Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study

Lamberink, Herm J.; Otte, Willem M.; Blümcke, Ingmar; Braun, Kees P.J.; Aichholzer, Martin; Amorim, Isabel R.; Aparicio, Javier Romano; Aronica, Eleonora; Arzimanoglou, Alexis; Barba, Carmen; Beck, Jürgen; Becker, Albert; Beckervordersandforth, Jan; Bien, Christian G.; Bódi, István; Catenoix, Hélène; Chassoux, Francine; Chipaux, Mathilde; Cloppenborg, Thomas; Coras, Roland; Cross, J. Helen; Palma, Luca De; Tisi, Jane de; Deleo, Francesco; Devaux, Bertrand; Gennaro, Giancarlo Di; Dorfmüller, Georg; Duncan, John S.; Elger, Christian E.; Ernst, Katharina; Esposito, Vincenzo; Feucht, Martha; Gadže, Željka Petelin; Garbelli, Rita; Geleijns, Karin; Gil‐Nagel, Antonio; Grote, Alexander; Grünwald, Thomas; Guerrini, Renzo; Hamer, Hajo M.; Honavar, Mrinalini; Jacques, Thomas S.; Jakovčević, Antonia; Jutila, Leena; Kalina, Adam; Kälviäinen, Reetta; Klein, Karl Martin; Koenig, Kristina; Kršek, Pavel; Kudernatsch, Manfred; Kudr, Martin; Malmgren, Kristina; Marusič, Petr; Melikyan, Armen; Menzler, Katja; Noachtar, Soheyl; Özkara, Çiğdem; Pieper, Tom; Pimentel, José; Raičević, Savo; Rheims, Sylvain; Ribeiro, Joana; Rosenow, Felix; Rössler, Karl; Rydenhag, Bertil; Sales, Francisco; Antonio‐Arce, Victoria San; Schaller, K.; Schijns, Olaf; Scholl, Theresa O.; Schramm, Johannes; Schulze‐Bonhage, Andreas; Sciot, Raf; Seeck, Margitta; Шишкина, Л. В.; Sokić, Dragoslav; Specchio, Nicola; Theys, Tom; Thom, Maria; Delgado, Rafael Toledano; Toulouse, Joseph; Uzan, Mustafa; Loon, J. van; Paesschen, Wim Van; Oertzen, Tim J. von; Jansen, Floor E.; Leijten, Frans S.S.; Rijen, Peter van; Spliet, Wim G.M.; Mühlebner, Angelika; Kasper, Burkhard S.; Fauser, Susanne; Polster, Tilman; Kalbhenn, Thilo; Delev, Daniel; McEvoy, Andrew W.; Miserocchi, Anna; Landré, Elisabeth; Turak, Bares; Varlet, Pascale; Ferrand-Sorbets, Sarah; Fohlen, Martine; Bulteau, Christine; Edelvik, Anna; Shah, Mukesch; Scheiwe, Christian; Delicado, Eva Gutierrez; Tisdall, Martin; Eltze, Christin; Akkol, Serdar; Deniz, Kaancan; Öz, Büğe; Holthausen, Hans; Hartlieb, Till; Staudt, Martin; Casciato, Sara; Quarato, Pier Paolo; Giangaspero, Felice; Streichenberger, Nathalie; Guénot, Marc; Isnard, Jean; Valentijn, Antonio; Chang, Amanda; Mullatti, Nandini; Zámečnı́k, Josef; Zárubová, Jana; Tomášek, Martin; Immonen, Arto; Saarela, Anni; Rauramaa, Tuomas; Lobrinus, Johannes Alexander; Egervari, Kristof; Momjian, Shahan; Harti, Elisabeth; Lohr, Hannah; Kroell, Judith; Vermeulen, Lynn; Cleeren, Evy; Власов, П. Н.; Kozlova, Antonia; Vorobyev, A. N.; Goeppel, Gudrun; Samueli, Sharon; Czech, Thomas; Hainfellner, Johannes A.; Puttinger, Gertraud; Schwarz, Gabriele; Stefanits, Harald; Weis, Serge; Spreafico, Roberto; Villani, Flavio; Rossini, Laura; Hermsen, A.; Knake, Susanne; Nimsky, Christopher; Carl, Barbara; Bělohlávková, Anežka; Beňová, Barbora; Bisschop, Jeroen; Colon, Albert; Kranen-Mastenbroek, Vivianne van; Rouhl, Rob P.W.; Hoogland, Govert; Rumià, Jordi; Ramírez‐Camacho, Alia; Candela-Cantó, Santiago; Ostrowsky‐Coste, Karine; Panagiotakaki, Eleni; Montavont, Alexandra; Kosal, Pascale Keo; Gokce-Samar, Zeynep; Milleret, C.; Buccoliero, Anna Maria; Giordano, Flavio; Šulentić, Vlatko; Mrak, Goran; Desnica, Andrej; Carfì-Pavia, Giusy; Benedictis, Alessandro De; Marras, Carlo Efisio; Baščarević, Vladimir; Vojvodić, Nikola; Ristić, Aleksandar J.; Rebelo, Olinda; Aledo‐Serrano, Ángel; García‐Morales, Irene; Anciones, Carla

doi:10.1016/s1474-4422(20)30220-9

Cited by 237 publications

(222 citation statements)

