0.001) with 100% sensitivity and 71% specificity.Significance: Understanding the factors associated with good or poor surgical outcomes can help choose the best candidates for SLAH. Of the variables assessed, scalp EEG findings were the most clearly associated with seizure outcomes after SLAH.

Download Full-text

Reassessing the impact of intraoperative electrocorticography on postoperative outcome of patients undergoing standard temporal lobectomy for MRI-negative temporal lobe epilepsy

Journal of Neurosurgery ◽

10.3171/2018.11.jns182124 ◽

2020 ◽

Vol 132 (2) ◽

pp. 605-614 ◽

Cited By ~ 3

Author(s):

Sanjeet S. Grewal ◽

Mohammed Ali Alvi ◽

William J. Perkins ◽

Gregory D. Cascino ◽

Jeffrey W. Britton ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Univariate Analysis ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Incomplete Resection ◽

Seizure Recurrence ◽

Cox Regression Analysis ◽

Epileptiform Discharges ◽

The Impact

OBJECTIVEAlmost 30% of the patients with suspected temporal lobe epilepsy (TLE) have normal results on MRI. Success rates for resection of MRI-negative TLE are less favorable, ranging from 36% to 76%. Herein the authors describe the impact of intraoperative electrocorticography (ECoG) augmented by opioid activation and its effect on postoperative seizure outcome.METHODSAdult and pediatric patients with medically resistant MRI-negative TLE who underwent standardized ECoG at the time of their elective anterior temporal lobectomy (ATL) with amygdalohippocampectomy between 1990 and 2016 were included in this study. Seizure recurrence comprised the primary outcome of interest and was assessed using Kaplan-Meier and multivariable Cox regression analysis plots based on distribution of interictal epileptiform discharges (IEDs) recorded on scalp electroencephalography, baseline and opioid-induced IEDs on ECoG, and extent of resection.RESULTSOf the 1144 ATLs performed at the authors’ institution between 1990 and 2016, 127 (11.1%) patients (81 females) with MRI-negative TLE were eligible for this study. Patients with complete resection of tissue generating IED recorded on intraoperative ECoG were less likely to have seizure recurrence compared to those with incomplete resection on univariate analysis (p < 0.05). No difference was found in seizure recurrence between patients with bilateral independent IEDs and unilateral IEDs (p = 0.15), presence or absence of opioid-induced epileptiform activation (p = 0.61), or completeness of resection of tissue with opioid-induced IEDs on intraoperative ECoG (p = 0.41).CONCLUSIONSThe authors found that incomplete resection of IED-generating tissue on intraoperative ECoG was associated with an increased chance of seizure recurrence. However, they found that induction of epileptiform activity with intraoperative opioid activation did not provide useful intraoperative data predictive of improving operative results for temporal lobectomy in MRI-negative epilepsy.

Download Full-text

Pluronic P85-coated poly(butylcyanoacrylate) nanoparticles overcome phenytoin resistance in P-glycoprotein overexpressing rats with lithium-pilocarpine-induced chronic temporal lobe epilepsy

Biomaterials ◽

10.1016/j.biomaterials.2016.04.021 ◽

2016 ◽

Vol 97 ◽

pp. 110-121 ◽

Cited By ~ 16

Author(s):

Ziyan Fang ◽

Shuda Chen ◽

Jiaming Qin ◽

Bao Chen ◽

Guanzhong Ni ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

P Glycoprotein ◽

Pluronic P85

Download Full-text

Leukocyte Infiltration Triggers Seizure Recurrence in a Rat Model of Temporal Lobe Epilepsy

Inflammation ◽

10.1007/s10753-016-0340-4 ◽

2016 ◽

Author(s):

Zanhua Liu ◽

Suping Wang ◽

Jinjie Liu ◽

Feng Wang ◽

Yi Liu ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Rat Model ◽

Leukocyte Infiltration ◽

Seizure Recurrence

Download Full-text

Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140199 ◽

2015 ◽

Vol 73 (2) ◽

pp. 79-82 ◽

Cited By ~ 10

Author(s):

Ana Carolina Coan ◽

Brunno M. Campos ◽

Felipe P.G Bergo ◽

Bruno Y. Kubota ◽

Clarissa L. Yasuda ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Similar Proportion ◽

Seizure Freedom ◽

Seizure Recurrence ◽

Prolonged Seizure ◽

Mesial Temporal Lobe

Objective Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis. Method We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50). Relapse-remitting pattern was defined as periods longer than two years of seizure-freedom intercalated with seizure recurrence. “Infrequent seizures” was considered as up to three seizures per year and “frequent seizures” as any period of seizures higher than that. Results Thirty-seven (30%) MTLE-HS and 18 (36%) MTLE-NL patients had relapse-remitting pattern (X2, p = 0.470). This was more common in those with infrequent seizures (X2, p < 0.001). Twelve MTLE-HS and one MTLE-NL patients had prolonged seizure remission between the first and second decade of life (X2, p = 0.06). Conclusion Similar proportion of MTLE-HS or MTLE-NL patients present relapse-remitting seizures and this occurs more often in those with infrequent seizures.

Download Full-text