Outcomes of cingulate epilepsy surgery: insights from an institutional and patient-level systematic review and meta-analysis

2021 ◽  
pp. 1-10
Author(s):  
Panagiotis Kerezoudis ◽  
Rohin Singh ◽  
Gregory A. Worrell ◽  
Jamie J. Van Gompel
Keyword(s):  
Epilepsy Surgery ◽  
Literature Search ◽  
Anterior Cingulate ◽  
Postoperative Outcomes ◽  
Cochrane Library ◽  
Rank Test ◽  
Seizure Freedom ◽  
Low Grade ◽  
Cingulate Gyrus

OBJECTIVE Due to their deep and medial location, range of seizure semiologies, and poor localization on ictal electroencephalography (EEG), cingulate gyrus seizures can be difficult to diagnose and treat. The aim of this study was to review the available evidence on postoperative outcomes after cingulate epilepsy surgery. METHODS A comprehensive literature search of the PubMed/MEDLINE, Ovid Embase, Ovid Scopus, and Cochrane Library databases was conducted to identify studies that investigated postoperative outcomes of patients with cingulate epilepsy. Seizure freedom at the last follow-up (at least 12 months) was the primary endpoint. The literature search was supplemented by the authors’ institutional series (4 patients). RESULTS Twenty-one studies were identified, yielding a total of 105 patients (68 with lesional epilepsy [65%]). Median age at surgery was 23 years, and 56% of patients were male. Median epilepsy duration was 7.5 years. Invasive EEG recording was performed on 69% of patients (53% of patients with lesional epilepsy and 97% of those with nonlesional epilepsy, p < 0.001). The most commonly resected region was the anterior cingulate (55%), followed by the posterior (17%) and middle (14%) cingulate. Lesionectomy alone was performed in 9% of patients. Additional extracingulate treatment was performed in 54% of patients (53% of patients with lesional epilepsy vs 57% of those with nonlesional epilepsy, p = 0.87). The most common pathology was cortical dysplasia (54%), followed by low-grade neoplasm (29%) and gliosis (8%). Seizure freedom was noted in 72% of patients (median follow-up 24 months). A neurological deficit was noted in 27% of patients (24% had temporary deficit), with the most common deficit being motor weakness (13%) followed by supplementary motor area syndrome (9.5%). Univariate survival analysis revealed significantly greater probability of seizure freedom in patients with lesional epilepsy (p = 0.015, log-rank test). CONCLUSIONS Surgical treatment of drug-resistant focal epilepsy originating from the cingulate gyrus is safe, leads to low rates of permanent adverse effects, and leads to high rates of long-term seizure freedom in carefully selected patients. These data may serve as a benchmark for surgical counseling of patients with cingulate epilepsy.

Insular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Panagiotis Kerezoudis ◽  
Rohin Singh ◽  
Anshit Goyal ◽  
Gregory A. Worrell ◽  
W. Richard Marsh ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Meta Analysis ◽  
Univariate Analysis ◽  
Brain Regions ◽  
Lessons Learned ◽  
Postoperative Outcomes ◽  
Seizure Freedom ◽  
Low Grade ◽  
Current Series

OBJECTIVE Insular lobe epilepsy is a challenging condition to diagnose and treat. Due to anatomical intricacy and proximity to eloquent brain regions, resection of epileptic foci in that region can be associated with significant postoperative morbidity. The aim of this study was to review available evidence on postoperative outcomes following insular epilepsy surgery. METHODS A comprehensive literature search (PubMed/MEDLINE, Scopus, Cochrane) was conducted for studies investigating the postoperative outcomes for seizures originating in the insula. Seizure freedom at last follow-up (at least 12 months) comprised the primary endpoint. The authors also present their institutional experience with 8 patients (4 pediatric, 4 adult). RESULTS A total of 19 studies with 204 cases (90 pediatric, 114 adult) were identified. The median age at surgery was 23 years, and 48% were males. The median epilepsy duration was 8 years, and 17% of patients had undergone prior epilepsy surgery. Epilepsy was lesional in 67%. The most common approach was transsylvian (60%). The most commonly resected area was the anterior insular region (n = 42, 21%), whereas radical insulectomy was performed in 13% of cases (n = 27). The most common pathology was cortical dysplasia (n = 68, 51%), followed by low-grade neoplasm (n = 16, 12%). In the literature, seizure freedom was noted in 60% of pediatric and 69% of adult patients at a median follow-up of 29 months (75% and 50%, respectively, in the current series). A neurological deficit occurred in 43% of cases (10% permanent), with extremity paresis comprising the most common deficit (n = 35, 21%), followed by facial paresis (n = 32, 19%). Language deficits were more common in left-sided approaches (24% vs 2%, p < 0.001). Univariate analysis for seizure freedom revealed a significantly higher proportion of patients with lesional epilepsy among those with at least 12 months of follow-up (77% vs 59%, p = 0.032). CONCLUSIONS These findings may serve as a benchmark when tailoring decision-making for insular epilepsy, and may assist surgeons in their preoperative discussions with patients. Although seizure freedom rates are quite high with insular epilepsy treatment, the associated morbidity needs to be weighed against the potential for seizure freedom.

