Surgical outcomes in children with bottom-of-sulcus dysplasia and drug-resistant epilepsy: a retrospective cohort study

OBJECTIVE Bottom-of-sulcus dysplasia (BOSD) is challenging to identify radiologically. The aim of this study was to explore seizure outcomes after resective surgery or MR-guided laser interstitial thermal therapy (MRgLITT) in children with BOSD. METHODS Children with radiologically defined BOSD who underwent resective surgery or MRgLITT, with at least 1 year of follow-up were included. Clinical, radiological, neurophysiological, and histological data were extracted from medical records. Invasive video EEG (IVEEG) was used to evaluate the ictal onset zone or motor/language mapping, wherever appropriate. Histology of MRI-visible BOSD, including the overlying and adjacent cortex, was also evaluated. RESULTS Forty-one children with BOSD underwent surgical treatment. The lesion was initially overlooked on MRI in 20 patients (48.8%). Of 34 patients who underwent IVEEG and who had available ictal data, the ictal onset zone extended beyond the MRI-visible BOSD in 23 patients (67.6%). Surgical treatment included lesionectomy (24 patients), extended lesionectomy (12 patients), lobectomy (1 patient), and ablation of BOSD (4 patients). The pathology in 37 patients who underwent resection showed focal cortical dysplasia type IIB and type IIA in 21 (53.8%) and 16 patients (41%), respectively. Seizure freedom was achieved in 32 patients (78.1%) after a mean follow-up of 4.3 years. CONCLUSIONS Seizure outcomes after resective surgery or MRgLITT in children with BOSD were generally favorable. The authors found that the neurophysiological abnormality and pathology often extended beyond the MRI-visible BOSD.

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Surgical treatment of drug resistant epilepsy in Sturge-Weber syndrome: review of the literature and clinical case presentation

Epilepsia and paroxyzmal conditions ◽

10.17749/2077-8333.2019.11.1.53-62 ◽

2019 ◽

Vol 11 (1) ◽

pp. 53-62

Author(s):

G. S. Ibatova ◽

S. K. Akshulakov ◽

S. M. Malyshev ◽

R. G. Khachatryan ◽

T. M. Alekseeva ◽

...

Keyword(s):

Surgical Treatment ◽

Medical Records ◽

Clinical Manifestations ◽

Epileptic Seizures ◽

Positive Outcomes ◽

Class Iii ◽

Case Presentation ◽

Weber Syndrome ◽

Sturge Weber Syndrome ◽

Drug Resistant Epilepsy

The paper addresses the relatively rare inherited neurodermal disorder – Sturge-Weber syndrome that can manifest in epileptic seizures. We describe updated concepts, epidemiology, etiology, pathogenesis, clinical manifestations, and surgical treatment of the disease. We examined medical records of 21 patients (aged from 1 to 11 years) with Sturge-Weber syndrome treated over the period of 1996-2016. After surgical treatment of 10 patients (five cases with hemispheretomy and five – with multifocal resection), positive outcomes (Engel class I, II) were found in 70% of cases, and negative (Engel class III, IV) – in 20% of cases. Оne child suddenly died during epileptic seizures. In non-operated children (age from 2 to 5 years) under our observation, an improvement was noted in six cases, no changes – in three cases, and a further progression of the disease – in three cases. In this article, we analyze two of these cases in detail.

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Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000919 ◽

2015 ◽

Vol 77 (5) ◽

pp. 762-768 ◽

Cited By ~ 16

Author(s):

Christian von der Brelie ◽

Matthias Simon ◽

Jonas Esche ◽

Johannes Schramm ◽

Azize Boström

Keyword(s):

