scholarly journals The delta between postoperative seizure freedom and persistence: Automatically detected focal slow waves after epilepsy surgery

2017 ◽  
Vol 13 ◽  
pp. 256-263 ◽  
Author(s):  
Margit Schönherr ◽  
Hermann Stefan ◽  
Hajo M. Hamer ◽  
Karl Rössler ◽  
Michael Buchfelder ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Slow Waves ◽  
Seizure Freedom ◽  
Postoperative Seizure

scholarly journals Scalp and Intracranial EEG in Medically Intractable Extratemporal Epilepsy with Normal MRI

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Tarek Zakaria ◽  
Katherine Noe ◽  
Elson So ◽  
Gregory D. Cascino ◽  
Nicholas Wetjen ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Favorable Outcome ◽  
Rank Test ◽  
Seizure Freedom ◽  
Intracranial Eeg ◽  
Scalp Eeg ◽  
Kaplan Meier ◽  
Postoperative Seizure ◽  
Beta Frequency

Purpose. To investigate EEG and SPECT in the surgical outcome of patients with normal MRI (nonlesional) and extratemporal lobe epilepsy. Methods. We retrospectively identified 41 consecutive patients with nonlesional extratemporal epilepsy who underwent epilepsy surgery between 1997 and 2007. The history, noninvasive diagnostic studies (scalp EEG, MRI, and SPECT) and intracranial EEG (iEEG) monitoring was reviewed. Scalp and iEEG ictal onset patterns were defined. The association of preoperative studies and postoperative seizure freedom was analyzed using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard. Results. Thirty-six of 41 patients had adequate information with a minimum of 1-year followup. Favorable surgical outcome was identified in 49% of patients at 1 year, and 35% at 4-year. On scalp EEG, an ictal onset pattern consisting of focal beta-frequency discharge (>13–125 Hz) was associated with favorable surgical outcome (P=0.02). Similarly, a focal fast-frequency oscillation (>13–125 Hz) on iEEG at ictal onset was associated with favorable outcome (P=0.03). Discussion. A focal fast-frequency discharge at ictal onset identifies nonlesional MRI, extratemporal epilepsy patients likely to have a favorable outcome after resective epilepsy surgery.

scholarly journals Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China

Brain ◽  
2020 ◽  
Vol 143 (2) ◽  
pp. 570-581 ◽  
Author(s):  
Shiyong Liu ◽  
Tao Yu ◽  
Yuguang Guan ◽  
Kai Zhang ◽  
Ping Ding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Tuberous Sclerosis Complex ◽  
Intelligence Quotient ◽  
Influence Factors ◽  
Seizure Freedom ◽  
Postoperative Seizure

Abstract At least 50% of patients with tuberous sclerosis complex present with intractable epilepsy; for these patients, resective surgery is a treatment option. Here, we report a nationwide multicentre retrospective study and analyse the long-term seizure and neuropsychological outcomes of epilepsy surgery in patients with tuberous sclerosis complex. There were 364 patients who underwent epilepsy surgery in the study. Patients’ clinical data, postoperative seizure outcomes at 1-, 4-, and 10-year follow-ups, preoperative and postoperative intelligence quotients, and quality of life at 1-year follow-up were collected. The patients’ ages at surgery were 10.35 ± 7.70 years (range: 0.5–47). The percentage of postoperative seizure freedom was 71% (258/364) at 1-year, 60% (118/196) at 4-year, and 51% (36/71) at 10-year follow-up. Influence factors of postoperative seizure freedom were the total removal of epileptogenic tubers and the presence of outstanding tuber on MRI at 1- and 4-year follow-ups. Furthermore, monthly seizure (versus daily seizure) was also a positive influence factor for postoperative seizure freedom at 1-year follow-up. The presence of an outstanding tuber on MRI was the only factor influencing seizure freedom at 10-year follow-up. Postoperative quality of life and intelligence quotient improvements were found in 43% (112/262) and 28% (67/242) of patients, respectively. Influence factors of postoperative quality of life and intelligence quotient improvement were postoperative seizure freedom and preoperative low intelligence quotient. The percentage of seizure freedom in the tuberectomy group was significantly lower compared to the tuberectomy plus and lobectomy groups at 1- and 4-year follow-ups. In conclusion, this study, the largest nationwide multi-centre study on resective epilepsy surgery, resulted in improved seizure outcomes and quality of life and intelligence quotient improvements in patients with tuberous sclerosis complex. Seizure freedom was often achieved in patients with an outstanding tuber on MRI, total removal of epileptogenic tubers, and tuberectomy plus. Quality of life and intelligence quotient improvements were frequently observed in patients with postoperative seizure freedom and preoperative low intelligence quotient.

Epilepsy surgery for Rasmussen encephalitis: the UCLA experience

2020 ◽  
Vol 26 (4) ◽  
pp. 389-397
Author(s):  
Nikhil Bellamkonda ◽  
H. Westley Phillips ◽  
Jia-Shu Chen ◽  
Alexander M. Tucker ◽  
Cassia Maniquis ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Outcome Data ◽  
Seizure Freedom ◽  
Rasmussen Encephalitis ◽  
Seizure Recurrence ◽  
Functional Hemispherectomy ◽  
Significant Difference ◽  
Seizure Relapse ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure

OBJECTIVERasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent epilepsy surgery for RE at a single institution.METHODSThe records of consecutive patients who had undergone epilepsy surgery for RE at the UCLA Mattel Children’s Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed.RESULTSThe cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after surgery was 39 weeks (IQR 11–355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric surgery. Following surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention.CONCLUSIONSA large proportion of RE patients will have seizure relapse after surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric surgery can be seen as palliative treatment for seizures rather than a cure for RE.

scholarly journals The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

2016 ◽  
Vol 40 (3) ◽  
pp. E16 ◽  
Author(s):  
Matthew F. Sacino ◽  
Cheng-Ying Ho ◽  
Jonathan Murnick ◽  
Robert F. Keating ◽  
William D. Gaillard ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Neurological Deficit ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Resection Group ◽  
Eloquent Cortex ◽  
Postoperative Seizure

OBJECTIVE Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale. RESULTS At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02). CONCLUSIONS These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.