scholarly journals Epilepsziasebészeti beavatkozások eredményei a Pécsi Epilepszia Centrumban 2005 és 2016 között

2019 ◽  
Vol 160 (7) ◽  
pp. 270-278 ◽  
Author(s):  
Katalin Nóra Lőrincz ◽  
Beáta Bóné ◽  
Márton Tóth ◽  
Réka Horváth ◽  
Norbert Kovács ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Epilepsy Surgery ◽  
Employment Status ◽  
Postoperative Outcome ◽  
Seizure Freedom ◽  
Neurologic Disease ◽  
Exact Test ◽  
Epileptic Patients

Abstract: Introduction: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. Aim: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. Method: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. Results: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher’s exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. Conclusion: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270–278.

scholarly journals Results of Epilepsy Surgery: Still So Much to Learn

2006 ◽  
Vol 6 (3) ◽  
pp. 80-82
Author(s):  
Donna C. Bergen
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Epilepsy Surgery ◽  
Disease Duration ◽  
Seizure Freedom ◽  
Hippocampal Atrophy ◽  
Younger Age ◽  
Seizure Relapse ◽  
Clonic Seizures

Predicting Long-Term Seizure Outcome after Resective Epilepsy Surgery: The Multicenter Study Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S, Langfitt JT, Walczak TS, Pacia SV Neurology 2005;65(6):912–918 Background In a seven-center prospective observational study of resective epilepsy surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse. Methods Patients aged 12 years and over were enrolled at time of referral for epilepsy surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using χ2 and proportional hazards analysis. Results Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic–clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients. Conclusion Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections. Antiepileptic Drug Withdrawal after Successful Surgery for Intractable Temporal Lobe Epilepsy Kim YD, Heo K, Park SC, Huh K, Chang JW, Choi JU, Chung SS, Lee BI Epilepsia 2005;46(2):251–257 Purpose To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction ( n = 60), and in 7 (12%) patients after discontinuation of AEDs ( n = 38). The seizure recurrence rate was not different between the immediate- and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, 9 (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in 6 of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

Epilepsy Surgery of the Cingulate Gyrus and the Frontomesial Cortex

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 900-910 ◽  
Author(s):  
Marec von Lehe ◽  
Jan Wagner ◽  
Joerg Wellmer ◽  
Hans Clusmann ◽  
Thomas Kral
Keyword(s):  
Epilepsy Surgery ◽  
Supplementary Motor Area ◽  
Focal Epilepsy ◽  
Case Reports ◽  
Motor Area ◽  
Seizure Outcome ◽  
Cingulate Gyrus ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND: Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. OBJECTIVE: To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment. METHODS: Twenty-two patients (mean age, 36; range, 12–63) with a mean seizure history of 23 years (range, 2–52) were retrospectively analyzed. We report presurgical diagnostics, surgical strategy, and postoperative follow-up concerning functional morbidity and seizures (mean follow-up, 86 months; range, 25–174). RESULTS: Nineteen patients showed potential epileptogenic lesions on preoperative magnetic resonance imaging (MRI). All patients had noninvasive presurgical workup; 15 (68%) underwent invasive Video-electroencephalogram (EEG)-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG results was done in 6 patients. In 4 patients, the resection was incomplete because of the involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, 3 in the posterior cingulate gyrus) and 14 extended supracingular frontal resections were performed. Nine patients experienced temporary postoperative supplementary motor area syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Postoperatively, 62% of patients were seizure-free (International League Against Epilepsy [ILAE] 1), and 76% had a satisfactory seizure outcome (ILAE 1–3). CONCLUSION: Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.

