scholarly journals Thermography mapping patterns in temporal lobe epilepsy surgery

2020 ◽  
Vol 11 ◽  
pp. 30
Author(s):  
Enrique de Font-Réaulx ◽  
Javier Terrazo Lluch ◽  
Ramón López López ◽  
Paul Shkurovich Bialik ◽  
Miguel Ángel Collado Corona ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Brain Metabolism ◽  
Electric Activity ◽  
Macroscopic Appearance ◽  
Activity Difference ◽  
Cortical Temperature ◽  
Lower Temperature ◽  
Heating Pattern ◽  
Cortical Point

Background: In several epilepsy etiologies, the macroscopic appearance of the epileptogenic tissue is identical to the normal, which makes it hard to balance between how much cytoreduction or disconnection and brain tissue preservation must be done. A strategy to tackle this situation is by evaluating brain metabolism during surgery using infrared thermography mapping (IrTM). Methods: In 12 epilepsy surgery cases that involved the temporal lobe, we correlated the IrTM, electrocorticography, and neuropathology results. Results: Irritative zones (IZ) had a lower temperature in comparison to the surrounding cortex with normal electric activity (difference in temperature (ΔT) from 1.2 to 7.1, mean 3.40°C standard deviation ± 1.61). The coldest zones correlated exactly with IZ in 9/10 cortical dysplasia (CD) cases. In case 3, the coldest area was at 1 cm away from the IZ. In 10/10 dysplasia cases (cases 1–4, 6–11), there was a radial heating pattern originating from the coldest cortical point. In 2/2 neoplasia cases, the temporal lobe cortical temperature was more homogeneous than in the CD cases, with no radial heating pattern, and there were no IZ detected. In case 8, we found the coldest IrTM recording in the hippocampus, which correlated to the maximal irritative activity recorded by strip electrodes. The ΔT is inversely proportional to epilepsy chronicity. Conclusion: IrTM could be useful in detecting hypothermic IZ in CD cases. As the ΔT is inversely proportional to epilepsy chronicity, this variable could affect the metabolic thermic patterns of the human brain.

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 Heart rate variability remains reduced and sympathetic tone elevated after temporal lobe epilepsy surgery

Seizure ◽  
2013 ◽  
Vol 22 (9) ◽  
pp. 713-718 ◽  
Author(s):  
Nese Dericioglu ◽  
Mehmet Demirci ◽  
Oguz Cataltepe ◽  
Nejat Akalan ◽  
Serap Saygi
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Sympathetic Tone

Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?

2009 ◽  
Vol 14 (3) ◽  
pp. 529-534 ◽  
Author(s):  
Ricardo Guarnieri ◽  
Roger Walz ◽  
Jaime E.C. Hallak ◽  
Érica Coimbra ◽  
Edna de Almeida ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Seizure Outcome ◽  
Psychiatric Comorbidities ◽  
Postoperative Seizure

scholarly journals Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Richard Drexler ◽  
Sharona Ben-Haim ◽  
Christian G. Bien ◽  
Valeri Borger ◽  
Francesco Cardinale ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Reference Values ◽  
Surgical Techniques ◽  
Mesial Temporal Lobe Epilepsy ◽  
Diagnostic Tools ◽  
Surgical Data ◽  
Mesial Temporal Lobe

Introduction: Optimizing patient safety and quality improvement is increasingly important in surgery. Benchmarks and clinical quality registries are being developed to assess the best achievable results for several surgical procedures and reduce unwarranted variation between different centers. However, there is no clinical database from international centers for establishing standardized reference values of patients undergoing surgery for mesial temporal lobe epilepsy.Design: The Enhancing Safety in Epilepsy Surgery (EASINESS) study is a retrospectively conducted, multicenter, open registry. All patients undergoing mesial temporal lobe epilepsy surgery in participating centers between January 2015 and December 2019 are included in this study. The patient characteristics, preoperative diagnostic tools, surgical data, postoperative complications, and long-term seizure outcomes are recorded.Outcomes: The collected data will be used for establishing standardized reference values (“benchmarks”) for this type of surgical procedure. The primary endpoints include seizure outcomes according to the International League Against Epilepsy (ILAE) classification and defined postoperative complications.Discussion: The EASINESS will define robust and standardized outcome references after amygdalohippocampectomy for temporal lobe epilepsy. After the successful definition of benchmarks from an international cohort of renowned centers, these data will serve as reference values for the evaluation of novel surgical techniques and comparisons among centers for future clinical trials.Clinical trial registration: This study is indexed at clinicaltrials.gov (NT 04952298).

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