Preoperative Epilepsy Network Distribution Correlates With Seizure Recurrence Following Epilepsy Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Long Di ◽  
Elliot G Neal ◽  
Stephanie Maciver ◽  
Fernando L Vale
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Demographic Data ◽  
Brain Network ◽  
Patient Specific ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Postoperative Seizure ◽  
Epileptic Networks

Abstract INTRODUCTION Surgery remains an essential option for the treatment of medically intractable temporal lobe epilepsy. However, only 66% of patients achieve postoperative seizure freedom, perhaps attributable to an incomplete understanding of brain network alterations in surgical candidates. Here, we present a novel network modeling algorithm that may be used to identify key characteristics of epileptic networks correlated with improved surgical outcome. METHODS Twenty-nine patients were prospectively included, and relevant demographic information was attained. Resting-state functional magnetic resonance imaging (MRI) and electroencephalography (EEG) data were recorded and preprocessed. Using our novel algorithm, patient-specific epileptic networks were mapped preoperatively and geographic spread was quantified. Global functional connectivity was also determined using a volumetric functional atlas. Key demographic data and features of epileptic networks were then correlated with surgical outcome using Pearson's product-moment correlation. RESULTS At an average follow-up of 19 mo, 20/29 (69%) patients were seizure-free. Higher rates of seizure recurrence correlated with the localization of the epilepsy network to either temporal lobe (R = –0.415, P = .039), with the stronger correlation found with the localization to the contralateral temporal lobe (R = –0.566, P = .003). When the volumetric functional atlas connectivity was measured, increased connectivity globally was correlated with seizure recurrence (R = –0.541, P = .006). Seizure recurrence also correlated with greater atlas-based connectivity within the contralateral hemisphere (R = –0.390, P = .049). CONCLUSION Network localization to the temporal lobes, in particular the contralateral temporal lobe, and increased atlas-defined connectivity contralateral to the surgery side are associated with seizure recurrence. These findings may reflect network-level disruption that has infiltrated the contralateral temporal lobe contributing to relatively worse surgical outcomes. Further identification of network parameters that predict patient outcomes may aid in patient selection, resection planning, and ultimately the efficacy of epilepsy surgery.

scholarly journals Epilepsy Surgery in Children and Adolescents

2017 ◽  
Vol 1 (02) ◽  
pp. E86-E97
Author(s):  
Georgia Ramantani ◽  
Josef Zentner
Keyword(s):  
Children And Adolescents ◽  
Epilepsy Surgery ◽  
Focal Cortical Dysplasia ◽  
Neurological Deficits ◽  
Epilepsy Syndrome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Presurgical Evaluation ◽  
Effective Treatment Option ◽  
Postoperative Seizure

AbstractEpilepsy surgery has been established in recent years as an effective treatment option for children and adolescents with pharmacoresistant structural epilepsies. Thanks to advances in neurosurgery, anesthesia and intensive care, epilepsy surgery is also possible in infants with excellent results. Epilepsy surgery should be considered in children with structural epilepsies and presurgical evaluation should be initiated at the latest when the criteria for pharmacoresistance are met. Focal cortical dysplasia and glioneuronal tumors are the most common etiologies in pediatric cohorts. Postoperative seizure-freedom depends on completeness of resection. In childhood, multilobular and hemispheric interventions predominate, whereas adults commonly undergo temporal resections. The extent of resections decreases with age. Younger children often require larger resections, but have higher capacities to compensate for neurological deficits, due to functional plasticity. Postoperative seizure freedom depends on the epilepsy syndrome, underlying etiology and accurate demarcation of the epileptogenic zone. Postoperatively, two-thirds of the children remain seizure-free in the long-term. Significant improvements in cognitive development are observed with seizure control. In addition to the development of non-invasive methods for presurgical evaluation, it is crucial to reduce the latency between the establishment of pharmacoresistance, presurgical evaluation and surgical treatment in suitable candidates. Multicentric studies with longer observation intervals are urgently needed in order to identify predictors of seizure freedom and favorable developmental trajectories, to facilitate the selection of optimal candidates and to improve counseling of patients and their families.

A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies

2020 ◽  
Vol 133 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Anthony T. Lee ◽  
John F. Burke ◽  
Pranathi Chunduru ◽  
Annette M. Molinaro ◽  
Robert Knowlton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Meta Analysis ◽  
Small Sample ◽  
Seizure Freedom ◽  
Level I ◽  
Study Designs ◽  
Medically Refractory Epilepsy

OBJECTIVERecent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions.METHODSThe authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012–April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort.RESULTSThe overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2< 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93–29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni’s multiple comparison test).CONCLUSIONSThe overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.

scholarly journals Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

2021 ◽  
Author(s):  
Valeri Borger ◽  
Motaz Hamed ◽  
Inja Ilic ◽  
Anna-Laura Potthoff ◽  
Attila Racz ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Temporal Lobectomy ◽  
Secondary Outcome ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Secondary Outcome Measure ◽  
Total Resection ◽  
Class 1 ◽  
Postoperative Seizure ◽  
The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

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