Hormonal treatment of metastatic endometrial stromal sarcoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16576-e16576
Author(s):  
K. Y. Terada ◽  
J. Davis ◽  
J. Kitayama ◽  
D. Shimizu
Keyword(s):  
Aromatase Inhibitors ◽  
Stable Disease ◽  
Progesterone Receptors ◽  
Rank Test ◽  
Low Grade ◽  
Image Analyzer ◽  
High Grade ◽  
Estrogen And Progesterone Receptors ◽  
Significant Difference

e16576 Background: Endometrial stromal sarcomas (ESS) traditionally have been classified as low grade or high grade based on mitotic activity and histologic appearance. High-grade tumors are currently referred to as undifferentiated uterine sarcomas and are not included in this series. ESS are known to have high expression of estrogen and progesterone receptors. This is a retrospective study of patients with metastatic ESS treated with hormonal therapy. Methods: Following approval by the institutional review board all patients diagnosed with ESS from 1987–2007 were identified. Clinical and demographic information were abstracted from the charts and all histologic materials were re-reviewed. Estrogen and progesterone receptor testing was performed utilizing mouse monoclonal antibodies and the Cell Analysis Systems 200 Image analyzer. Survival was calculated using the Kaplan-Meier method and comparisons utilized the log rank test. Results: Thirteen patients with ESS were identified during this period. Seven had disease confined to the uterus. Six had extrauterine disease; 5 patients presented with metastases and 1 patient presented with a pelvic recurrence 20 years following a hysterectomy. All underwent surgical resection except for 1 patient that declined surgery. All 6 patients with metastases had tumors that tested positive for estrogen and progesterone receptors; all were treated with megestrol acetate initially for a period of 1–4 years. Two patients were then changed to maintenance with medroxyprogesterone acetate. Three patients with persistent disease were changed to aromatase inhibitors; 1 to letrozole and 2 to anastrazole. One of these patients has had a complete response and 2 have had stable disease. One patient has been lost to follow-up. Follow-up for the 6 patients was 2–22 years; no known patients died of their disease. Actuarial 2- and 5-year survivals were 80% and 65%, respectively. There was no significant difference in survival between patients with metastases and without metastases. Conclusions: ESS tumors are relatively uncommon and there is an absence of studies to guide treatment of patients with metastases. This experience indicates that these tumors respond well to hormonal manipulation. Treatment with progestins or aromatase inhibitors may result in remission or stable disease. No significant financial relationships to disclose.

scholarly journals Psychosis and Violence: Stories, Fears, and Reality

2008 ◽  
Vol 53 (10) ◽  
pp. 647-659 ◽  
Author(s):  
Pamela J Taylor
Keyword(s):  
Literature Search ◽  
Cochrane Library ◽  
Significant Relation ◽  
Manual Search ◽  
Violent Acts ◽  
Victims Of Violence ◽  
Almost All ◽  
The Cochrane Library ◽  
Substantial Change

Individuals with psychosis are often feared. In fact, they are themselves likely to be victims of violence; however, the main aim of this review is to provide an overview of the evidence on relations between psychosis and violence to others. The terms psychosis and violence were used in a literature search limited to the Cochrane Library and PubMed, a manual search of 8 journals, and a follow-up of additional references in the articles found. The overview draws on new empirical data and major reviews. Almost all sound epidemiologic data on psychosis and violence dates from 1990. There is consistency on a small but significant relation between schizophrenia and violent acts. Since then there has also been movement toward understanding the nature of associations and progress on strategies for managing individuals who have psychosis and are violent. Public fears about individuals with psychotic illnesses are largely unfounded, although there would be benefit in greater attention to the safety of those in their close social circle. The task for the next 10 years must be the development and application of knowledge to improve specific treatments—that is, interventions that go beyond holding and caring to bring about substantial change.

scholarly journals Blinded study: prospectively defined high frequency oscillations predict seizure outcome in individual patients

2020 ◽  
Author(s):  
V Dimakopoulos ◽  
P Mégevand ◽  
E Boran ◽  
S Momjian ◽  
M Seeck ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
High Frequency ◽  
Dwell Time ◽  
Nrem Sleep ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
University Hospitals ◽  
High Frequency Oscillations ◽  
Depth Electrodes

AbstractBackgroundInterictal high frequency oscillations (HFO) are discussed as biomarkers for epileptogenic brain tissue that should be resected in epilepsy surgery to achieve seizure freedom. The prospective classification of tissue sampled by individual electrode contacts remains a challenge. We have developed an automated, prospective definition of clinically relevant HFO in intracranial EEG (iEEG) from MNI Montreal and tested it in iEEG from Zurich. We here validate the algorithm on iEEG recorded in an independent epilepsy center so that HFO analysis was blinded to seizure outcome.MethodsWe selected consecutive patients from Geneva University Hospitals who underwent resective epilepsy surgery with postsurgical follow-up > 12 months. We analyzed long-term iEEG recordings during non-rapid eye movement (NREM) sleep that we segmented into intervals of 5 min. HFOs were defined in the ripple (80-250 Hz) and the fast ripple (FR, 250-500 Hz) frequency band. Contacts with the highest rate of ripples co-occurring with FR (FRandR) designated the HFO area. If the HFO area was not fully resected and the patient suffered from recurrent seizures (ILAE 2-6), this was classified as a true positive (TP) prediction.ResultsWe included iEEG recordings from 16 patients (median age 32 y, range [18-53]) with stereotactic depth electrodes and/or with subdural electrode grids (median follow-up 27 mo, range [12-55]). The HFO area had high test-retest reliability across intervals (median dwell time 95%). We excluded two patients with dwell time < 50% from further analysis.The HFO area was fully included in the resected volume in 2/4 patients who achieved postoperative seizure freedom (ILAE 1, specificity 50%) and was not fully included in 9/10 patients with recurrent seizures (ILAE > 1, sensitivity 90%), leading to an accuracy of 79%.ConclusionsWe validated the automated procedure to delineate the clinical relevant HFO area in individual patients of an independently recorded dataset and achieved the same good accuracy as in our previous studies.SignificanceThe reproducibility of our results across datasets is promising for a multicienter study testing the clinical application of HFO detection to guide epilepsy surgery.

