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; Pedley, Timothy A.

doi:10.1046/j.1528-1157.2001.35100.x

Cited by 200 publications

(137 citation statements)

References 4 publications

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“…In the Engel scale, the seizure‐free category can be divided into continued auras and aura‐free 12. The International League against Epilepsy (ILAE) scale considers seizure freedom, continued auras, and postoperative seizures in terms of improvement or lack thereof from the preoperative seizure status with a 6‐point scale 13. These scales are not so useful for patients with severe epilepsies when the intervention is palliative and it can be ascertained what the patients or their caregivers expect to gain from surgery.…”

Section: Measuring Outcomementioning

confidence: 99%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

192

139

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Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690

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Section: Measuring Outcomementioning

confidence: 99%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

192

139

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“…Additional, all the cases of the control group were not allowed to show a history of epilepsy or any other neurologic disease. Besides the histological diagnosis, clinical data like gender, age, seizure frequency, relative epilepsy duration (normalized to age), AEDs, post‐surgical outcome 45 and location of resected material was assessed. The study was performed according to the guidelines of good laboratory practice of the European commission, and the local ethics committee of the Medical University of Vienna gave a positive vote for the study plan (EC978/2009).…”

Section: Methodsmentioning

confidence: 99%

Impaired oligodendroglial turnover is associated with myelin pathology in focal cortical dysplasia and tuberous sclerosis complex

et al. 2017

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Conventional antiepileptic drugs suppress the excessive firing of neurons during seizures. In drug‐resistant patients, treatment failure indicates an alternative important epileptogenic trigger. Two epilepsy‐associated pathologies show myelin deficiencies in seizure‐related brain regions: Focal Cortical Dysplasia IIB (FCD) and cortical tubers in Tuberous Sclerosis Complex (TSC). Studies uncovering white matter‐pathology mechanisms are therefore urgently needed to gain more insight into epileptogenesis, the propensity to maintain seizures, and their associated comorbidities such as cognitive defects. We analyzed epilepsy surgery specimens of FCD IIB (n = 22), TSC (n = 8), and other malformations of cortical development MCD (n = 12), and compared them to autopsy and biopsy cases (n = 15). The entire lesional pathology was assessed using digital immunohistochemistry, immunofluorescence and western blotting for oligodendroglial lineage, myelin and mTOR markers, and findings were correlated to clinical parameters. White matter pathology with depleted myelin and oligodendroglia were found in 50% of FCD IIB and 62% of TSC cases. Other MCDs had either a normal content or even showed reactive oligodendrolial hyperplasia. Furthermore, myelin deficiency was associated with increased mTOR expression and the lower amount of oligodendroglia was linked with their precursor cells (PDGFRa). The relative duration of epilepsy (normalized to age) also correlated positively to mTOR activation and negatively to myelination. Decreased content of oligodendroglia and missing precursor cells indicated insufficient oligodendroglial development, probably mediated by mTOR, which may ultimately lead to severe myelin loss. In terms of disease management, an early and targeted treatment could restore normal myelin development and, therefore, alter seizure threshold and improve cognitive outcome.

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“…All patients underwent standardized amygdalohippocampectomy20 and routine diagnostic analysis of resected hippocampal specimens by an experienced neuropathologist. Postsurgical seizure outcome was assessed using the International League Against Epilepsy (ILAE) outcome classification system 21. All patients had a minimum of 1 year and an average of 2 years of postoperative follow‐up.…”

Section: Methodsmentioning

confidence: 99%

Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy

Keller

Richardson

Schoene-Bake

et al. 2015

Annals of Neurology

112

127

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ObjectiveThere are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI).MethodsWe performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy.ResultsQuantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI‐derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection.InterpretationPatients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group‐based findings to individualize prediction of patient outcomes. Ann Neurol 2015;77:760–774

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

Cited by 200 publications

References 4 publications

Getting the best outcomes from epilepsy surgery

Getting the best outcomes from epilepsy surgery

Impaired oligodendroglial turnover is associated with myelin pathology in focal cortical dysplasia and tuberous sclerosis complex

Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy

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