Life Quality ◽

Seizure Outcome ◽

Seizure Freedom ◽

Common Symptom ◽

Extensive Resection ◽

Chronic Epilepsy ◽

Epilepsy Classification ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

Abstract BACKGROUND: Epilepsy is the second most common symptom in cerebral arteriovenous malformation (AVM) patients. The consecutive reduction of life quality is a clinically underrated problem because treatment usually focuses on the prevention of intracerebral hemorrhage. OBJECTIVE: To evaluate postoperative seizure outcome with the aim of more accurate counseling for postoperative seizure outcome. METHODS: From 1985 to 2012, 293 patients with an AVM were surgically treated by J.S. One hundred twenty-six patients with preoperative seizures or epilepsy could be identified; 103 of 126 had a follow-up of at least 12 months and were included in the analysis. The different epilepsy subtypes were categorized (sporadic seizures, chronic epilepsy, drug-resistant epilepsy [DRE]). Preoperative workup and surgical technique were evaluated. Seizure outcome was analyzed by using International League Against Epilepsy classification. RESULTS: Sporadic seizures were identified in 41% of patients (chronic epilepsy and DRE were identified in 36% and 23%, respectively). Detailed preoperative epileptological workup was done in 13%. Seizure freedom was achieved in 77% (79% at 5 years, 84% at 10 years). Outcome was significantly poorer in DRE cases. More extensive resection was performed in 11 cases with longstanding symptoms (>24 months) and resulted in better seizure outcome as well as the short duration of preoperative seizure history. CONCLUSION: Patients presenting with AVM-associated epilepsy have a favorable seizure outcome after surgical treatment. Long-standing epilepsy and the progress into DRE markedly deteriorate the chances to obtain seizure freedom and should be considered an early factor in establishing the indication for AVM removal.

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Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i1.138 ◽

2019 ◽

Vol 13 (1) ◽

pp. 108-115

Author(s):

Nael Husain Zaer

Keyword(s):

Drug Resistance ◽

Medical History ◽

Refractory Epilepsy ◽

Seizure Freedom ◽

Drug Resistant ◽

Past Medical History ◽

Number Of Patients ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed. Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy. Type of the study: This is a retrospective study. Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up. Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient. Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

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Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

10.47363/jcrr/2021(3)145 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1-4

Author(s):

Vanessa Rebelo dos Santos ◽

◽

Carlota Ramos ◽

Rafael Cruz ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Surgical Approach ◽

Medical Records ◽

Surgical Intervention ◽

Female Gender ◽

The Body ◽

Head Of The Pancreas ◽

The Mean

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

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Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia: A Systematic Review and Meta-analysis

Neurology ◽

10.1212/wnl.0000000000013066 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013066

Author(s):

Anna Willard ◽

Ana Antonic-Baker ◽

Zhibin Chen ◽

Terence John O'Brien ◽

Patrick Kwan ◽

...

Keyword(s):

Systematic Review ◽

Focal Cortical Dysplasia ◽

Meta Analysis ◽

Cortical Dysplasia ◽

Favorable Outcome ◽

Seizure Outcome ◽

Drug Resistant ◽

Resective Surgery ◽

Post Surgery ◽

Drug Resistant Epilepsy

Objective:Focal cortical dysplasia (FCD) has been associated with poorer post-surgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histological diagnosis, including patients with abnormal as well as normal pre-operative MRI. However, in clinical workflow, patient selection for surgery is based on pre-operative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.Methods:We devised our study protocol in accordance with PRISMA guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel Class I, ILAE Classes 1-2, or “seizure-free” status. Meta-regression was performed to investigate sources of heterogeneity.Results:Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed patients for ≥24 months post-surgery. The overall post-surgical favorable outcome rate was 70% (95% CI: 64-75). There was high inter-study heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion [risk ratio, RR=2.42 (95% CI: 1.55-3.76), p<0.001] and location of the FCD lesion in the temporal lobe [RR=1.38 (95% CI: 1.07-1.79), p=0013], but not lesion extent, intracranial EEG use, or FCD histological type. The number of FCD histological types included in the same study accounted for 7.6% of the observed heterogeneity.Conclusions:70% of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome following resective surgery. Our findings can be incorporated in routine pre-operative counselling and reinforce the importance of resecting completely the MRI-detected FCD where this is safe and feasible.

