Tailoring of Cortical Excisions for Frontal Lobe Epilepsy

ABSTRACT:Follow-up data of 2 to 49 years' duration are presented on 257 patients with cortical excisions for non-tumoral frontal lobe epilepsy. Twenty-six percent have become and remained seizure free. Another 30% have had a marked reduction of seizure tendency. Thus a total of 56% have had a long term complete or marked reduction of seizure tendency after the cortical resection. The cortical resections were classified into 5 regional categories. Forty-seven percent of patients with anterior frontal resections were in the seizure free category, as were 35% of patients with excisions limited to the convexity cortex and 32% of patients with maximal or near maximal frontal lobectomy. Only 18% of patients with frontal parasaggital excisions were in the seizure free category, and 10% of the patients who had excision of frontal cortex plus limited excision of adjacent central and/or temporal cortex.

Download Full-text

Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2012.1.jns111620 ◽

2012 ◽

Vol 116 (5) ◽

pp. 1042-1048 ◽

Cited By ~ 77

Author(s):

Dario J. Englot ◽

Doris D. Wang ◽

John D. Rolston ◽

Tina T. Shih ◽

Edward F. Chang

Keyword(s):

Systematic Review ◽

Frontal Lobe ◽

Focal Epilepsy ◽

Meta Analysis ◽

Epileptic Focus ◽

Epilepsy Syndrome ◽

Frontal Lobe Epilepsy ◽

Seizure Freedom

Object Frontal lobe epilepsy (FLE) is the second-most common focal epilepsy syndrome, and seizures are medically refractory in many patients. Although various studies have examined rates and predictors of seizure freedom after resection for FLE, there is significant variability in their results due to patient diversity, and inadequate follow-up may lead to an overestimation of long-term seizure freedom. Methods In this paper the authors report a systematic review and meta-analysis of long-term seizure outcomes and predictors of response after resection for intractable FLE. Only studies of at least 10 patients examining seizure freedom after FLE surgery with postoperative follow-up duration of at least 48 months were included. Results Across 1199 patients in 21 studies, the overall rate of postoperative seizure freedom (Engel Class I outcome) was 45.1%. No trend in seizure outcomes across all studies was observed over time. Significant predictors of long-term seizure freedom included lesional epilepsy origin (relative risk [RR] 1.67, 95% CI 1.36–28.6), abnormal preoperative MRI (RR 1.64, 95% CI 1.32–2.08), and localized frontal resection versus more extensive lobectomy with or without an extrafrontal component (RR 1.71, 95% CI 1.26–2.43). Within lesional FLE cases, gross-total resection led to significantly improved outcome versus subtotal lesionectomy (RR 1.99, 95% CI 1.47–2.84). Conclusions These findings suggest that FLE patients with a focal and identifiable lesion are more likely to achieve seizure freedom than those with a more poorly defined epileptic focus. While seizure freedom can be achieved in the surgical treatment of medically refractory FLE, these findings illustrate the compelling need for improved noninvasive and invasive localization techniques in FLE.

Download Full-text

Prognostic Factors and Longitudinal Change in Long-Term Outcome of Frontal Lobe Epilepsy Surgery

World Neurosurgery ◽

10.1016/j.wneu.2018.08.192 ◽

2019 ◽

Vol 121 ◽

pp. e32-e38 ◽

Cited By ~ 2

Author(s):

Cuiping Xu ◽

Tao Yu ◽

Guojun Zhang ◽

Yuping Wang ◽

Yongjie Li

Keyword(s):

Prognostic Factors ◽

Frontal Lobe ◽

Epilepsy Surgery ◽

Longitudinal Change ◽

Frontal Lobe Epilepsy ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

Frontal lobe epilepsy manifesting as vertigo: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520946166 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052094616

Author(s):

Yongning Jiang ◽

Xiangqin Zhou

Keyword(s):

Frontal Lobe ◽

Cortical Neurons ◽

Relevant Literature ◽

Frontal Lobe Epilepsy ◽

Epileptiform Discharges ◽

History Of ◽

Clonic Seizures ◽

Wave Complex ◽

Oral Sodium

Frontal lobe epilepsy is a common neurological disorder with a broad spectrum of symptoms. Frontal lobe epilepsy presenting with vertigo is extremely rare, and the relevant pathogenesis remains unclear. Herein, we report a case of frontal lobe epilepsy manifesting as vertigo, and we review the relevant literature. A 34-year-old woman presented with a 10-year history of general tonic–clonic seizures. In the month prior to admission, she experienced nocturnal seizures on two occasions. Video electroencephalogram monitoring showed frequent clinical seizures during which the patient felt transient vertigo. The ictal electroencephalogram revealed a medium-amplitude spike and slow wave complex originating from the frontal lobes. The patient was treated with oral sodium valproate, levetiracetam, and lamotrigine. After a 6-month follow-up period, her seizures were well controlled. Our findings expand the symptom spectrum of epilepsy, suggesting that vertigo can be an uncommon clinical manifestation of frontal lobe epilepsy. Although the pathological correlation between vertigo and epilepsy remains elusive, our findings indicate that vestibular cortical neurons may participate in periodic epileptiform discharges of the frontal lobe. Clinicians should be aware of a potential diagnosis of epilepsy in patients presenting with vertigo as the onset symptom because this condition is usually underdiagnosed.

Download Full-text

Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography

Neurosurgery ◽

10.1093/neuros/nyx342 ◽

2017 ◽

Vol 83 (2) ◽

pp. 217-225 ◽

Cited By ~ 16

Author(s):

Francesca Bonini ◽

Aileen McGonigal ◽

Didier Scavarda ◽

Romain Carron ◽

Jean Régis ◽

...

Keyword(s):

Frontal Lobe ◽

Surgical Resection ◽

Complete Resection ◽

Conditional Inference ◽

Prognostic Indicators ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome ◽

Seizure Freedom ◽

Epileptogenic Zone

Abstract BACKGROUND Resective surgery established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies. OBJECTIVE To study long-term seizure outcome and identify prognostic factors. METHODS We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan–Meier analysis and multivariate and conditional inference procedures. RESULTS At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging. CONCLUSION Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.

Download Full-text

Epilepsy Surgery in the Frontal Lobe: Terra Incognita or New Frontier?

Epilepsy Currents ◽

10.1111/j.1535-7511.2007.00186.x ◽

2007 ◽

Vol 7 (4) ◽

pp. 98-99 ◽

Cited By ~ 3

Author(s):

John W. Miller

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Prognostic Indicators ◽

P Value ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome ◽

Seizure Freedom ◽

Ratio Test ◽

Longitudinal Outcome ◽

Frontal Lobectomy

Surgical Outcome and Prognostic Factors of Frontal Lobe Epilepsy Surgery. Jeha LE, Najm I, Bingaman W, Dinner D, Widdess-Walsh P, Luders H. Brain 2007;130(Pt 2):574–584. Epub 2007 Jan 5. Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 (mean follow-up 4.1 ± 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50–62] at 1 post-operative year, 45.1% (95% CI = 39–51) at 3 years, and 30.1% (95% CI = 21–39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [risk ratio (RR) = 2.22, 95% CI = 1.40–3.47], any extrafrontal MRI abnormality (RR = 1.75, 95% CI = 1.12–2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15–2.87), occurrence of acute post-operative seizures (RR = 2.17, 95% CI = 1.50–3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66–4.05) (log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to <15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.

Download Full-text