scholarly journals Predictors of Postoperative Seizure Recurrence: A Longitudinal Study of Temporal and Extratemporal Resections

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Hai Chen ◽  
Pradeep N. Modur ◽  
Niravkumar Barot ◽  
Paul C. Van Ness ◽  
Mark A. Agostini ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Intractable Epilepsy ◽  
Seizure Recurrence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Longitudinal Outcome ◽  
Ictal Eeg ◽  
Multiple Variables ◽  
Postoperative Seizure

Objective. We investigated the longitudinal outcome of resective epilepsy surgery to identify the predictors of seizure recurrence. Materials and Methods. We retrospectively analyzed patients who underwent resections for intractable epilepsy over a period of 7 years. Multiple variables were investigated as potential predictors of seizure recurrence. The time to first postoperative seizure was evaluated using survival analysis and univariate analysis at annual intervals. Results. Among 70 patients, 54 (77%) had temporal and 16 (23%) had extratemporal resections. At last follow-up (mean 48 months; range 24–87 months), the outcome was Engel class I in 84% (n=59) of patients. Seizure recurrence followed two patterns: recurrence was “early” (within 2 years) in 82% of patients, of whom 83% continued to have seizures despite optimum medical therapy; recurrence was “late” (after 2 years) in 18%, of whom 25% continued to have seizures subsequently. Among the variables of interest, only resection site and ictal EEG remained as independent predictors of seizure recurrence over the long term (p<0.05). Extratemporal resection and discordance between ictal EEG and resection area were associated with 4.2-fold and 5.6-fold higher risk of seizure recurrence, respectively. Conclusions. Extratemporal epilepsy and uncertainty in ictal EEG localization are independent predictors of unfavorable outcome. Seizure recurrence within two years of surgery indicates poor long-term outcome.

scholarly journals Long-term outcome of indigenous 177Lu-DOTATATE PRRT in patients with Metastatic Advanced Neuroendocrine Tumours: a single institutional observation in a large tertiary care setting

2021 ◽  
Vol 94 (1117) ◽  
pp. 20201041
Author(s):  
Keerti Sitani ◽  
Rahul V Parghane ◽  
Sanjay Talole ◽  
Sandip Basu
Keyword(s):  
Primary Tumour ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Previous History ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wide Range ◽  
Grade 3

