Impact of focal cortical dysplasia Type IIIa on seizure outcome following anterior mesial temporal lobe resection for the treatment of epilepsy

OBJECTIVETemporal lobe epilepsy (TLE) is the most common type of pharmacoresistant focal epilepsy, for which anterior mesial temporal lobe resection (AMTLR) is a treatment option. Focal cortical dysplasia Type IIIa (FCD IIIa), a developmental lesion resulting from defects in neuronal formation and migration into the temporal pole (FCD I) combined with hippocampal sclerosis (HS), can be a neuropathological finding. In this study, the authors investigate the impact of FCD IIIa on seizure outcome in patients with TLE who underwent AMTLR.METHODSThe authors performed a retrospective analysis of all patients with TLE who underwent AMTLR at their institution between June 2011 and April 2014. Histopathological analysis was used to determine whether patients had HS together with FCD I (FCD IIIa) or HS alone. The groups were compared with regard to age, sex, years of epilepsy, and seizure outcome using the Engel classification.RESULTSA total of 51 patients with TLE underwent AMTLR at the authors’ institution. FCD IIIa was diagnosed in 13 cases. The patients experienced seizures for a mean duration of 31.1 years. The mean length of follow-up after the procedure was 18 months. All patients with FCD IIIa had a favorable seizure outcome (Engel Class I or II) compared with 71% of the patients with no pathological findings in the temporal pole (p < 0.01).CONCLUSIONSPatients with histopathologically proven FCD IIIa had a significantly better seizure outcome after AMTLR than patients with HS alone. Further effort should be made during presurgical evaluation to detect FCD IIIa so that the most suitable resection technique can be chosen and postoperative seizure outcome can be predicted for patient counseling.

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Occult focal cortical dysplasia may predict poor outcome of surgery for drug-resistant mesial temporal lobe epilepsy

PLoS ONE ◽

10.1371/journal.pone.0257678 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257678

Author(s):

Arkadiusz Nowak ◽

Aleksandra Bala

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Mesial Temporal Lobe Epilepsy ◽

Cortical Dysplasia ◽

Class I ◽

Seizure Outcome ◽

Epileptogenic Zone ◽

Dual Pathology ◽

Mesial Temporal Lobe

Purpose The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. Methods We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005–2016, and correlated factors associated with seizure relapse. Results At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. Conclusions The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.

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Multiple hippocampal transections for mesial temporal lobe epilepsy

Surgical Neurology International ◽

10.25259/sni_350_2021 ◽

2021 ◽

Vol 12 ◽

pp. 372

Author(s):

David Pitskhelauri ◽

Elina Kudieva ◽

Maria Kamenetskaya ◽

Antonina Kozlova ◽

Pavel Vlasov ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Verbal Memory ◽

Visual Memory ◽

Focal Cortical Dysplasia ◽

Mesial Temporal Lobe Epilepsy ◽

Drug Resistant ◽

Preoperative Level ◽

Temporal Pole ◽

Mesial Temporal Lobe

Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.

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Differential modulation of various inflammatory mediators in mesial temporal lobe epilepsy and focal cortical dysplasia patients

International Journal of Epilepsy ◽

10.1016/j.ijep.2015.12.007 ◽

2016 ◽

Vol 3 (1) ◽

pp. 44

Author(s):

Aparna Banerjee Dixit ◽

Debasmita Paul ◽

Arpna Srivastava ◽

Jyotirmoy Banerjee ◽

Manjari Tripathi ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Inflammatory Mediators ◽

Focal Cortical Dysplasia ◽

Mesial Temporal Lobe Epilepsy ◽

Cortical Dysplasia ◽

Differential Modulation ◽

Mesial Temporal Lobe

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Familial temporal lobe epilepsy due to focal cortical dysplasia type IIIa

Seizure ◽

10.1016/j.seizure.2015.07.014 ◽

2015 ◽

Vol 31 ◽

pp. 120-123 ◽

Cited By ~ 3

Author(s):

Petr Fabera ◽

Hana Krijtova ◽

Martin Tomasek ◽

David Krysl ◽

Josef Zamecnik ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Type Iiia

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The Impact of Intraoperative Electrocorticography on Seizure Outcome After Resection of Pediatric Brain Tumors: A Cohort Study

Neurosurgery ◽

10.1093/neuros/nyy342 ◽

2018 ◽

Vol 85 (3) ◽

pp. 375-383 ◽

Cited By ~ 1

Author(s):

Faith C Robertson ◽

Nicole J Ullrich ◽

Peter E Manley ◽

Hasan Al-Sayegh ◽

Clement Ma ◽

...

