Retrospective analysis of variables favouring good surgical outcome in posterior epilepsies

Barba, Carmen; Doglietto, Francesco; Luca, Laura De; Faraca, G.; Marra, Camillo; Meglio, Mario; Gf, Rossi; Colicchio, Gabriella

doi:10.1007/s00415-005-0676-4

Cited by 22 publications

(17 citation statements)

References 27 publications

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“…However, findings on intracranial EEG recording may be relevant in predicting outcome. Similar to previous studies (Bautista et al., 1999; Barba et al., 2005), focal interictal spiking correlated with better outcomes. Although the focalization of ictal onset and the ictal onset frequency in invasive studies were not related to surgical outcome in previous cohorts of neocortical epilepsy (Lee et al., 2005; Widdess‐Walsh et al., 2007), we found that fast activity at seizure onset correlated with better outcome (8% recurrence risk vs. 57%) but only on univariate analysis.…”

Section: Predictors Of Seizure Recurrencesupporting

confidence: 89%

“…Similar to previous studies, we found no correlation of side of surgery, gender, presence or absence of auras, clinical semiology, or surgical outcome (Blume et al., 1991; Salanova et al., 1992; Aykut‐Bingol et al., 1998; Bautista et al., 1999; Boesebeck et al., 2002; Barba et al., 2005; Dalmagro et al., 2005). Previous studies have correlated younger age at onset (Blume et al., 1991), and longer epilepsy duration (Dalmagro et al., 2005) with worse outcomes.…”

Section: Predictors Of Seizure Recurrencesupporting

confidence: 89%

“…Similar to a previous PCE surgery series (Barba et al., 2005) we found completeness and extent of resection to be an important outcome predictor: Patients who underwent a lesionectomy were about twice as likely to exhibit seizure recurrence as compared to those who underwent either a lobectomy or multilobar resection (Table 8). In our study, we used the traditional way of completeness of resection assessment through analysis of postoperative MRI.…”

Section: Predictors Of Seizure Recurrencesupporting

confidence: 83%

“…Previously reported success rates following PCE surgery varied from 25–90% (Blume et al., 1991; Salanova et al., 1992; Williamson et al., 1992a, 1992b; Cascino et al., 1993; Salanova et al., 1995a, 1995b; Aykut‐Bingol et al., 1998; Bautista et al., 1999; Boesebeck et al., 2002; Barba et al., 2005). Review of the curve of seizure recurrence in our cohort (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Despite major advances in diagnostic and surgical techniques, parietooccipital resections still represent <10% of all epilepsy surgeries (Barba et al., 2005; Blume et al., 2005; Dalmagro et al., 2005). Reported success rates vary from 25–90% (Blume et al., 1991; Salanova et al., 1992, 1995a,b; Williamson et al., 1992a,b; Cascino et al., 1993; Aykut‐Bingol et al., 1998; Bautista et al., 1999; Boesebeck et al., 2002; Barba et al., 2005), leaving this patient category in an undefined “outcome group” between the traditionally considered more “favorable” prospects of anterior temporal lobectomy (Yoon et al., 2003; McIntosh et al., 2004; Jeha et al., 2006) and the frontal lobe surgeries with a relatively poor prognosis (Janszky et al., 2000; Jeha et al., 2007).…”

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confidence: 99%

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A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

Jehi¹,

O’Dwyer²,

Najm³

et al. 2009

Epilepsia

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SUMMARYPurpose: To investigate the longitudinal seizure outcome and identify potential prognostic indicators following posterior cortex epilepsy (PCE) surgery. Methods: We reviewed patients who underwent a parietal, occipital, or parietooccipital resections between 1994 and 2006, using survival analysis and multivariate regression with Cox proportional hazard modeling. A favorable outcome was defined as Engel Class I at last follow-up. Results: Fifty-seven patients were identified with a mean follow-up of 3.3 years (range 1-12 years). The estimated chance of seizure freedom (SF) was 73.1% % at 6 postoperative months, 68.5% % at 1 year, 65.8% % at between 2 and 5 years, and 54.8% % at 6 years and beyond. Most recurrences (75% %) occurred within the first 6 postoperative months. Parietal resections had a worse outcome than occipital or parietooccipital resections (52% % SF vs. 89% % and 93% %, respectively, at 5 years). Independent predictors of recurrence included an epilepsy etiology other than tumor or dysplasia [risk ratio (RR) 2.29], limiting resection to a lesionectomy (RR 2.10), having ipsilateral temporal spiking on preoperative scalp electroencephalography (EEG) (RR 2.06), or any ipsilateral spiking on postoperative EEG (RR 2.70) (Log likelihood-ratio test p < 0.0001). Only 40-50% % of patients with a poor outcome predictor were SF at 5 postoperative years as opposed to about 80% % otherwise. In surgical failures, recurrent seizure frequency was related directly to baseline seizure frequency and to the presence of ipsilateral spiking on postoperative EEG. Discussion: These data highlight favorable longterm outcomes following PCE surgery. Limited surgical resection and diffuse baseline epileptogenicity may be important predictors of seizure recurrence.