Objectives: Assessment of long-term outcome and toxicity of indigenous 177Lu-DOTATATE PRRT in patients of metastatic/advanced NETs in a large tertiary-care PRRT setting. Methods: A total of 468 metastatic/advanced NET patients (wide range of primary sites including CUP-NETs), who underwent at least two cycles of 177Lu-DOTATATE PRRT with available follow-up information, were included and analysed retrospectively in this study. In-house labelling of DOTATATE with 177Lu (direct route produced) was carried out in the hospital radiopharmacy and treatment administered in cycles (dose: 5.55 to 7.4 GBq per patient), at 10–12 weeks interval. The assessment of long-term outcome was undertaken under three broad headings: (a) Therapeutic response, (b) Survival outcome and (c) Toxicity assessment. The median point estimate with 95% CI for progression free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic covariates for association with PFS and OS was investigated by Cox proportional hazards model (univariate and multivariate Hazard Ratios) and with disease control rate (DCR) by Chi-square test, with significant P value defined as <0.05. Results: Long-term outcome (follow-up ranging from 4 to 97.6 months; median period:46 months following first 177Lu-DOTATATE PRRT) results showed, (i) on symptomatic response evaluation scale, complete response (CR) in 214 patients (45.7%), partial response (PR) in 108 (23.1%), stable disease (SD) in 118 (25.2%), progressive disease (PD) in 28 (6%). (ii) Biochemical response evaluation showed CR in 52 (12%), PR in 172 (40%), SD in 161 (38%), and PD in 42 patients (10%). (iii) Molecular imaging response (by PERCIST criteria) showed CR in 29 (6%), PR in 116 (25%), SD in 267 (57%) and PD in 56 (12%) patients. (iv) On RECIST 1.1 criteria, CR was observed in 14 patients (3%), PR in 126 patients (27%), SD in 282 patients (60%) and PD in 46 patients (10%). The median PFS and OS were not reached at a median follow-up of 46 months. Observed PFS and OS at 7 years were 71.1% 95% CI (62.4–79.7%) and 79.4% 95% CI (71.4–86.9%) respectively. PFS was dependent on previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake, site of primary tumour, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake and number of PRRT cycles. The OS was dependent on baseline 68Ga-DOTATATE uptake, site of primary tumour, presence of bony metastatic disease, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for bony metastatic disease and number of PRRT cycles. Transient haematological toxicity of Grade 1, Grade 2, and Grade 3 was found in 8 (1.7%), 1 (0.2%) and one patient (0.2%), respectively. Nephrotoxicity of Grade 1, Grade 2, Grade 3, and Grade 4 were seen in 16 (3.5%), 3 (0.6%), 2 (0.4%) and one patient (0.2%), respectively. On a separate sub-analysis of 322 NET patients with progressive disease at the initiation point of PRRT, overall response rates (CR + PR + SD) were 93.5%, 88.5%, 89.1 and 87.9% on symptomatic, biochemical, RECIST 1.1 and PERCIST criteria and PFS and OS at 7 years 68.3% and 79.2%, respectively. Conclusions: The present results demonstrate that 177Lu-DOTATATE PRRT improved symptoms and biochemical markers substantially in most of the NET patients, with disease stabilisation on both anatomical and molecular imaging in majority and response in a sizeable fraction. Additionally, the therapeutic protocol with lesser dose per cycle (mean 5.92 GBq/cycle) and prolonged duration (over 5 cycles and 1.5 years) in a metastatic NET setting proved equally efficacious (with superior PFS and OS rates) and relatively better tolerated with minimal toxicity. Advances in knowledge: The present work critically examines the long-term results, survival outcome and toxicity profile of the indigenous 177Lu-DOTATATE (produced through direct neutron activation of enriched 176Lu) in metastatic progressive NETs across a wide range of primary sites and malignancies. Such long-term outcome data establishes the favourable impact of PRRT in a wide patient base and also the therapeutic efficacy of the product.

Individualised prediction of seizure recurrence and long-term outcome after antiepileptic drug withdrawal

2017 ◽  
Vol 21 ◽  
pp. e159
Author(s):  
H.J. Lamberink ◽  
W.M. Otte ◽  
A.T. Geerts ◽  
M. Pavlovic ◽  
J. Ramos-Lizana ◽  
...  
Keyword(s):  
Antiepileptic Drug ◽  
Drug Withdrawal ◽  
Seizure Recurrence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Antiepileptic Drug Withdrawal

A second chance—reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications

2015 ◽  
Vol 87 (4) ◽  
pp. 379-385 ◽  
Author(s):  
Alexander Grote ◽  
Juri-Alexander Witt ◽  
Rainer Surges ◽  
Marec von Lehe ◽  
Madeleine Pieper ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Failed Surgery ◽  
Second Chance

Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients

2009 ◽  
Vol 110 (6) ◽  
pp. 1135-1146 ◽  
Author(s):  
Alaa Eldin Elsharkawy ◽  
Abdel Hamid Alabbasi ◽  
Heinz Pannek ◽  
Falk Oppel ◽  
Reinhard Schulz ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Focal Cortical Dysplasia ◽  
Hazard Ratio ◽  
Adult Patients ◽  
Seizure Recurrence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk

Object The aim of this study was to evaluate the long-term efficacy of temporal lobe epilepsy (TLE) surgery and potential risk factors for seizure recurrence after surgery. Methods This retrospective study included 434 consecutive adult patients who underwent TLE surgery at Bethel Epilepsy Centre between 1991 and 2002. Results Hippocampal sclerosis was found in 62% of patients, gliosis in 17.3%, tumors in 20%, and focal cortical dysplasia (FCD) in 6.9%. Based on a Kaplan-Meier analysis, the probability of Engel Class I outcome for the patients overall was 76.2% (95% CI 71–81%) at 6 months, 72.3% (95% CI 68–76%) at 2 years, 71.1% (95% CI 67–75%) at 5 years, 70.8% (95% CI 65–75%) at 10 years, and 69.4% (95% CI 64–74%) at 16 years postoperatively. The likelihood of remaining seizure free after 2 years of freedom from seizures was 90% (95% CI 82–98%) for 16 years. Seizure relapse occurred in all subgroups. Patients with FCD had the highest risk of recurrence (hazard ratio 2.15, 95% CI 0.849–5.545). Predictors of remission were the presence of hippocampal atrophy on preoperative MR imaging and a family history of epilepsy. Predictors of relapse were the presence of bilateral interictal sharp waves and versive seizures. Six-month follow-up electroencephalography predicted relapse in patients with FCD. Short epilepsy duration was predictive of seizure remission in patients with tumors and gliosis; 28.1% of patients were able to discontinue antiepileptic medications without an increased risk of seizure recurrence (hazard ratio 1.05, 95% CI 0.933–1.20). Conclusions These findings highlight the role of etiology in prediction of long-term outcome after TLE surgery.