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Over 10-Year Outcomes of Infantile-Onset Epilepsies

Journal of Clinical Medicine ◽

10.3390/jcm10030430 ◽

2021 ◽

Vol 10 (3) ◽

pp. 430

Author(s):

Hyun-Jin Kim ◽

Han Na Jang ◽

Hyunji Ahn ◽

Mi-Sun Yum ◽

Tae-Sung Ko

Keyword(s):

Medical Records ◽

Medical Center ◽

Neurological Deficits ◽

Seizure Freedom ◽

Neuropsychiatric Complications ◽

Intractable Seizures ◽

Tertiary Center ◽

Long Term Follow Up ◽

Asan Medical

Seizures in infancy have highly variable courses and underlying etiologies. However, there are only a few long-term follow-up studies regarding infantile-onset epilepsy. Therefore, we aimed to describe the clinical courses, seizure outcomes, and risk factors of infantile-onset epilepsy followed up for more than 10 years in a tertiary center. Methods: Data of the patients with epilepsy, diagnosed under the age of 12 months and followed up for more than 10 years, were retrieved from the electronic medical records of Asan Medical Center Children’s Hospital. The patients’ medical records were retrospectively reviewed, and clinical outcomes were assessed based on the duration of seizure freedom at the last follow-up. Results: Of the 146 patients, 103 (70.5%) entered at least one remission, of whom epilepsy was resolved in 46 (31.5%). Forty-nine (33.6%) were found to be intractable at last contact. Delayed development, neurological deficits, and later onset (>3 months) were significantly associated with intractable epilepsies (p < 0.01). Conclusions: This study demonstrated that many patients with infantile-onset epilepsy can experience seizure remission. However, in some cases, early onset epilepsy was highly associated with various comorbidities and intractable seizures. Therefore, appropriate diagnosis and treatment are necessary to prevent further neuropsychiatric complications.

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Determinants of seizure outcome after resective surgery following stereoelectroencephalography

Journal of Neurosurgery ◽

10.3171/2021.6.jns204413 ◽

2021 ◽

pp. 1-9

Author(s):

Juan C. Bulacio ◽

James Bena ◽

Piradee Suwanpakdee ◽

Dileep Nair ◽

Ajay Gupta ◽

...

Keyword(s):

Temporal Lobe ◽

Univariate Analysis ◽

Cleveland Clinic ◽

Secondary Outcome ◽

Seizure Outcome ◽

Seizure Freedom ◽

Outcome Predictors ◽

Seizure Recurrence ◽

Resective Surgery

OBJECTIVE The aim of this study was to investigate seizure outcomes after resective epilepsy surgery following stereoelectroencephalography (SEEG), including group characteristics, comparing surgical and nonsurgical groups and assess predictors of time to seizure recurrence. METHODS Clinical and EEG data of 536 consecutive patients who underwent SEEG at Cleveland Clinic Epilepsy Center between 2009 and 2017 were reviewed. The primary outcome was defined as complete seizure freedom since the resective surgery, discounting any auras or seizures that occurred within the 1st postoperative week. In addition, the rate of seizure freedom based on Engel classification was determined in patients with follow-up of ≥ 1 year. Presumably significant outcome variables were first identified using univariate analysis, and Cox proportional hazards modeling was used to identify outcome predictors. RESULTS Of 527 patients satisfying study criteria, 341 underwent resective surgery. Complete and continuous seizure freedom after surgery was achieved in 55.5% of patients at 1 year postoperatively, 44% of patients at 3 years, and 39% of patients at 5 years. As a secondary outcome point, 58% of patients achieved Engel class I seizure outcome for at least 1 year at last follow-up. Among surgical outcome predictors, in multivariate model analysis, the seizure recurrence rate by type of resection (p = 0.039) remained statistically significant, with the lowest risk of recurrence occurring after frontal and temporal lobe resections compared with multilobar and posterior quadrant surgeries. Patients with a history of previous resection (p = 0.006) and bilateral implantations (p = 0.023) were more likely to have seizure recurrence. The absence of an MRI abnormality prior to resective surgery did not significantly affect seizure outcome in this cohort. CONCLUSIONS This large, single-center series shows that resective surgery leads to continuous seizure freedom in a group of patients with complex and severe pharmacoresistant epilepsy after SEEG evaluation. In addition, up to 58% of patients achieved seizure freedom at last follow-up. The authors’ results suggest that SEEG is equally effective in patients with frontal and temporal lobe epilepsy with or without MRI identified lesions.