Keyword(s):

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Tumor Resection ◽

Cortical Dysplasia ◽

Class I ◽

Gross Total Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Total Resection ◽

The Impact

AbstractBACKGROUNDIntraoperative electrocorticography (ECoG) has been utilized in patients with tumor-associated seizures; however, its effectiveness for seizure control remains controversial.OBJECTIVETo evaluate clinical outcomes in pediatric patients undergoing lesionectomy with or without ECoG.METHODSPatients undergoing brain tumor resection at Boston Children's Hospital were examined retrospectively (2005-2014). Inclusion criteria involved diagnosis of a supratentorial tumor, ≥2 unequivocal seizures, and ≥6 mo follow-up. Patients with isolated cortical dysplasia or posterior fossa tumors were excluded. Logistic regression models evaluated predictors of ECoG use, and the impact of ECoG, gross total resection, and focal cortical dysplasia with tumors on seizure freedom by Engel Class and anti-epileptic drug use (AED).RESULTSA total of 119 pediatric patients were included (n = 69 males, 58%; median age, 11.3 yr). Forty-one patients (34.5%) had ECoG-guided surgery. Preoperative seizure duration and number and duration of AED use were significant predictors for undergoing ECoG. There were no differences in seizure freedom (Engel Class I) or improved Engel Score (Class I-II vs III-IV) in patients who did or did not have ECoG at 30 d, 6 mo, and 1, 2, or 5 yr. Patients undergoing ECoG required a greater number of AEDs at 6 mo (P = .01), although this difference disappeared at subsequent time intervals. Gross total resection predicted seizure freedom at 30 d and 6 mo postsurgery (P = .045).CONCLUSIONThis retrospective study, one of the largest evaluating the use of ECoG during tumor resection, suggests that ECoG does not provide improved seizure freedom compared to lesionectomy alone for children.

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The role of voxel-based morphometry in the detection of cortical dysplasia within the temporal pole in patients with intractable mesial temporal lobe epilepsy

Epilepsia ◽

10.1111/j.1528-1167.2012.03456.x ◽

2012 ◽

Vol 53 (6) ◽

pp. 1004-1012 ◽

Cited By ~ 15

Author(s):

Martin Pail ◽

Radek Mareček ◽

Markéta Hermanová ◽

Bronislava Slaná ◽

Ivana Tyrlíková ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Cortical Dysplasia ◽

Voxel Based Morphometry ◽

Temporal Pole ◽

Mesial Temporal Lobe

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Electroclinical and Multimodality Neuroimaging Characteristics and Predictors of Post-Surgical Outcome in Focal Cortical Dysplasia Type IIIa

Frontiers in Bioengineering and Biotechnology ◽

10.3389/fbioe.2021.810897 ◽

2022 ◽

Vol 9 ◽

Author(s):

Lingling Zhang ◽

Hailing Zhou ◽

Wei Zhang ◽

Xueying Ling ◽

Chunyuan Zeng ◽

...

Keyword(s):

Epilepsy Surgery ◽

Focal Cortical Dysplasia ◽

Univariate Analysis ◽

Postoperative Outcome ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Seizure Freedom ◽