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Section: Predictors Of Seizure Recurrencesupporting

confidence: 89%

Section: Predictors Of Seizure Recurrencesupporting

confidence: 89%

Section: Predictors Of Seizure Recurrencesupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

Jehi¹,

O’Dwyer²,

Najm³

et al. 2009

Epilepsia

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Total posterior quadrant disconnection for drug‐resistant epilepsy in children

Yu,

Liu,

Sun

et al. 2024

Epilepsia Open

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ObjectiveTo assess seizure outcomes, prognostic factors, and developmental changes in children undergoing total posterior quadrant disconnection (PQD) for drug‐resistant epilepsy (DRE).MethodsWe conducted a retrospective analysis of the clinical data of children with DRE who underwent total PQD surgery. The study focused on Engel's classification for seizure outcomes, exploring correlation of preoperative data and surgical effectiveness, and predictors of seizure prognosis. It involved a comparative analysis of developmental levels pre‐ and 3 months postoperatively using Griffiths Mental Development Scales‐China (GMDS‐C), and the correlation between clinical characteristics and GMDS‐C results.ResultsOut of 61 pediatric patients, 70.5% showed no seizure recurrence postoperatively. In the univariate analysis, interictal electroencephalogram (EEG), magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG‐PET), and acute postoperative seizure (APOS) were significantly related to surgical prognosis. In multivariate analysis, interictal EEG and APOS were identified as predictors of seizure prognosis. Survival analysis indicated significant associations between MRI, interictal EEG, FDG‐PET, APOS and postoperative seizure occurrence. Preoperative GMDS‐C levels were significantly correlated with epilepsy duration, seizure frequency, interictal EEG, and FDG‐PET. GMDS‐C scores improved postoperatively, while developmental quotients remained stable.SignificanceFor patients with structural abnormalities in the entire posterior quadrant, thorough preoperative assessment and timely total PQD surgery can effectively control seizures without causing neurological development deterioration. APOS and interictal EEG abnormalities beyond the posterior quadrant are predictors for seizure prognosis but should not be deemed contraindications for surgery.Plain Language SummaryDue to lack of analysis on pediatric total PQD cases, 61 pediatric patients who underwent total PQD surgery were retrospectively enrolled. Seizure and development results were collected and analyzed as dependent variables. The study found that 70.5% of patients were seizure‐free and showed development improvement, with no deaths or severe complications reported. Prognosis predictors included APOS and interictal EEG abnormalities beyond the posterior quadrant.

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Pädiatrische Epilepsiechirurgie bei posterioren Epilepsien

2020

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Zusammenfassung Hintergrund Die Epilepsiechirurgie hat sich als wirksame Behandlungsmethode für pharmakoresistente, strukturelle Epilepsien erwiesen. Läsionen im posterioren Kortex stellen dabei – gerade bei Kindern – eine besondere Herausforderung dar. Fragestellung Wirksamkeit der epilepsiechirurgischen Eingriffe bei Kindern und Jugendlichen mit posterioren strukturellen Läsionen. Material und Methoden Literaturüberblick und Zusammenfassung der hauptsächlichen Befunde publizierter Studien zu pädiatrischen Kohorten nach epilepsiechirurgischer Behandlung posteriorer Epilepsien. Ergebnisse Epilepsien aufgrund posteriorer Läsionen sind bei Kindern häufiger als bei Erwachsenen und sind oft weniger klar lokalisiert und weniger deutlich von eloquentem Kortex abgrenzbar. Dennoch haben sich die postoperativen Verläufe in den letzten Jahrzehnten auf Grund von Fortschritten in der Abklärung deutlich verbessert. Schlussfolgerung Auch bei posterioren epileptogenen Läsionen ist die Epilepsiechirurgie oft eine wirksame Behandlungsmethode. Dabei bestehen die besten Aussichten auf Anfallsfreiheit nach frühzeitigen, ausreichend ausgedehnten Eingriffen. Das heißt, diese Kinder und Jugendlichen müssen für ein optimales Outcome umfangreich und v. a. frühzeitig abgeklärt werden.

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Retrospective analysis of variables favouring good surgical outcome in posterior epilepsies

Abstract: The correlation between completeness of epileptogenic zone resection and surgical outcome suggests that a presurgical protocol, allowing a precise definition of the area of resection, could help in obtaining more satisfying results in posterior epilepsies.

Cited by 22 publications

References 27 publications

A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery

Total posterior quadrant disconnection for drug‐resistant epilepsy in children

Pädiatrische Epilepsiechirurgie bei posterioren Epilepsien

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