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Tailored multilobar disconnective epilepsy surgery in the posterior quadrant

Journal of Neurosurgery ◽

10.3171/2019.1.jns183103 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1345-1357 ◽

Cited By ~ 3

Author(s):

Michele Rizzi ◽

Martina Revay ◽

Piergiorgio d’Orio ◽

Pina Scarpa ◽

Valeria Mariani ◽

...

Keyword(s):

Safety Profile ◽

Class I ◽

Seizure Outcome ◽

Seizure Freedom ◽

Type I ◽

Drug Resistant ◽

Presurgical Evaluation ◽

Posterior Quadrant ◽

Drug Resistant Epilepsy

OBJECTIVESurgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disconnective approach; only small series with short postoperative follow-ups have been reported. The aim of the present study was to present a tailored approach to multilobar PQ disconnections (MPQDs) for epilepsy and to provide details about selection of patients, presurgical investigations, surgical technique, treatment safety profile, and seizure and cognitive outcome in a large, single-center series of patients with a long-term follow-up.METHODSIn this retrospective longitudinal study, the authors searched their prospectively collected database for patients who underwent MPQD for drug-resistant epilepsy in the period of 2005–2017. Tailored MPQDs were a posteriori grouped as follows: type I (classic full TPO disconnection), type II (partial TPO disconnection), type III (full temporooccipital [TO] disconnection), and type IV (partial TO disconnection), according to the disconnection plane in the occipitoparietal area. A bivariate statistical analysis was carried out to identify possible predictors of seizure outcome (Engel class I vs classes II–IV) among several presurgical, surgical, and postsurgical variables. Preoperative and postoperative cognitive profiles were also collected and evaluated.RESULTSForty-two consecutive patients (29 males, 24 children) met the inclusion criteria. According to the presurgical evaluation (including stereo-electroencephalography in 13 cases), 12 (28.6%), 24 (57.1%), 2 (4.8%), and 4 (9.5%) patients received a type I, II, III, or IV MPQD, respectively. After a mean follow-up of 80.6 months, 76.2% patients were in Engel class I at last contact; at 6 months and 2 and 5 years postoperatively, Engel class I was recorded in 80.9%, 74.5%, and 73.5% of cases, respectively. Factors significantly associated with seizure freedom were the occipital pattern of seizure semiology and the absence of bilateral interictal epileptiform abnormalities at the EEG (p = 0.02). Severe complications occurred in 4.8% of the patients. The available neuropsychological data revealed postsurgical improvement in verbal domains, whereas nonunivocal outcomes were recorded in the other functions.CONCLUSIONSThe presented data indicate that the use of careful anatomo-electro-clinical criteria in the presurgical evaluation allows for customizing the extent of surgical disconnections in PQ epilepsies, with excellent results on seizures and an acceptable safety profile.

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Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective?

Journal of Neurosurgery ◽

10.3171/2019.4.jns1912 ◽

2020 ◽

Vol 133 (4) ◽

pp. 950-959

Author(s):

Alain Bouthillier ◽

Alexander G. Weil ◽

Laurence Martineau ◽

Laurent Létourneau-Guillon ◽

Dang Khoa Nguyen

Keyword(s):

