Seizure outcome after temporal lobectomy for temporal lobe epilepsy

Foldvary, Nancy; Nashold, Blaine S.; Mascha, Edward J.; Thompson, Elizabeth A.; Lee, N.; McNamara, J. O.; Lewis, Darrell V.; Luther, J. S.; Friedman, Allan H.; Radtke, Rodney A.

doi:10.1212/wnl.54.3.630

Cited by 189 publications

(150 citation statements)

References 14 publications

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“…37,51,64,81,82,84,85 In the remaining one-third of patients, seizures usually recur during the first postoperative year, 37,48,97 although the percentage of patients who remain seizure free may decline with longer follow-up, with reported rates as low as 53% for patients with at least 5 years of follow-up and 41% for 10 years. 3,7,28,30,48,64,90 Recent data suggest that the histopathological abnormalities underlying surgically treated drug-resistant MTLE are the main factor predictive of seizure outcome.…”

Section: Discussionmentioning

confidence: 99%

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Giulioni¹,

Marucci

Martinoni³

et al. 2013

JNS

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D rug-resistant MTLE is the most common type of epilepsy requiring surgical treatment, with a favorable seizure outcome being achieved in about 60%-75% of patients. 50,51,64,82,89 Clinically, MTLE is often regarded as a relatively homogeneous syndromic entity, with seizures characterized by typical ictal semiology 32,96 and EEG findings. 29,96 However, a variety of MTLE subtypes have been described according to the underlying etiology, with different surgical prognoses. 47,89,92 Recent neuropathological classifications of epi lep to gen ic lesions, such as mesial temporal sclerosis (MTS), 11 granule cell pathology (GCP), 10 focal cortical dysplasia (FCD), 12 and epilepsy-associated low-grade tumor (ELGT) 1,54,55,73,74,91 Object. The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications of mesial temporal sclerosis (MTS), granule cell pathology (GCP), focal cortical dysplasia (FCD) and epilepsy-associated low-grade tumors (ELGT).Methods. The authors analyzed data obtained in 120 consecutive cases involving patients presenting with drugresistant MTLE, who underwent tailored anteromesial temporal lobe resection, and correlated seizure outcome with pathological findings. They identified 5 histopathological groups: Group 1-ELGT, alone or associated with other lesions (30 cases); Group 2-isolated FCD (17 cases); Group 3-MTS, with or without GCP (28 cases); Group 4-MTS associated with FCD, with or without GCP (37 cases); Group 5-other lesions (8 cases).Results. Engel Class I outcome was observed in 83% of patients with ELGT (Class IA in 63%); in 59% of patients with isolated FCD, with FCD Type II showing a better prognosis than FCD Type I; in 82% of patients with isolated MTS (Class IA in 50%), with MTS Type 1a and MTS Type 1b showing a better prognosis than MTS Type 2 and patients with MTS and GCP having better postsurgical results than those with MTS without GCP. Engel Class I outcome was also achieved in 84% of patients with FCD associated with MTS (Engel Class IA in 62%); also in this group MTS 1a and MTS 1b associated with FCD showed a better prognosis than FCD associated with MTS 2. Finally, Engel Class I was also achieved in 2 patients with vascular malformation and in 1 with a temporal pole encephalocele.Conclusions. Patients with MTLE and ELGT, MTS, or MTS associated with FCD showed the best postsurgical seizure outcome (Engel Class I in more than 80% of cases), whereas only 63% of patients with isolated FCD achieved the same type of outcome. Interestingly, the analysis of seizure outcome in histopathological subtypes of FCD and of MTS showed different prognoses in the different pathological subgroups, with worse outcomes for atypical MTS, absence of GCP, and isolated FCD Type I. 37Abbreviations used in this paper: EEG = electroencephalographic; ELGT = epilepsy-associated low-grade tumor; FCD = focal cortical dysplasia; GCP = granule cell ...