scholarly journals Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children

2020 ◽  
Vol 63 (5) ◽  
pp. 171-177
Author(s):  
Ara Ko ◽  
Joon Soo Lee
Keyword(s):  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Cognitive Outcomes ◽  
Optimal Time ◽  
Seizure Freedom ◽  
Low Grade ◽  
Neuroepithelial Tumors ◽  
Factors Associated ◽  
Younger Age ◽  
Poor Cognitive Function

Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are responsible for drug-resistant chronic focal epilepsy, and are the second-most common reason for epilepsy surgery in children. LEATs are extremely responsive to surgical treatment, and therefore epilepsy surgery should be considered as a treatment option for LEATs. However, the optimal time for surgery remains controversial, and surgeries are often delayed. In this review, we reviewed published article on the factors associated with seizure and cognitive outcomes after epilepsy surgery for LEATs in children to help clinicians in their decision whether to pursue epilepsy surgery for LEATs. The achievement of gross total resection may be the most important prognostic factor for seizure freedom. A shorter duration of epilepsy, a younger age at surgery, and extended resection of temporal lobe tumors have also been suggested as favorable prognostic factors in terms of seizure control. Poor cognitive function in children with LEATs is associated with a longer duration of epilepsy and a younger age at seizure onset.

Outcomes of epilepsy surgery in the older population: not too old, not too late

2021 ◽  
pp. 1-10
Author(s):  
Panagiotis Kerezoudis ◽  
Rohin Singh ◽  
Veronica Parisi ◽  
Gregory A. Worrell ◽  
Kai J. Miller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Mortality Rates ◽  
Temporal Lobectomy ◽  
Administrative Database ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Complication Rates ◽  
Older Population ◽  
Safety And Efficacy

OBJECTIVE The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients. METHODS The authors’ institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002–2018. Cases were grouped into 50–59, 60–69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016–2019). RESULTS A total of 73 patients (n = 16 for 50–59 years, n = 47 for 60–69, and n = 10 for 70+) were treated at the authors’ institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50–59 group, 77% for the 60–69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6–114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%–72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1–3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1–0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50–59, 60–69, and 70+ years, respectively. CONCLUSIONS While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.

scholarly journals Scalp and Intracranial EEG in Medically Intractable Extratemporal Epilepsy with Normal MRI

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Tarek Zakaria ◽  
Katherine Noe ◽  
Elson So ◽  
Gregory D. Cascino ◽  
Nicholas Wetjen ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Favorable Outcome ◽  
Rank Test ◽  
Seizure Freedom ◽  
Intracranial Eeg ◽  
Scalp Eeg ◽  
Kaplan Meier ◽  
Postoperative Seizure ◽  
Beta Frequency

Purpose. To investigate EEG and SPECT in the surgical outcome of patients with normal MRI (nonlesional) and extratemporal lobe epilepsy. Methods. We retrospectively identified 41 consecutive patients with nonlesional extratemporal epilepsy who underwent epilepsy surgery between 1997 and 2007. The history, noninvasive diagnostic studies (scalp EEG, MRI, and SPECT) and intracranial EEG (iEEG) monitoring was reviewed. Scalp and iEEG ictal onset patterns were defined. The association of preoperative studies and postoperative seizure freedom was analyzed using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard. Results. Thirty-six of 41 patients had adequate information with a minimum of 1-year followup. Favorable surgical outcome was identified in 49% of patients at 1 year, and 35% at 4-year. On scalp EEG, an ictal onset pattern consisting of focal beta-frequency discharge (>13–125 Hz) was associated with favorable surgical outcome (P=0.02). Similarly, a focal fast-frequency oscillation (>13–125 Hz) on iEEG at ictal onset was associated with favorable outcome (P=0.03). Discussion. A focal fast-frequency discharge at ictal onset identifies nonlesional MRI, extratemporal epilepsy patients likely to have a favorable outcome after resective epilepsy surgery.

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