Surgical outcome and prognostic factors of frontal lobe epilepsy surgery

Jeha, Lara E.; Najm, Imad; Bingaman, William; Dinner, Dudley S.; Widdess‐Walsh, Peter; Lüders, Hans

doi:10.1093/brain/awl364

Cited by 369 publications

(356 citation statements)

References 56 publications

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“…4 Our MRInegative cohort (comprised of temporal and extratemporal cases) had seizure-free rate of 59% at 12 months, this percentage is consistent with other studies from our center and can be anticipated to drop as follow-up durations increase. 10,34,35 Overall, we found that positive pathology in surgical specimen positively associated with seizure-free outcome at 6 months, but not at 12 months. This finding is consistent with the hypothesis that immediate postoperative seizure recurrence may indicate a mislocalization and/or incomplete resection of the active epileptic focus, whereas long-term recurrence may be attributed to other factors such as the natural history of the disease and the postsurgical development of secondary epileptogenesis.…”

Section: Discussionmentioning

confidence: 54%

“…[5][6][7][8] Despite substantial efforts, the lack of a lesion on MRI has consistently been shown to be one of the predictors for surgical failure. 9,10 Therefore, MRI-negative patients are usually considered unfavorable surgical candidates 4 and are often denied epilepsy surgery. Yet, surgical resection can be effective in well-selected patients with no visible MRI abnormality.…”

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confidence: 99%

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The pathology of magnetic-resonance-imaging-negative epilepsy

et al. 2013

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Patients with magnetic-resonance-imaging (MRI)-negative (or 'nonlesional') pharmacoresistant focal epilepsy are the most challenging group undergoing presurgical evaluation. Few large-scale studies have systematically reviewed the pathological substrates underlying MRI-negative epilepsies. In the current study, histopathological specimens were retrospectively reviewed from MRI-negative epilepsy patients (n ¼ 95, mean age ¼ 30 years, 50% female subjects). Focal cortical dysplasia cases were classified according to the International League Against Epilepsy (ILAE) and Palmini et al classifications. The most common pathologies found in this MRI-negative cohort included: focal cortical dysplasia (n ¼ 43, 45%), gliosis (n ¼ 21, 22%), hamartia þ gliosis (n ¼ 12, 13%), and hippocampal sclerosis (n ¼ 9, 9%). The majority of focal cortical dysplasia were ILAE type I (n ¼ 37) or Palmini type I (n ¼ 39). Seven patients had no identifiable pathological abnormalities. The existence of positive pathology was not significantly associated with age or temporal/extratemporal resection. Follow-up data post surgery was available in 90 patients; 63 (70%) and 57 (63%) attained seizure freedom at 6 and 12 months, respectively. The finding of positive pathology was significantly associated with seizure-free outcome at 6 months (P ¼ 0.035), but not at 12 months. In subgroup analysis, the focal cortical dysplasia group was not significantly correlated with seizure-free outcome, as compared with the negative-pathology groups at either 6 or 12 months. Of note, the finding of hippocampal sclerosis had a significant positive correlation with seizurefree outcome when compared with the negative-pathology group (P ¼ 0.009 and 0.004 for 6-and 12-month outcome, respectively). Absence of a significant histopathology in the resected surgical specimen did not preclude seizure freedom. In conclusion, our study highlights the heterogeneity of epileptic pathologies in MRInegative epilepsies, with focal cortical dysplasia being the most common finding. The existence of positive pathology in surgical specimen may be a good indication for short-term good seizure outcome. There is a small subset of cases in which no pathological abnormalities are identified.

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Section: Discussionmentioning

confidence: 54%

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confidence: 99%

The pathology of magnetic-resonance-imaging-negative epilepsy

et al. 2013

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“…In effect, both time and brain area of seizure occurrence are diffi cult to predict [ 103 ]. Interestingly, for cases where antiepileptic medication does not exhibit seizure-suppressing effects, a possible therapy is to remove parts of the temporal lobe or to disconnect specifi c projections that allow for seizure spreading [ 104 ].…”

Section: Componentsmentioning

confidence: 99%

Neurological Diseases from a Systems Medicine Point of View

Ostaszewski

Skupin

Balling

2016

Methods in Molecular Biology

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The diffi culty to understand, diagnose, and treat neurological disorders stems from the great complexity of the central nervous system on different levels of physiological granularity. The individual components, their interactions, and dynamics involved in brain development and function can be represented as molecular, cellular, or functional networks, where diseases are perturbations of networks. These networks can become a useful research tool in investigating neurological disorders if they are properly tailored to refl ect corresponding mechanisms. Here, we review approaches to construct networks specifi c for neurological disorders describing disease-related pathology on different scales: the molecular, cellular, and brain level. We also briefl y discuss cross-scale network analysis as a necessary integrator of these scales.

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“…Up to 72% of patients with MR imaging-negative epilepsy who had surgery were found to have FCD, and others have nonspecific findings such as gliosis on histopathology. [9][10][11][12][13] Identification of an anatomic abnormality has important therapeutic and prognostic implications, with considerably better outcomes in patients with an identifiable lesion than in those with MR imaging-negative localization-related epilepsy.…”

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confidence: 99%