Long-term outcome of extratemporal resection in posttraumatic epilepsy

2012 ◽  
Vol 32 (3) ◽  
pp. E10 ◽  
Author(s):  
Shahin Hakimian ◽  
Amir Kershenovich ◽  
John W. Miller ◽  
Jeffrey G. Ojemann ◽  
Adam O. Hebb ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Term Outcome ◽  
Intracranial Eeg ◽  
Long Term Outcome ◽  
Posttraumatic Epilepsy ◽  
Factors Associated

Object Posttraumatic epilepsy (PTE) is a common cause of medically intractable epilepsy. While much of PTE is extratemporal, little is known about factors associated with good outcomes in extratemporal resections in medically intractable PTE. The authors investigated and characterized the long-term outcome and patient factors associated with outcome in this population. Methods A single-institution retrospective query of all epilepsy surgeries at Regional Epilepsy Center at the University of Washington was performed for a 17-year time span with search terms indicative of trauma or brain injury. The query was limited to adult patients who underwent an extratemporal resection (with or without temporal lobectomy), in whom no other cause of epilepsy could be identified, and for whom minimum 1-year follow-up data were available. Surgical outcomes (in terms of seizure reduction) and clinical data were analyzed and compared. Results Twenty-one patients met inclusion and exclusion criteria. In long-term follow-up 6 patients (28%) were seizure-free and an additional 6 (28%) had a good outcome of 2 or fewer seizures per year. Another 5 patients (24%) experienced a reduction in seizures, while only 4 (19%) did not attain significant benefit. The presence of focal encephalomalacia on imaging was associated with good or excellent outcomes in 83%. In 8 patients with the combination of encephalomalacia and invasive intracranial EEG, 5 (62.5%) were found to be seizure free. Normal MRI examinations preoperatively were associated with worse outcomes, particularly when combined with multifocal or poorly localized EEG findings. Two patients suffered complications but none were life threatening or disabling. Conclusions Many patients with extratemporal PTE can achieve good to excellent seizure control with epilepsy surgery. The risks of complications are acceptably low. Patients with focal encephalomalacia on MRI generally do well. Excellent outcomes can be achieved when extratemporal resection is guided by intracranial EEG electrodes defining the extent of resection.

NPM Mutations in Adult AML with Normal Karyotype: A Retrospective Study of the Acute Leukemia French Association (ALFA).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2359-2359
Author(s):  
Nicolas Boissel ◽  
Aline Renneville ◽  
Valeria Biggio ◽  
Nathalie Philippe ◽  
Xavier Thomas ◽  
...  
Keyword(s):  
Minimal Residual Disease ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Normal Karyotype ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mutational Status ◽  
Relapse Time ◽  
Minimal Residual

