Surgical outcome of temporal plus epilepsy is improved by multilobar resection

Barba, Carmen; Rheims, Sylvain; Minotti, Lorella; Grisotto, Laura; Chabardès, Stéphan; Guénot, Marc; Isnard, Jean; Pellacani, Simona; Hermier, M.; Ryvlin, Philippe; Kahane, Philippe

doi:10.1111/epi.17185

Cited by 7 publications

(8 citation statements)

References 29 publications

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“…Figure 3 illustrates a very similar pattern of late recurrence for those who had ATL compared to the ET cohort, with the difference in risk between these two groups (higher for ET cohort) restricted to the early postsurgical period. Other studies have also reported late seizures in cohorts with a mixture of pathologies and/or surgeries 2 , 14 , 17 , 19 , 23 ; abnormal and/or normal pathology 15 ; lesional and/or nonlesional cases 24 , 25 , 26 , 27 , 28 , 29 ; focal cortical dysplasia 30 ; temporal lobe and "temporal plus" epilepsy 20 , 31 ; and ATL, ET, and amygdalohippocampectomy surgeries. 5 , 6 , 12 , 22 , 32 , 33 These findings favor hypotheses relating to causes of late seizure recurrence that apply broadly across these groups.…”

Section: Discussionmentioning

confidence: 95%

“…Early studies by Rasmussen 18 described long‐term surgical outcome, noting 13% of "nontumoral" (median follow‐up = 12 years) and 6% of "tumoral" cases (median follow‐up = 8 years) experienced occasional seizures after at least 3 years free of seizures postsurgery. Late recurrences between 5 and 10 years postsurgery have been described in more recent cohorts 2,5,6,14,17,19,20 . There are few detailed data available relevant to the period after 10 postoperative years, although first recurrences after this time have been noted 2,14,21,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Late recurrences between 5 and 10 years postsurgery have been described in more recent cohorts. 2 , 5 , 6 , 14 , 17 , 19 , 20 There are few detailed data available relevant to the period after 10 postoperative years, although first recurrences after this time have been noted. 2 , 14 , 21 , 22 In our study, the data demonstrate seizure recurrence over several decades of follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrences may also relate to the activity of a residual seizure focus other than a structural abnormality. Hypotheses include aberrant activity in distributed brain networks involving but not restricted to the region of the resected tissue, 20 , 34 , 35 , 36 , 37 or the effects of genetic variants present throughout the brain. 38 , 39 "Temporal‐lobe plus" epilepsy (TPE), with an epileptogenic zone extending beyond the temporal lobe identified by stereo‐electroencephalography, has been associated with recurrence in HS and nonlesional cases.…”

Section: Discussionmentioning

confidence: 99%

“… 38 , 39 "Temporal‐lobe plus" epilepsy (TPE), with an epileptogenic zone extending beyond the temporal lobe identified by stereo‐electroencephalography, has been associated with recurrence in HS and nonlesional cases. 20 , 31 It is also possible that new seizure mechanisms evolve over time. In particular, age‐related seizure conditions may present as postsurgical follow‐up extends into decades and patients grow older.…”

Section: Discussionmentioning

confidence: 99%

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Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

2022

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Objective: Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up.Methods: Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly.Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98).Results: Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizurefree after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74).Significance: Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

2022

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A survey of the prevalence and patterns of neuropsychological assessment practices across epilepsy surgery centers in India: Toward establishing a national guideline

