Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis

Sastri, B.V. Savitr; Arivazhagan, A; Sinha, Sanjib; Mahadevan, Anita; Bharath, Rose Dawn; Saini, Jitender; Rajan, Jamuna; Kumar, J. Keshav; Rao, S.L.; Chandramouli, Balasubramanian; Shankar, Susarla Krishna; Satishchandra, P

doi:10.1016/j.jns.2014.03.026

Cited by 27 publications

(15 citation statements)

References 67 publications

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“…During the short‐term (2‐year) follow‐up, 89% of the patients with type 1 and 85% of those with type 2 had an Engel class I outcome, a higher success rate (only 11–15% outside class I) than that observed in other surgical series, although the outcomes were not as good when considering class Ia in both groups (respectively, 66% and 76%), with no significant difference between them. Differences in recruitment, classification, and outcome scales make it difficult to compare these findings with previously published data, but it can be said that they are similar to those of Blumcke et al., de Lanerolle et al., and Savitr Sastri et al., all of which showed that there is no significant short‐term difference in the percentage of class I outcomes between patients with different HS types, and the studies indicating a difference may have been affected by the small number of patients with type 2 …”

Section: Discussionsupporting

confidence: 52%

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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SUMMARYObjective: Hippocampal sclerosis (HS) is the most frequent neuropathologic finding in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). The International League Against Epilepsy (ILAE) has recently proposed a new classification of HS based on specific patterns of cell loss. The aim of this study was to investigate the relationships between HS types, their etiologic factors, and the short-and long-term postsurgical outcomes of patients undergoing surgery because of drug-resistant TLE with HS. Methods: Two hundred thirteen patients with a neuropathologic diagnosis of HS and a minimum follow-up of 2 years were divided on the basis of their ILAE HS type and further classified into: (1) isolated HS, (2) HS associated with focal cortical dysplasia (FCD IIIa), or (3) HS associated with other lesions. Their clinical and neuropathologic data were correlated with their Engel class postsurgical outcomes. Results: The main findings were the following: (1) HS type 1 was associated with a longer duration of epilepsy; (2) >80% of the patients had an Engel class I short-and long-term outcomes, regardless of HS type and associated pathology; (3) short-and long-term postsurgical outcomes were less satisfactory in the patients who were completely seizure-free (Engel class Ia), and patients with HS type 2 had better long-term seizure outcomes than those with type 1; (4) the concomitant presence of FCD contributed to a worse outcome, regardless of HS type; and (5) a shorter duration of epilepsy significantly correlated with an Engel class Ia outcome. Significance: These data suggest that HS type and associated pathologies may predict the risk of recurrence, but other variables such as the duration of epilepsy need to be considered. A common neuropathologic classification system may help to identify preoperative predictive factors and improve the selection of patients who may benefit from epilepsy surgery.

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Section: Discussionsupporting

confidence: 52%

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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“…Using the extensive epilepsy surgical literature regarding risk factors of poor surgical outcomes, presumably some from multifocal epilepsy as well as other sources of information such as the relevance of interictal discharges in predicting multifocal epilepsy found in this study allow for a reasonable estimate of a pretest probability. For example, if a patient is found to have unilateral temporal interictal discharges and concordant magnetic resonance imaging (MRI) evidence of hippocampal sclerosis, a reasonable pretest probability of multifocal seizures is 20% . If a patient has bilateral hippocampal changes, the postsurgical data would suggest the estimate would be closer to 50% .…”

Section: Discussionmentioning

confidence: 99%

The number of seizures needed in the EMU

et al. 2015

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Summary Objective The purpose of this study was to develop a quantitative framework to estimate the likelihood of multifocal epilepsy based on the number of unifocal seizures observed in the epilepsy monitoring unit (EMU). Methods Patient records from the EMU at Massachusetts General Hospital (MGH) from 2012 to 2014 were assessed for the presence of multifocal seizures as well the presence of multifocal interictal discharges and multifocal structural imaging abnormalities during the course of the EMU admission. Risk factors for multifocal seizures were assessed using sensitivity and specificity analysis. A Kaplan-Meier survival analysis was used to estimate the risk of multifocal epilepsy for a given number of consecutive seizures. To overcome the limits of the Kaplan-Meier analysis, a parametric survival function was fit to the EMU subjects with multifocal seizures and this was used to develop a Bayesian model to estimate the risk of multifocal seizures during an EMU admission. Results Multifocal interictal discharges were a significant predictor of multifocal seizures within an EMU admission with a p < 0.01, albeit with only modest sensitivity 0.74 and specificity 0.69. Multifocal potentially epileptogenic lesions on MRI were not a significant predictor p = 0.44. Kaplan-Meier analysis was limited by wide confidence intervals secondary to significant patient dropout and concern for informative censoring. The Bayesian framework provided estimates for the number of unifocal seizures needed to predict absence of multifocal seizures. To achieve 90% confidence for the absence of multifocal seizure, three seizures are needed when the pretest probability for multifocal epilepsy is 20%, seven seizures for a pretest probability of 50%, and nine seizures for a pretest probability of 80%. Significance These results provide a framework to assist clinicians in determining the utility of trying to capture a specific number of seizures in EMU evaluations of candidates for epilepsy surgery.

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“…Across patients, HS encompasses a broad spectrum of structural changes, which can be categorized into different subtypes based on neuropathological grading systems [Blumcke et al, ; Blümcke et al, ]. Previous findings have suggested an association between histopathological subtypes, postsurgical seizure outcomes, and postoperative memory impairment [Blümcke et al, ; Savitr Sastri et al, ; Thom et al, ].…”

Section: Introductionmentioning

confidence: 99%

In vivo MRI signatures of hippocampal subfield pathology in intractable epilepsy

Goubran

Bernhardt

Cantor-Rivera

et al. 2015

Human Brain Mapping

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Our aim is to assess the subfield-specific histopathological correlates of hippocampal volume and intensity changes (T1, T2) as well as diffusion MRI markers in TLE, and investigate the efficacy of quantitative MRI measures in predicting histopathology in vivo. We correlated in vivo volumetry, T2 signal, quantitative T1 mapping, as well as diffusion MRI parameters with histological features of hippocampal sclerosis in a subfield-specific manner. We made use of on an advanced co-registration pipeline that provided a seamless integration of preoperative 3T MRI with post-operative histopathological data, on which metrics of cell loss and gliosis were quantitatively assessed in CA1, CA2/3, and CA4/DG. MRI volumes across all subfields were positively correlated with neuronal density and size. Higher T2 intensity related to increased GFAP fraction in CA1, while quantitative T1 and diffusion MRI parameters showed negative correlations with neuronal density and/or size in CA4/DG/. Subfield-based multiple linear regression analysis revealed that in vivo multi-parametric MRI can predict neuronal loss in all subfields with up to 97% accuracy. Our results, based on an accurate co-registration pipeline and a subfield-specific analysis of MRI and histology, demonstrate the potential of MRI volumetry, diffusion, and quantitative T1 as accurate in vivo biomarkers of hippocampal subfield pathology.

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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis

Cited by 27 publications

References 67 publications

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

The number of seizures needed in the EMU

In vivo MRI signatures of hippocampal subfield pathology in intractable epilepsy

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