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

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.

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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.

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Seizure outcome and its predictors after frontal lobe epilepsy surgery

Acta Neurologica Scandinavica ◽

10.1111/ane.13139 ◽

2019 ◽

Vol 140 (4) ◽

pp. 259-267 ◽

Cited By ~ 2

Author(s):

Joseph Samuel P ◽

Ramshekhar N. Menon ◽

Anuvitha Chandran ◽

Sanjeev V. Thomas ◽

George Vilanilam ◽

...

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome

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Longitudinal Change in Outcome of Frontal Lobe Epilepsy Surgery

Neurosurgery ◽

10.1227/neu.0b013e3181f2380b ◽

2010 ◽

Vol 67 (5) ◽

pp. 1222-1229 ◽

Cited By ~ 12

Author(s):

Chi Heon Kim ◽

Chun Kee Chung ◽

Sang Kun Lee

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Late Recurrence ◽

Early Recurrence ◽

Cortical Dysplasia ◽

Longitudinal Change ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome ◽

Longitudinal Changes ◽

Free Rate

Abstract BACKGROUND: Although the outcome of epilepsy surgery changes with time, few studies have considered longitudinal changes after frontal lobe epilepsy (FLE) surgery. OBJECTIVE: To assess the longitudinal changes after FLE surgery. METHODS: Resection of the seizure onset zone was performed in 76 patients with FLE. Invasive monitoring was performed in 56 of these 76. Awake craniotomy was performed in 43 of the 76 patients. More than 50% of patients were followed up for at least 7 years. The mean follow-up was 81 months. RESULTS: For all patients, the seizure-free rate was 79% at 6 months, 64% at 1 year, 55% at 2 years, and 55% at 7 years. For patients with cortical dysplasia, the seizure-free rate was 72% at 6 months, 53% at 1 year, 51% at 2 years, and 46% at 7 years. For patients with tumor, the seizure-free rate was 89% at 6 months, 83% at 1 year, 83% at 2 years, and 74% at 7 years. Patients with tumor showed better outcome than those with cortical dysplasia (P = .04). Although the overall seizure-free rate became stable after 2 years, individual status changed for up to 5 years. Seizures recurred in 11 patients within 1 year (early recurrence) and in 12 patients by 1 to 5 years (late recurrence). Antiepileptic drug (AED) medication was adjusted in all patients with recurrence. Patients with late recurrence had a more favorable response (Engel class I or II) than early recurrence (P < .01). CONCLUSION: The overall seizure outcome changes mostly during the first year. However, individual seizure status changes for up to 5 years. The outcome of late recurrence is favorable to AED adjustment.

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Very long-term seizure outcome in frontal lobe epilepsy surgery

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.107848 ◽

2021 ◽

Vol 117 ◽

pp. 107848

Author(s):

Sara Casciato ◽

Roberta Morace ◽

Pier Paolo Quarato ◽

Addolorata Mascia ◽

Alfredo D'Aniello ◽

...

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome

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Long-term seizure outcome in frontal lobe epilepsy surgery

Epilepsy & Behavior ◽

10.1016/j.yebeh.2018.10.033 ◽

2019 ◽

Vol 90 ◽

pp. 93-98 ◽

Cited By ~ 4

Author(s):

Roberta Morace ◽

Sara Casciato ◽

Pier Paolo Quarato ◽

Addolorata Mascia ◽

Alfredo D’Aniello ◽

...

Keyword(s):

Frontal Lobe ◽

Epilepsy Surgery ◽

Frontal Lobe Epilepsy ◽

Seizure Outcome

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The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14282 ◽

2015 ◽

Vol 15 (6) ◽

pp. 644-650 ◽

Cited By ~ 30

Author(s):

Chima O. Oluigbo ◽

Jichuan Wang ◽

Matthew T. Whitehead ◽

Suresh Magge ◽

John S. Myseros ◽

...

Keyword(s):

Epilepsy Surgery ◽

Seizure Control ◽

Brain Mri ◽

Age At Onset ◽

Cortical Dysplasia ◽

Complete Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Lesion Volume ◽

Resection Volume

OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

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