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Section: Discussionmentioning

confidence: 99%

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Giulioni¹,

Marucci

Martinoni³

et al. 2013

JNS

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“…Moreover, pediatric patients may have a more normal neurologic development, whereas adolescents and adults may have improved psychosocial outcomes (71,73). In a recent long-term study of temporal lobectomy (mean follow-up, 14 years), patients who were seizure free for 2 years after surgery were unlikely to become refractory, and none of the patients who had seizures recurring more than 1 year after surgery became refractory, suggesting that the underlying disease process was arrested (74). A direct measure of the improvement seen with surgery was demonstrated in a study in which MR spectroscopic imaging of the ipsilateral temporal lobe normalized postoperatively in patients with TLE (75).…”

Section: Can "Progressive Epilepsy" Be Halted?mentioning

confidence: 99%

Is Refractory Epilepsy Preventable?

et al. 2002

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Summary: About a third of the patients diagnosed with epilepsy will not be fully controlled with antiepileptic drugs (AEDs), and many of them will have frequent and disabling seizures. These patients will undergo multiple drug trials, most often without complete seizure remission. Moreover, refractory epilepsy is associated with increased morbidity (from seizures and medications), social isolation, unemployment, and overall reduced quality of life. There is evidence that refractory epilepsy can be a progressive disorder, which, if controlled early, might never develop into a full syndrome with all of its associated sequelae. The difficulty lies in identifying at an early stage patients who are likely to progress to intractability. No currently known markers enable clinicians to make this identification with confidence. Advances in pharmacogenomics and our understanding of pharmacologic responsiveness in epilepsy may change this situation. Even now, we are able to identify many patients with a poor prognosis earlier than before, particularly in the pediatric population, in which syndromic classification may provide an approach to predict intractability. The early initiation of aggressive therapy may improve outcome and overall quality of life.

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“…8) Only a few reports have examined the outcome of epilepsy surgery after more than 5 years. 6,7,10,22) In the present study, the follow-up period was 5 years or more, with a mean of about 12 years, so is one of the longest reported follow-up periods of patients undergoing epilepsy surgery. 5,6,19,25,28,34) The proportion of patients remaining seizure-free postoperatively for several years shows a progressive decline, 2,5,8,25,34) although half of the patients who suffered relapse had, at most, one seizure per year.…”

Section: Discussionmentioning

confidence: 69%

“…5,22) However, the number of studies of longterm outcome has increased dramatically, and evidence of late seizure recurrence is mounting. 25) Almost all of these studies have been of patients undergoing temporal lobe resections, 7,10,14,21,26,30,32) with few long-term follow-up studies of patients undergoing extratemporal resections. 5,28) The present study evaluated the efficacy of resective surgery in patients with lesional epilepsy identified by MR imaging for postoperative long-term seizure control extending for 5 years or more.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Seizure Outcome in Patients Undergoing Resection of Lesions Detected by Magnetic Resonance Imaging

Moritake

Mikuni

Akiyama

et al. 2008

Neurol. Med. Chir.(Tokyo)

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The long-term efficacy of resective surgery was investigated in patients with lesions detected by magnetic resonance (MR) imaging. Thirty of 47 patients who had undergone lesionectomy between 1987-2001 were followed up by questionnaire. Patients with extratemporal resections outnumbered those with temporal lobe resections. The mean follow-up period was 12.4 ± 3.7 years. Outcomes were graded according to Engel's criteria, and an arbitrary seizure outcome score was given for quantitative assessment. The mean seizure outcome scores were significantly lower in the early childhood (less than 3 years) onset group than in the late childhood (3 to 15 years) onset group, and significantly lower in the extratemporal resection of the cortical dysplasia group than in the temporal resection and the extratemporal resection of non-cortical dysplasia groups. This study indicated that lesionectomy based on MR imaging findings in patients with intractable epilepsy achieved effective long-term seizure control, and the outcome was related mainly to the pathology of the epileptogenic lesions and the temporal or extratemporal location.

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Seizure outcome after temporal lobectomy for temporal lobe epilepsy

Abstract: TL provides sustained, long-term benefit in patients with medically refractory TLE. Seizure-free status at 2 years from the time of surgery is predictive of long-term remission.

Cited by 189 publications

References 14 publications

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

Is Refractory Epilepsy Preventable?

Long-Term Seizure Outcome in Patients Undergoing Resection of Lesions Detected by Magnetic Resonance Imaging

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