Abstract NPM mutation (NPMm) has been recently reported as the most frequent mutation in AML, especially in the presence of a normal karyotype. Association of NPMm with an increased complete remission (CR) rate has been suggested, but the long-term prognosis is not known. The abnormal mutated NPM protein shows an aberrant cytoplasmic localization that allows an immunohistochemical detection of NPM status. However, all mutations reported are insertion/deletion of exon 12 resulting in a global insertion of 4 nucleotides. We therefore developed a NPMm detection test based on DNA PCR amplification and fragment length analysis. As previously reported, we observed a higher frequency of NPMm in AML with normal karyotype (47%, 50/106) than in CBF AML (0%, 0/7) or in AML with poor risk cytogenetic (13%, 4/32). We further evaluated the clinical profile and the prognosis of NPM mutations in a retrospective cohort of 106 patients with normal karyotype treated according to the ALFA-9000 or ALFA-9802 protocols between 1990 and 2004. In these patients aged 17–65 years, NPMm was significantly associated with a high white blood cell count (69 vs 18 G/L, p&lt;.001) and an involvement of the monocytic lineage (FAB AML-M4/M5, p=.009). NPMm was also associated with a low rate of CEBPA mutation (CEBPAm, 10% vs 27%, p=.05) and a higher rate of FLT3 internal tandem duplication (FLT3/ITD, 38% vs 25%, p=NS). We did not find any correlation between NMPm and CR rate (86% vs 88%, p=NS). Long-term outcome did not differ between NPMm and NPM wild-type (NPMwt) patients neither in univariate analysis (6y-OS, 43% vs 37%; 6y-RFS, 47% vs 34%, p=NS) nor in multivariate analysis after adjustment on covariates significantly associated with prognosis in univariate analysis (age, CEBPAm, FLT3/ITD). NPM mutational status was available for 15 patients at relapse time. Ten patients out of 15 had NPM mutations at diagnosis and still displayed NPM mutations at relapse time. None of the 5 NPMwt patients acquired NPM mutation at relapse. Recently, we developed a RQ PCR technique to study minimal residual disease. Fifteen patients were evaluated at diagnosis and follow-up. In the majority of the cases a sensitivity of 10−4 was obtained. The high frequency, the stability, and the homogeneity of NPMm provide a promising minimal residual disease marker that we are prospectively evaluating. Prospective studies are also needed to confirm the definitive role of NPM mutation in the prognosis of AML patients.

Prognostic (Px) significance of Ki67 before and after neoadjuvant chemotherapy (CT) in early breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 573-573 ◽  
Author(s):  
R. L. Jones ◽  
J. Salter ◽  
A. Nerurkar ◽  
M. Parton ◽  
R. A’Hern ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endocrine Therapy ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Adjuvant Endocrine Therapy ◽  
Nodal Status ◽  
Term Outcome ◽  
Long Term Outcome ◽  
N Stage

573 Background: High levels of the proliferation marker Ki67 are associated with a higher response rate to CT but poorer long-term outcome. The Px significance of Ki67 before CT and at surgical excision was compared. Methods: 103 patients treated with CT with pre- and post- (excision) CT tissue and a further 181 with only excision tissue available were identified, 37 and 76 of these respectively were ER+ and also received tamoxifen. The following factors were considered pre-CT and at excision (where relevant) for their relationship with relapse-free (RFS) and overall (OS) survival: ER, PR, HER2, grade, Ki67, histological type, vascular invasion, age/menses, T and N stage, pre-therapy operability, clinical response, CT regimen, type of surgery, adjuvant therapy, pathological tumour size and nodal involvement. Results: In the paired cohort univariate analysis of RFS the following factors were associated with poorer Px (a) pre-CT: ER- (p=0.003); increasing T stage (p<0.001), N stage (p=0.002) and Ki67 (p<0.001); (b) at excision: increasing grade (p=0.01), tumour size (p=0.02), nodal status (p<0.001) and Ki67 (p<0.001); no adjuvant endocrine therapy (p<0.001). On multivariate analysis only excision Ki67 (p<0.001) was significant although there was a suggestion pre-therapy Ki67 was important (p<0.10). On univariate analysis of OS the following factors associated with poorer Px (a) pre-CT: ER- (p=0.006); increasing T stage (p<0.001) and Ki67 (p<0.001); (b) at excision: increasing grade (p=0.04), tumour size (p=0.005), nodal status (p<0.03) and Ki67 (p<0.001); no adjuvant endocrine therapy (p=0.001). On multivariate analysis both pre-CT and excision Ki67 were significant independent predictors but the latter was more highly significant. (p<0.02 + p<0.0001, respectively) Assessing the combined group of 284 patients, after 5 years the highest and lowest tertiles of excision Ki67 had strikingly different Px: RFS 36% and 73%; OS 50% and 85%, respectively. Conclusions: Ki67 after CT is a strong predictor of long-term outcome. The greater significance of Ki67 in the excision sample may be due to this identifying patients in whom residual highly proliferative disease remains after CT. No significant financial relationships to disclose.

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