scholarly journals Cognitive and developmental outcomes after pediatric insular epilepsy surgery for focal cortical dysplasia

2020 ◽  
Vol 26 (5) ◽  
pp. 543-551
Author(s):  
Naoki Ikegaya ◽  
Masaki Iwasaki ◽  
Yuu Kaneko ◽  
Takanobu Kaido ◽  
Yuiko Kimura ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Repeated Measures ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Developmental Outcomes ◽  
Insular Cortex ◽  
Cortical Dysplasia ◽  
Motor Deficits ◽  
Seizure Outcome ◽  
Epileptogenic Zone

OBJECTIVECognitive risk associated with insular cortex resection is not well understood. The authors reviewed cognitive and developmental outcomes in pediatric patients who underwent resection of the epileptogenic zone involving the insula.METHODSA review was conducted of 15 patients who underwent resective epilepsy surgery involving the insular cortex for focal cortical dysplasia, with a minimum follow-up of 12 months. The median age at surgery was 5.6 years (range 0.3–13.6 years). Developmental/intelligence quotient (DQ/IQ) scores were evaluated before surgery, within 4 months after surgery, and at 12 months or more after surgery. Repeated measures multivariate ANOVA was used to evaluate the effects on outcomes of the within-subject factor (time) and between-subject factors (resection side, anterior insular resection, seizure control, and antiepileptic drug [AED] reduction).RESULTSThe mean preoperative DQ/IQ score was 60.7 ± 22.8. Left-side resection and anterior insular resection were performed in 9 patients each. Favorable seizure control (International League Against Epilepsy class 1–3) was achieved in 8 patients. Postoperative motor deficits were observed in 9 patients (permanent in 6, transient in 3). Within-subject changes in DQ/IQ were not significantly affected by insular resection (p = 0.13). Postoperative changes in DQ/IQ were not significantly affected by surgical side, anterior insular resection, AED reduction, or seizure outcome. Only verbal function showed no significant changes before and after surgery and no significant effects of within-subject factors.CONCLUSIONSResection involving the insula in children with impaired development or intelligence can be performed without significant reduction in DQ/IQ, but carries the risk of postoperative motor deficits.

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

2015 ◽  
Vol 15 (6) ◽  
pp. 644-650 ◽  
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.

Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 174-182
Author(s):  
Evangelos Kogias ◽  
Thomas Bast ◽  
Susanne Schubert-Bast ◽  
Gert Wiegand ◽  
Armin Brandt ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Benign Tumors ◽  
Seizure Freedom ◽  
Childhood And Adolescence ◽  
Epileptogenic Zone ◽  
Seizure Recurrence ◽  
Eloquent Cortex

Abstract BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones–and lesions–localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report

2018 ◽  
Vol 128 (4) ◽  
pp. 1173-1177 ◽  
Author(s):  
Naoki Ikegaya ◽  
Akio Takahashi ◽  
Takanobu Kaido ◽  
Yuu Kaneko ◽  
Masaki Iwasaki ◽  
...  
Keyword(s):  
Seizure Control ◽  
Pyramidal Tract ◽  
Focal Cortical Dysplasia ◽  
Insular Cortex ◽  
Motor Deficits ◽  
Corona Radiata ◽  
Ischemic Complications ◽  
Posterior Insula ◽  
Functional Preservation ◽  
Perforating Arteries

Surgical treatment of the insula is notorious for its high probability of motor complications, particularly when resecting the superoposterior part. Ischemic damage to the pyramidal tract in the corona radiata has been regarded as the cause of these complications, resulting from occlusion of the perforating arteries to the pyramidal tract through the insular cortex. The authors describe a strategy in which a small piece of gray matter is spared at the bottom of the periinsular sulcus, where the perforating arteries pass en route to the pyramidal tract, in order to avoid these complications. This method was successfully applied in 3 patients harboring focal cortical dysplasia in the posterior insula and frontoparietal operculum surrounding the periinsular sulcus. None of the patients developed permanent postoperative motor deficits, and seizure control was achieved in all 3 cases. The method described in this paper can be adopted for functional preservation of the pyramidal tract in the corona radiata when resecting epileptogenic pathologies involving insular and opercular regions.

Surgery for Nontumoral Insular Epilepsy Explored by Stereoelectroencephalography

Neurosurgery ◽  
2016 ◽  
Vol 79 (4) ◽  
pp. 578-588 ◽  
Author(s):  
Guillaume Gras-Combe ◽  
Lorella Minotti ◽  
Dominique Hoffmann ◽  
Alexandre Krainik ◽  
Philippe Kahane ◽  
...  
Keyword(s):  
Focal Cortical Dysplasia ◽  
Intractable Epilepsy ◽  
Insular Cortex ◽  
Cavernous Angioma ◽  
Cortical Dysplasia ◽  
Electrode Placement ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Pharmacoresistant Epilepsy ◽  
The Right

