Factors predicting the outcome following medical treatment of mesial temporal epilepsy with hippocampal sclerosis

Sanchez, Javier; Centanaro, Mirella; Solís, Juanita; Delgado, Fabrizio; Yépez, Luis

doi:10.1016/j.seizure.2014.03.003

Cited by 29 publications

(24 citation statements)

References 35 publications

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“…In our study, 24.7% of patients exhibited seizure freedom of at least one year at most recent follow-up, in line with the 5% to 42% described in previous studies (Sànchez et al, 2014). There was no significant difference in prognosis associated with gender, laterality of lesion, history of CNS infections, history of head trauma, history of febrile seizures, history of cognitive impairment, family history of seizures, or current age.…”

Section: Discussionsupporting

confidence: 93%

“…However, pharmacoresistant MTS was associated with an earlier age of onset (13.72 vs 25.38), longer duration of epilepsy (31.13 years vs 21.62 years), greater number of current AEDs (2.1 vs 1.4), and greater number of total AED trials (4.50 vs 2.52). Previous studies have mixed results over the significance of these clinical and demographic factors in determining prognosis, but support has been shown for the association between poor outcome and earlier age of onset, longer duration of epilepsy, and greater number of failed AED trials (Kuzmanovski et al, 2016; Pittau et al, 2009; Sànchez et al, 2014; Varoglu et al, 2009). Importantly, the association of poor outcome with greater number of failed AED trials is in line with previous studies showing a poor response to therapy after the first or second AED trial (Dlugos et al, 2001; Kwan and Brodie, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, patients with MTLE-HS may remit and later relapse despite a period of seemingly adequate seizure control (Coan et al, 2015). Negative prognostic factors include earlier age at onset of epilepsy, bilateral or left-sided lesions, head injury at a young age, EEG abnormalities, and a large number of previously tried anti-epileptic drugs (AEDs) (Gomez-Ibañez et al, 2013; Sànchez et al, 2014). Studies are mixed regarding the role of gender in determining prognosis (Kuzmanovski et al, 2016; Varoglu et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

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Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

et al. 2017

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This study aims to evaluate the overall prognosis, prognostic factors, and efficacy of treatment in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who have access to third generation anti-epileptic drugs but not to epilepsy surgery. Eighty-five MTLE-HS patients were retrospectively placed into a seizure-free (seizure-free for >1 year) or drug-resistant group, and the two groups were compared on the basis of age, sex, age at onset of seizures, duration of epilepsy, side of lesion, handedness, EEG findings, history of CNS infection, history of febrile convulsions, history of head trauma, history of cognitive impairment, family history of seizures, number of current anti-epileptic drugs (AEDs), total number of AED trials, and presence of individual AEDs. Only 24.7% of MTLE-HS patients had achieved seizure freedom for >1 year. Poor prognosis and drug-resistance were associated with younger age at onset of seizures (p=0.002), longer duration of epilepsy (p=0.018), greater number of current AEDs (p<0.001), and greater total number of AED trials (p<0.001). In addition, regimens with newer AEDs had no greater efficacy than regimens with older AEDs. Most medically managed MTLE-HS patients do not achieve seizure freedom despite multiple AED trials, and treatment with third generation AEDs should not preclude evaluation for epilepsy surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

et al. 2017

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“…Unusual foci are located at different places and the features of the patients do not indicate a specific sub-type. A comparison of an AED-resistant MTLE group with a non-resistant group showed that inter-ictal epileptic or nonspecific anomalies have an effect on prognosis (18,19). However, in our study it was interesting that there was no difference between groups according to prognosis or drug resistance despite a difference in basic activity failure, nonspecific anomaly or seizure type.…”

Section: Discussioncontrasting

confidence: 49%

Investigation of Patients with Hippocampal Sclerosis Associated with Unusual Epileptic Activities

