Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery

Wieser, Heinz‐Gregor; Blume, Warren T.; Fish, D. R.; Goldensohn, Eli S.; Hufnagel, A.; King, Don W.; Sperling, Michael R.; Lüders, Hans

doi:10.1046/j.1528-1157.2001.4220282.x

Cited by 852 publications

(549 citation statements)

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“…34 We tried to overcome some of these pitfalls by carefully selecting patients in order to have a homogeneous population of patients affected by TLE with HS, and considering both Engel class I and class Ia (the latter corresponding to ILAE class 1). 35 Furthermore, as the main aim of the study was to assess outcomes by the HS types making up the new ILAE classification, we excluded patients without HS, or for whom only unreliable specimens were available. (74) 88 (56) 42 (27) 31 (20) 6 (3-12) (25) 28 (52) 12 (22) 14 ( 116 (55) 54 (25) 45 (21) 6 (3-12)…”

Section: Discussionmentioning

confidence: 99%

“…25 (17-34) 36 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) 186 (88) 145 ( Most published studies aimed at identifying the factors predicting outcomes are mainly based on electroclinical parameters, but it has been pointed that etiology may play a role in influencing the long-term efficacy of TLE surgery. 21 We therefore evaluated outcomes in relation to the pathologic categories of IHS and HS associated with other pathologies (FCD IIIa or DP).…”

Section: (4-15)mentioning

confidence: 99%

“…26 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) 36 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) 85 (91) 62 (67) Type 1 70 (74) 33 (47) 38 (54) 27 (39) 13 (19) 6 (3-10) (25) 7 (30) 11 (48) 5 (22) 7 ( 42 (43) 58 (60) 22 (23) 19 (20) 8 (4-13)…”

Section: (4-15)unclassified

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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: Discussionmentioning

confidence: 99%

Section: (4-15)mentioning

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

et al. 2015

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“…b) Seizure outcome: Seizure outcome is evaluated according to the classification of ILAE for seizure outcome following epilepsy surgery. [15] According to this classification, class 1 is completely seizure free and no auras; class 2 is only auras and no other seizures; class 3 is 1-3 seizure days per year with or without auras; class 4 is 4 seizure days per year to 50% reduction of baseline seizure days with or without auras; class 5 is less than 50% reduction of baseline seizure days with or without auras; class 6 is more than 100% increase of baseline seizure days with or without auras. [15] c) Antiepileptic drug usage: The number of AEDs and their dosages are obtained before and 18 months after the surgery.…”

Section: Methodsmentioning

confidence: 99%

Quality of Life and Cost analysis Following Epilepsy Surgery in Turkish Patients

Acar¹,

Acar²,

Gedi̇k³

et al. 2011

Epilepsi

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ÖzetAmaç: Bu çalışmanın amacı, epilepsi cerrahisinden sonra nöbet kontrolü, antiepileptik ilaç kullanımı, yaşam kalitesindeki değişim ve bunlara paralel olarak epilepsiye bağlı sağlık harcamalarında ve ilaç maliyetindeki değişimi belirlemektir. Gereç ve Yöntem:İlaca dirençli epilepsi nedeniyle takip edilen 24 hasta (11 kadın, 13 erkek) çalışmaya alındı. Cerrahi öncesi ve sonrası nö-bet sıklığı, antiepileptik sayıları belirlenerek SF-36 ölçeği uygulandı. Cerrahi öncesinde ve sonrasında epilepsiye bağlı sağlık harcamaları ve antiepileptik ilaç giderleri hastane bilgi yönetim sisteminden ve ulusal sosyal güvenlik kurumu veri tabanından elde edildi. Bulgular:Yirmi dört hastaya ilaca dirençli epilepsisi nedeniyle ATLE ya da lezyonektomi uygulandı. Ortalama 24 ay sonunda hastaların %67'sinde nöbet kontrolü (ILAE sınıf I ve II) sağlandı. Postoperatif antiepileptik ilaç sayısında belirgin azalma görüldü (p=0.005). SF-36'ya göre hastaların genel sağlık durumlarını algılayışlarında, duygusal sorunlara bağlı kısıtlılıklarında düzelme tespit edildi (p<0.005). Maliyet analizinde cerrahi uygulanan hastalarda hem antiepileptik ilaç maliyeti hem de epileptik nöbetlere bağlı sağlık giderlerinde belirgin azalma olduğu saptandı (p<0.005).Sonuç: İlaca dirençli epilepside cerrahinin nöbet kontrolündeki etkinliği ve yaşam kalitesi üzerine yararları ve bunlara paralel ekonomik yararları dikkat çekicidir. Hem medikal hem de ekonomik açılardan olumlu sonuçları olan cerrahi uygulamaların ülkemizde artabilmesi için ilaca dirençli epilepsisi olan hastaların bu konuda özelleşmiş ve cerrahi uygulayan merkezlere daha fazla yönlendirilmeleri gerekmektedir.Anahtar sözcükler: Maliyet; epilepsi; yaşam kalitesi; cerrahi. SummaryObjectives: The aim of this study was to evaluate postoperative changes in terms of seizure frequency, antiepileptic drug (AED) consumption and quality of life, and in parallel with this, to determine the changes in AED and healthcare costs after surgery. Methods:Twenty-four patients who underwent epilepsy surgery with medically intractable epilepsy were included in the study. Demographic features, seizure frequency and number of AEDs were obtained, and the Short Form Health Survey (SF-36) was administered pre-and postoperatively. Financial records were accessed via the university hospital database and the central network database of the national social security administration.Results: ATLE or lesionectomy was carried out in 24 patients. During the mean follow-up period of 24 months, 67% of patients achieved Class 1 and 2 seizure control and a significant reduction in the number of AEDs (p<0.005). On the SF-36, the general perception of health and role limitations due to emotional problems significantly improved postoperatively. The cost analysis revealed a significant reduction in AED and healthcare costs due to epilepsy in patients who underwent surgery (p<0.005). Conclusion:Surgical interventions for medically intractable epilepsy are effective in seizure control and have a notable beneficial effect on quality of life as...