Incomplete Resection ◽

Type Iiia ◽

Imaging Characteristics

Focal cortical dysplasia (FCD) type IIIa is an easily ignored cause of intractable temporal lobe epilepsy. This study aimed to analyze the clinical, electrophysiological, and imaging characteristics in FCD type IIIa and to search for predictors associated with postoperative outcome in order to identify potential candidates for epilepsy surgery. We performed a retrospective review including sixty-six patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. We evaluated the clinical, electrophysiological, and neuroimaging features for potential association with seizure outcome. Univariate and multivariate analyses were conducted to explore their predictive role on the seizure outcome. We demonstrated that thirty-nine (59.1%) patients had seizure freedom outcomes (Engel class Ia) with a median postsurgical follow-up lasting 29.5 months. By univariate analysis, duration of epilepsy (less than 12 years) (p = 0.044), absence of contralateral insular lobe hypometabolism on PET/MRI (pLog-rank = 0.025), and complete resection of epileptogenic area (pLog-rank = 0.004) were associated with seizure outcome. The incomplete resection of the epileptogenic area (hazard ratio = 2.977, 95% CI 1.218–7.277, p = 0.017) was the only independent predictor for seizure recurrence after surgery by multivariate analysis. The results of past history, semiology, electrophysiological, and MRI were not associated with seizure outcomes. Carefully included patients with FCD type IIIa through a comprehensive evaluation of their clinical, electrophysiological, and neuroimaging characteristics can be good candidates for resection. Several preoperative factors appear to be predictive of the postoperative outcome and may help in optimizing the selection of ideal candidates to benefit from epilepsy surgery.

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Temporal pole blurring in temporal lobe epilepsy revealed by 3D Edge-Enhancing Gradient Echo MRI

The Neuroradiology Journal ◽

10.1177/19714009211067404 ◽

2022 ◽

pp. 197140092110674

Author(s):

Lela Okromelidze ◽

Vivek Gupta ◽

Ayushi Jain ◽

Neethu Gopal ◽

Anteneh M Feyissa ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Early Age ◽

Neuropsychological Performance ◽

Gradient Echo ◽

Seizure Onset ◽

Lower Baseline ◽

Temporal Pole

While abnormalities of the hippocampus have been well characterized in temporal lobe epilepsy, various additional temporal lobe abnormalities have also been described. One poorly understood entity, the so-called temporal pole blurring (TPB), is one of the more frequently described neocortical abnormalities in TLE and is thought to represent dysmyelination and axonal loss due to chronic electrical perturbations in early age-onset temporal lobe epilepsy. In this study, we describe the first reported cases of TPB diagnosed by a recently described MRI sequence known as 3D Edge-Enhancing Gradient Echo (3D-EDGE), which has an effective “myelin weighting” making it exquisitely sensitive to this temporal pole dysmyelination. The value of detection of TPB lies in lateralizing seizure onset, as well as predicting a lower baseline neuropsychological performance compared to temporal lobe epilepsy without TPB. Additionally, it is critical to not mistake TPB for alternative diagnoses, such as focal cortical dysplasia or neoplasm.

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Side of Lesions Predicts Surgical Outcomes in Patients With Drug-Resistant Temporal Lobe Epilepsy Secondary to Focal Cortical Dysplasia Type IIIa

Frontiers in Neurology ◽

10.3389/fneur.2020.580221 ◽

2020 ◽

Vol 11 ◽

Author(s):

Xinghui He ◽

Dingyang Liu ◽

Zhuanyi Yang ◽

Junmei Zhang ◽

Sushan Li ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Surgical Outcomes ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Freedom ◽

Drug Resistant ◽

Type Iiia ◽

Postoperative Seizure ◽

The Right

Objective: This study aims to evaluate the surgical outcomes and analyze the predictors of surgical outcomes in patients undergoing anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) secondary to focal cortical dysplasia (FCD) type IIIa.Methods: Data on patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL at Xiangya Hospital, Central South University from January 2014 to April 2018, were collected retrospectively. International League Against Epilepsy (ILAE) classification was used to evaluate postoperative seizure outcomes. Predictors of surgical outcomes were identified by using univariate and multivariate analyses.Results: A total of 43 patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL were included in this study. Twenty patients had right ATL, and 23 patients had left ATL. With a follow-up of 2–6 years, 76.7% (33 of 43) of patients were seizure-free. Univariate and multivariate analysis results indicated that lesions on the right side independently predict postoperative seizure freedom (OR, 0.08; 95% CI, 0.01–0.72; P = 0.024).Conclusion: ATL is an effective therapy for patients with drug-resistant TLE secondary to FCD type IIIa. Patients with lesions on the right side are more likely to achieve postoperative seizure freedom.

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