Yavuz¹,

Yener²,

Özemir³

et al. 2016

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Objective: Hippocampal sclerosis (HS) is usually associated with typical anterior temporal spikes/sharp waves in the electroencephalography (EEG). We aimed to investigate the clinical, electrophysiologic differences, and prognosis between HS patients with unusual epileptic foci in comparison with patients with typical foci. Materials and Methods:Patients diagnosed who were diagnosed as having mesial temporal lobe epilepsy with HS in our center were included. All magnetic resonance imaging (MRI) results were investigated for the presence of two major criteria of HS diagnosis, namely T1 atrophy and T2 hyperintensity. All EEG and video-EEG investigations (a total of 496) were re-evaluated for unusual epileptic activities except T1/2, F7/8, T3/4 foci. Clinical and other laboratory data were retrospectively reevaluated by two investigators and the groups with usual and unusual epileptic activities for this syndrome were statistically compared.Results: A total of 124 patients including 20 (16.1%) with unusual epileptic activities (group 1) and 104 patients with typical foci (group 2) were evaluated. We observed 11 posterior temporal (T5/T6), four frontal (F3/F4), four frontopolar (Fp1/2), two occipital (O1/O2), three central (CP/FC) unusual foci, and two generalized epileptiform discharges in these 20 patients. Impaired background activity, nonspecific interictal diffuse slowing, and atypical seizure offset patterns were more frequently observed in group 1. Forty-nine patients underwent surgery after appropriate preoperative diagnostics; there was no significant difference in the postoperative outcome between the groups despite a tendency to better prognosis in group 2. Conclusion:Our study showed that unusual epileptic foci could be seen in 16.1% of patients with HS. Although some patients with HS have these atypical interictal EEG findings, they might obtain good post-operative outcomes when preoperative diagnostics are appropriately planned. Keywords: Mesial temporal lobe epilepsy, hippocampal sclerosis, electroencephalography, prognosisAmaç: Hipokampal skleroz (HS) genelde elektroensefalografide (EEG) ön temporal elektrotlarda görülen tipik dikenler/keskin dalgalar ile ilişkilidir. Çalışmada bu odaklardan farklı lokalizasyonlarda epileptik odakların ve aktivitelerin görüldüğü olguların, tipik odakları olanlara kıyasla klinik, elektrofizyolojik özelliklerinin ve prognoz farklarının araştırılması amaçlanmıştır. Gereç ve Yöntem:Merkezimizde mezyal temporal lob epilepsisi ile giden HS tanısıyla takipli olgular çalışmaya dahil edildi. Tüm manyetik rezonans görüntülemeler (MRG) iki ana HS tanı kriterinin (hipokampal yapılarda atrofi ve T2 ya da FLAIR sekanslarında sinyal artışı) varlığı açısından incelendi. Tüm EEG ve video EEG incelemeleri (toplam 496 adet) T1/2, F7/8, T3/4 odakları dışında farklı bir alanda epileptik aktivitesi olan ve olmayan hastalar açısından incelendi. Klinik ve diğer laboratuvar incelemeleri iki araştırmacı tarafından retrospektif olarak değerlendirildi. Olağan dışı odağı olan hastalarla olağan d...

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“…30 There were also lower reported rates of SE (0% to 8%), in a large group of HS patients including only 18 BHS patients. 31 The fundamental question remained still unanswered: Why is HS often unilateral following diffuse identical brain insults? This might also indicate that the risk of HS following a brain insult also depended on the person's genetic background or preexisting neuronal developmental anomalies.…”

Section: Differentiating Clinical Features Of Bhsmentioning

confidence: 99%

How Different Are the Patients With Bilateral Hippocampal Sclerosis From the Unilateral Ones Clinically?

et al. 2016

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Factors predicting the outcome following medical treatment of mesial temporal epilepsy with hippocampal sclerosis

Cited by 29 publications

References 35 publications

Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

Investigation of Patients with Hippocampal Sclerosis Associated with Unusual Epileptic Activities

How Different Are the Patients With Bilateral Hippocampal Sclerosis From the Unilateral Ones Clinically?

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