References 29 publications

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“…Consistent with a recent study, 4 69% of patients with FCD in the MELD cohort were seizure free post-surgically. We found that a longer duration of epilepsy was significantly associated with a reduced chance of seizure freedom (Figure 4A), but the impact of duration was small, with a 3% decrease in likelihood of seizure freedom for every 10 year increase in duration of epilepsy (Figure 3B).…”

Section: Discussionsupporting

confidence: 89%

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MELD Project: Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia

Wagstyl¹,

Whitaker²,

Raznahan³

et al. 2021

Preprint

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Background Drug-resistant focal epilepsy is often caused by focal cortical dysplasia (FCD). The impact of FCD location on clinical presentation and surgical outcome is largely unknown. We created a large neuroimaging cohort of patients with individually mapped FCDs to determine predictors of lesion location and postsurgical seizure freedom to aid presurgical decision-making. Methods The Multi-centre Epilepsy Lesion Detection (MELD) project collated a retrospective cohort of 580 patients with epilepsy due to FCD from 20 epilepsy centres worldwide. MRI-based maps of individual FCD lesions with accompanying demographic, clinical and surgical information were collected for each patient. We mapped the distribution of FCD lesions across the cerebral cortex and examined for associations between clinical factors and lesion location. Findings FCDs were non-uniformly distributed across the brain, concentrating in the superior frontal sulcus, frontal pole and temporal pole. Age of epilepsy onset was typically before age 10. Earlier epilepsy onset was associated with lesions in primary sensory areas while later epilepsy onset was associated with lesions in association cortices. Lesions in temporal and occipital lobes tended to be larger than frontal lobe lesions. Seizure freedom rates varied with FCD location, being around 30% in visual, motor and premotor areas to 75% in superior temporal and frontal gyri. These differences are likely attributable to reduced resection volumes due to neurosurgical caution around eloquent cortex. Interpretation The MELD project has gathered the largest neuroimaging cohort of patients with FCD to date. The location of the FCD is non-uniformly distributed across the cerebral cortex and is an important determinant of its size, the age of epilepsy onset and the likelihood of seizure freedom post-surgery. Using an open-science collaborative initiative, we have characterised the spatial distribution of a focal pathology to identify data-driven, patient-specific predictors of lesion location and postsurgical seizure freedom to inform clinical decision-making.

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Section: Discussionsupporting

confidence: 89%

“…2,3 In many patients, FCD is amenable to surgical resection, with reported long term seizure freedom rates of 69%. 4…”

Section: Introductionmentioning

confidence: 99%

MELD Project: Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia

Wagstyl¹,

Whitaker²,

Raznahan³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other treatment options, such as surgery, are widely considered a last resort. Sadly, the associated time delay means such treatments may be less effective 78. The result is often years of reduced quality of life, lost productivity, and increased mortality 9…”

Section: Uncertainty In Treatment Response Is Major Problemmentioning

confidence: 99%

New era of personalised epilepsy management

Chen

Rollo

Antonic‐Baker

et al. 2020

BMJ

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The trial and error approach to epilepsy treatment has not changed for over a century but machine learning and patient derived stem cells promise a personalised and more effective strategy, argue Patrick Kwan and colleagues E pilepsy affects 50 million people worldwide with no age, ethnic, or geographical boundary. 1 Patients have recurrent seizures that can lead to injuries, cognitive decline, psychosocial dysfunction, and even death. Epilepsy is caused by brain insults such as trauma, stroke, tumour, inflammation, and infection as well as systemic changes resulting from genomic variation. Patients with epilepsy have increased comorbidities, including cerebrovascular, neurocognitive, and psychiatric diseases. 2 Better epilepsy control will therefore improve overall brain health.

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“…Finally, the causal link between high potassium and demyelination and axon degeneration should be strengthened by ad hoc experiments performed in focal epilepsy models. The validation of the proposed hypothesis with solid cause-effect scientific evidence could set the framework for possible new treatments for patients with focal epilepsies resistant to current antiepileptic drugs, who represent a large population of subjects with a long history of epilepsy 83,120 associated with a prominent burden for health systems and society at large.…”

mentioning

confidence: 93%

A hypothesis for the role of axon demyelination in seizure generation

2021

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Loss of myelin and altered oligodendrocyte distribution in the cerebral cortex are commonly observed both in postsurgical tissue derived from different focal epilepsies (such as focal cortical dysplasias and tuberous sclerosis) and in animal models of focal epilepsy. Moreover, seizures are a frequent symptom in demyelinating diseases, such as multiple sclerosis, and in animal models of demyelination and oligodendrocyte dysfunction. Finally, the excessive activity reported in demyelinated axons may promote hyperexcitability. We hypothesize that the extracellular potassium rise generated during epileptiform activity may be amplified by the presence of axons without appropriate myelin coating and by alterations in oligodendrocyte function. This process could facilitate the triggering of recurrent spontaneous seizures in areas of altered myelination and could result in further demyelination, thus promoting epileptogenesis.

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Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study

Cited by 237 publications

References 29 publications

MELD Project: Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia

MELD Project: Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia

New era of personalised epilepsy management

A hypothesis for the role of axon demyelination in seizure generation

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