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“…Mean follow-up was 38.72 months (SD 26.53 months; range 3 -106 months). Seizure outcome was classified according to the ILAE classification by Wieser et al [10].…”

Section: Patientsmentioning

confidence: 99%

Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy

Woernle

Neidert

Wulf

et al. 2013

Clinical Neurology and Neurosurgery

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OBJECTIVE: We present a series of 87 patients who underwent anteromesial temporal lobe resections for therapy refractory temporal lobe epilepsy. In addition to seizure outcome, we observed excessively elevated CRP-levels in this patient population. METHODS: We followed 87 patients (m=39, f=48; mean age 33.73±12.92, range 5-67 years) who underwent surgery between July 2003 and November 2011. Seizure outcome was classified in all patients according to the ILAE-classification by . CRP levels were measured in 59 patients of the epilepsy surgery group and in a control group of 44 consecutive patients with supratentorial tumors (22 glioblastomas, 22 meningiomas). RESULTS: Clinical benefit was seen in 96.6% of the patients (ILAE classes 1-4), 80.5% were completely seizure free (ILAE class 1). Post-OP CRP values were significantly higher in the epilepsy group (n=59; mean CRP peak value: 100.86mg/l, range: 16-258mg/l) compared to the control group (n=44; mean CRP peak value: 36.85mg/l, range: 0.4-233mg/l) (p<0.001), but the correlation of mean CRP value and mean temperature peak is weak (r=0.31). CONCLUSIONS: Seizure outcome after surgery for temporal lobe epilepsy was excellent, CRP levels were excessively elevated in these patients in the absence of clinical infection and significantly higher compared to resections of supratentorial lesions. We present a series of 87 patients who underwent anteromesial temporal lobe resections for therapy refractory temporal lobe epilepsy. In addition to seizure outcome, we observed excessively elevated CRP-levels in this patient population. Methods:We followed 87 patients (m=39, f=48; mean age 33. Results:Clinical benefit was seen in 96.6% of the patients (ILAE classes 1 to 4), 80.5% were completely seizure free (ILAE class 1). Post-OP CRP values were significantly higher in the epilepsy group (n=59; mean CRP peak value: 100.86 mg/l, range: 16 -258 mg/l) compared to the control group (n=44; mean CRP peak value: 36.85 mg/l, range: 0.4 -233 mg/l) (p<0.001), but the correlation of mean CRP value and mean temperature peak is weak (r=0.31). Conclusions:Seizure outcome after surgery for temporal lobe epilepsy was excellent, CRP levels were excessively elevated in these patients in the absence of clinical infection and significantly higher compared to resections of supratentorial lesions.3

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Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery

Cited by 852 publications

References 4 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

Quality of Life and Cost analysis Following Epilepsy Surgery in Turkish Patients

Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy

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