Shah,

Rathore,

Radhakrishnan

et al. 2024

Epilepsia Open

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Neuropsychology plays an important role in optimizing epilepsy management, but there are no practice guidelines for low‐ and middle‐income countries with emerging services. The National Epilepsy Surgery Support Activity Network (NESSAN), a national working group that supports and optimizes epilepsy surgery programs in India, explored the present status of pre‐ and post epilepsy surgery neuropsychological assessment practices across India as an initial step in developing national evidence‐based test guidelines. An online survey was conducted using two questionnaires, one for neurologists and the second for neuropsychologists and speech–language pathologists working in epilepsy surgery centers. The questions to neurologists covered the setting, description, and nature of the neuropsychology services provided for adults and children as part of the epilepsy surgery program, and their perceptions about the importance and indications for neuropsychological assessment in epilepsy surgery. The questions to neuropsychologists inquired about their qualifications and training, pre‐ and postsurgical assessment procedures, and domain‐specific cognitive tests and scales for mood, quality of life, and language evaluations. Forty‐three centers responded, and neuropsychology services were available at three fourth of the centers, but a dedicated full‐time neuropsychologist was available in only 16% of centers. Ninety percent of the neurologists considered neuropsychological evaluation an indispensable part of presurgical evaluation. However, only a few of them believed that the results influenced their decision about the extent of resection and ruling against surgery. The survey found considerable heterogeneity in terms of qualifications and training of neuropsychologists, evaluation procedures, test protocols, and normative data that will need to be harmonized to ensure uniform practice across the country. We believe that the results from this survey provide a road map for implementing measures to minimize existing inadequacies and harmonize neuropsychology services in India and as well as in other countries with emerging neuropsychology services.Plain Language SummaryNeuropsychological assessment is an integral part of the pre‐ and post epilepsy surgery evaluations. In India, the National Epilepsy Surgery Support Activity Network (NESSAN), a body of multidisciplinary professionals, conducted a survey to examine existing neuropsychology practices. The responses from 43 centers across the country revealed considerable heterogeneity in tests and few trained and qualified neuropsychologists. In low‐ and middle‐income countries (LMIC) with emerging neuropsychology services, there is a need to have uniform test protocols, specialized training, and guidelines for optimizing neuropsychology services across all the epilepsy surgery centers.

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New epilepsy surgical techniques and intraoperative monitoring in non-lesional MRI negative epilepsy

Rössler

Dorfer

2023

Clin Epileptol

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ZusammenfassungDurch die Einführung moderner Techniken für die neurochirurgische Intervention bei nichtläsionellen (NL) MRT-negativen medikamentös therapierefraktären Epilepsien (temporal, aber v. a. auch extratemporal) zeigte sich im letzten Jahrzehnt sowohl bei Kindern und Adoleszenten als auch bei Erwachsenen eine deutliche Zunahme diese Eingriffe um etwa 10–15 % [1]. Für die prächirurgische Evaluation von NL-Epilepsien ist das invasive Monitoring zur Diagnostik einer fokalen Epilepsie bzw. zur Definition der potenziellen epileptogenen Zone für eine mögliche Resektion oder Ablation – insbesondere extratemporal – wünschenswert. Die Technik der invasiven Abklärung von NL-Epilepsien hat im letzten Jahrzehnt eine grundsätzliche Strategieänderung erfahren, weg von über eine Kraniotomie eingebrachten subduralen Elektroden, hin zum weniger invasiven Stereo-EEG (sEEG) mit Tiefenelektroden. Das minimal-invasive und weniger komplikationsbehaftete sEEG kann auch tief gelegene Anfallsgeneratoren und unter Einbeziehung von künstlicher Intelligenz (AI) auch sterische Ausdehnung der potenziellen epileptogenen Zone darstellen, was für eine mögliche Resektion bei nichtläsionellen Epilepsien Voraussetzung ist. In sprachrelevanten Kortexarealen bleiben allerdings das Monitoring und Mapping mit Subduralelektroden alternativlos. Gleichzeitig ermöglichen neue Techniken in der Neurochirurgie wie Neuronavigation, Neuromonitoring (IONM) und intraoperative MR-Bildgebung, Robotik und Laserablation (LITT) die Schonung von eloquenten Hirnarealen in der Nachbarschaft der epileptogenen Zone. Zusätzlich können neuerdings traditionelle Techniken (Elektrokortikographie (ECoG) und Neuromonitoring (IONM)) mit der Bildgebung direkt durch Dateneinspiegelung ins Operationsmikroskop in den operativen Situs zur Resektion miteinbezogen werden. Diese Entwicklungen haben dazu geführt, dass für immer mehr NL-fokale Epilepsien die Resektion möglich ist und dass sich das postoperative Epilepsie-Outcome von NL-Epilepsien deutlich verbessert hat.

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Surgical outcome of temporal plus epilepsy is improved by multilobar resection

Cited by 7 publications

References 29 publications

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

Extended follow‐up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery

A survey of the prevalence and patterns of neuropsychological assessment practices across epilepsy surgery centers in India: Toward establishing a national guideline

New epilepsy surgical techniques and intraoperative monitoring in non-lesional MRI negative epilepsy

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