Surgical Treatment ◽

Frontal Lobe ◽

Seizure Control ◽

Refractory Epilepsy ◽

Seizure Outcome ◽

Seizure Freedom ◽

Invasive Monitoring ◽

Seizure Semiology ◽

Intracranial Electrodes

OBJECTIVEPatients with refractory epilepsy of operculoinsular origin are often denied potentially effective surgical treatment with operculoinsular cortectomy (also termed operculoinsulectomy) because of feared complications and the paucity of surgical series with a significant number of cases documenting seizure control outcome. The goal of this study was to document seizure control outcome after operculoinsular cortectomy in a group of patients investigated and treated by an epilepsy team with 20 years of experience with this specific technique.METHODSClinical, imaging, surgical, and seizure control outcome data of all patients who underwent surgery for refractory epilepsy requiring an operculoinsular cortectomy were retrospectively reviewed. Tumors and progressive encephalitis cases were excluded. Descriptive and uni- and multivariate analyses were done to determine seizure control outcome and predictors.RESULTSForty-three patients with 44 operculoinsular cortectomies were studied. Kaplan-Meier estimates of complete seizure freedom (first seizure recurrence excluding auras) for years 0.5, 1, 2, and 5 were 70.2%, 70.2%, 65.0%, and 65.0%, respectively. With patients with more than 1 year of follow-up, seizure control outcome Engel class I was achieved in 76.9% (mean follow-up duration 5.8 years; range 1.25–20 years). With multivariate analysis, unfavorable seizure outcome predictors were frontal lobe–like seizure semiology, shorter duration of epilepsy, and the use of intracranial electrodes for invasive monitoring. Suspected causes of recurrent seizures were sparing of the language cortex part of the focus, subtotal resection of cortical dysplasia/polymicrogyria, bilateral epilepsy, and residual epileptic cortex with normal preoperative MRI studies (insula, frontal lobe, posterior parieto-temporal, orbitofrontal).CONCLUSIONSThe surgical treatment of operculoinsular refractory epilepsy is as effective as epilepsy surgeries in other brain areas. These patients should be referred to centers with appropriate experience. A frontal lobe–like seizure semiology should command more sampling with invasive monitoring. Recordings with intracranial electrodes are not always required if the noninvasive investigation is conclusive. The complete resection of the epileptic zone is crucial to achieve good seizure control outcome.

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Sulcus-centered resection for focal cortical dysplasia type II: surgical techniques and outcomes

Journal of Neurosurgery ◽

10.3171/2020.5.jns20751 ◽

2020 ◽

pp. 1-7

Author(s):

Baotian Zhao ◽

Chao Zhang ◽

Xiu Wang ◽

Yao Wang ◽

Chang Liu ◽

...

Keyword(s):

Focal Cortical Dysplasia ◽

Surgical Techniques ◽

Cortical Dysplasia ◽

Neurological Deficits ◽

Type Ii ◽

Motor Weakness ◽

Resective Surgery ◽

Electrophysiological Recordings ◽

Technical Details

Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection is to remove the folded gray matter surrounding a dysplastic sulcus, particularly that at the bottom of the sulcus. The authors also retrospectively reviewed the records of 88 consecutive patients with FCD II treated with resective surgery between January 2015 and December 2018. The demographics, clinical characteristics, electrophysiological recordings, neuroimaging studies, histopathological findings, surgical outcomes, and complications were collected. After the exclusion of diffusely distributed and gyrus-based lesions, 71 patients (30 females, 41 males) who had undergone sulcus-centered resection were included in this study. The mean (± standard deviation) age of the cohort was 17.78 ± 10.54 years (38 pediatric patients, 33 adults). Thirty-five lesions (49%) were demonstrated on MRI; 42 patients (59%) underwent stereo-EEG monitoring before resective surgery; and 37 (52%) and 34 (48%) lesions were histopathologically proven to be FCD IIa and IIb, respectively. At a mean follow-up of 3.34 ± 1.17 years, 64 patients (90%) remained seizure free, and 7 (10%) had permanent neurological deficits including motor weakness, sensory deficits, and visual field deficits. The study findings showed that in carefully selected FCD II cases, sulcus-centered resection is an effective and safe surgical strategy.

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