Abstract BACKGROUND Hidden by the perisylvian operculi, insular cortex has long been underexplored in the context of epilepsy surgery. Recent studies advocated stereoelectroencephalography (SEEG) as a reliable tool to explore insular cortex and its involvement in intractable epilepsy and suggested that insular seizures could be an underestimated entity. However, the results of insular resection to treat pharmacoresistant epilepsy are rarely reported. OBJECTIVE We report 6 consecutive cases of right insular resection performed based on anatomoelectroclinical correlations provided by SEEG. METHODS Six right-handed patients (3 male, 3 female) with drug-resistant epilepsy underwent comprehensive presurgical evaluation. Based on video electroencephalographic recordings, they all underwent SEEG evaluation with bilateral (n = 4) or unilateral right (n = 2) insular depth electrode placement. All patients had both orthogonal and oblique (1 anterior, 1 posterior) insular electrodes (n = 4-6 electrodes). Preoperative magnetic resonance imaging findings were normal in 4 patients, 1 patient had right insular focal cortical dysplasia, and 1 patient had a right opercular postoperative scar (cavernous angioma). All patients underwent right partial insular corticectomy via the subpial transopercular approach. RESULTS Intracerebral recordings demonstrated an epileptogenic zone confined to the right insula in all patients. After selective insular resection, 5 of 6 patients were seizure free (Engel class I) with a mean follow-up of 36.2 months (range, 18-68 months). Histological findings revealed focal cortical dysplasia in 5 patients and a gliosis scar in 1 patient. All patients had minor transient neurological deficit (eg, facial paresis, dysarthria). CONCLUSION Insular resection based on SEEG findings can be performed safely with a significant chance of seizure freedom.

scholarly journals Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey

2017 ◽  
Vol 19 (5) ◽  
pp. 606-615 ◽  
Author(s):  
Hiroshi Hosoyama ◽  
Kazumi Matsuda ◽  
Tadahiro Mihara ◽  
Naotaka Usui ◽  
Koichi Baba ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Antiepileptic Drugs ◽  
Epilepsy Surgery ◽  
Social Engagement ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Seizure Outcome ◽  
Neoplastic Lesions ◽  
The Mean

OBJECTIVEThe aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier.METHODSBetween 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe.RESULTSFor 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome.CONCLUSIONSThe seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.

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

PLoS ONE ◽  
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.

scholarly journals Long‐term seizure outcome after epilepsy surgery in patients with mild malformation of cortical development and focal cortical dysplasia

2018 ◽  
Vol 4 (1) ◽  
pp. 170-175 ◽  
Author(s):  
Tim J. Veersema ◽  
Banu Swampillai ◽  
Cyrille H. Ferrier ◽  
Pieter Eijsden ◽  
Peter H. Gosselaar ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Focal Cortical Dysplasia ◽  
Cortical Development ◽  
Cortical Dysplasia ◽  
Seizure Outcome ◽  
Malformation Of Cortical Development

Epilepsy Surgery in Children with Focal Cortical Dysplasia (FCD): Results of Long-Term Seizure Outcome

2002 ◽  
Vol 33 (1) ◽  
pp. 21-26 ◽  
Author(s):  
S. Kloss ◽  
T. Pieper ◽  
H. Pannek ◽  
H. Holthausen ◽  
I. Tuxhorn
Keyword(s):  
Epilepsy Surgery ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Seizure Outcome

Predictors of postoperative long-term seizure outcome in pediatric patients with focal cortical dysplasia type II at a German tertiary epilepsy center

2021 ◽  
pp. 1-9
Author(s):  
Abdallah Salemdawod ◽  
Johannes Wach ◽  
Mohammed Banat ◽  
Valeri Borger ◽  
Motaz Hamed ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Patients ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Complete Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Type Ii ◽  
Younger Age

OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of early-onset intractable epilepsy, and resection is a highly sufficient treatment option. In this study, the authors aimed to provide a retrospective analysis of pre- and postoperative factors and their impact on postoperative long-term seizure outcome. METHODS The postoperative seizure outcomes of 50 patients with a mean age of 8 ± 4.49 years and histologically proven FCD type II were retrospectively analyzed. Furthermore, pre- and postoperative predictors of long-term seizure freedom were assessed. The seizure outcome was evaluated based on the International League Against Epilepsy (ILAE) classification. RESULTS Complete resection of FCD according to MRI criteria was achieved in 74% (n = 37) of patients. ILAE class 1 at the last follow-up was achieved in 76% (n = 38) of patients. A reduction of antiepileptic drugs (AEDs) to monotherapy or complete withdrawal was achieved in 60% (n = 30) of patients. Twelve patients (24%) had a late seizure recurrence, 50% (n = 6) of which occurred after reduction of AEDs. A lower number of AEDs prior to surgery significantly predicted a favorable seizure outcome (p = 0.013, HR 7.63). Furthermore, younger age at the time of surgery, shorter duration of epilepsy prior to surgery, and complete resection were positive predictors for long-term seizure freedom. CONCLUSIONS The duration of epilepsy, completeness of resection, number of AEDs prior to surgery, and younger age at the time of surgery served as predictors of postoperative long-term seizure outcome, and, as such, may improve clinical practice when selecting and counseling appropriate candidates for resective epilepsy surgery. The study results also underscored that epilepsy surgery should be considered early in the disease course of pediatric patients with FCD type II.

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

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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