Surgical outcomes in lesional and non-lesional epilepsy: A systematic review and meta-analysis

Téllez‐Zenteno, José F.; Ronquillo, Lizbeth Hernández; Moien‐Afshari, Farzad; Wiebe, Samuel

doi:10.1016/j.eplepsyres.2010.02.007

Cited by 692 publications

(538 citation statements)

References 45 publications

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“…A recent meta-analysis showed only 34-45% long-term seizure-free rate, whereas MRI-positive (or 'lesional') surgical candidates may have a two times higher probability of attaining seizure freedom. 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.…”

Section: Discussionsupporting

confidence: 89%

“…[1][2][3] The overall prevalence of nonlesional epilepsy in all surgical studies is B26%. 4 At present, surgical management of MRInegative pharmacoresistant focal epilepsy patients relies heavily on invasive intracranial electroencephalography, which is based on complimentary review of other noninvasive modalities including positron emission tomography, ictal single-photon emission computed tomography, and magnetoencephalography when available. [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.…”

mentioning

confidence: 99%

“…[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: Discussionsupporting

confidence: 89%

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confidence: 99%

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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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“…This leaves open the possibility that MTS could itself be pathological, causing increased seizures, at least in some cases. Additionally, MTS identification is still an important prognostic factor since it has been shown that medical treatment will be less effective and it is a positive indicator for outcomes after surgery (Téllez-Zenteno et al, 2010). Thus, regardless of whether TLE with MTS and without MTS are distinct entities, more accurately identifying MTS should assist with clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

Machine learning classification of mesial temporal sclerosis in epilepsy patients

Rudie¹,

Colby²,

Salamon

2015

Epilepsy Research

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a b s t r a c tBackground and purpose: Novel approaches applying machine-learning methods to neuroimaging data seek to develop individualized measures that will aid in the diagnosis and treatment of brain-based disorders such as temporal lobe epilepsy (TLE). Using a large cohort of epilepsy patients with and without mesial temporal sclerosis (MTS), we sought to automatically classify MTS using measures of cortical morphology, and to further relate classification probabilities to measures of disease burden. Materials and methods: Our sample consisted of high-resolution T1 structural scans of 169 adults with epilepsy collected across five different 1.5 T and four different 3 T scanners at UCLA. We applied a multiple support vector machine recursive feature elimination algorithm to morphological measures generated from FreeSurfer's automated segmentation and parcellation in order to classify Epilepsy patients with MTS (n = 85) from those without MTS (N = 84). Results: In addition to hippocampal volume, we found that alterations in cortical thickness, surface area, volume and curvature in inferior frontal and anterior and inferior temporal regions contributed to a classification accuracy of up to 81% (p = 1.3 × 10 −17 ) in identifying MTS. We also found that MTS classification probabilities were associated with a longer duration of disease for epilepsy patients both with and without MTS. Conclusions: In addition to implicating extra-hippocampal involvement of MTS, these findings shed further light on the pathogenesis of TLE and may ultimately assist in the development of automated tools that incorporate multiple neuroimaging measures to assist clinicians in detecting more subtle cases of TLE and MTS.

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“…In addition, various neuro-radiological imaging techniques are employed to further identify the structural or functional epileptogenic lesion(s). Multiple studies have shown that the prognosis of epilepsy surgery varies depending on the etiology and location of the epileptogenic zone [43][44][45][46][47][48][49][50][51][60][61][62][63][64]. Radiographically identifiable epileptogenic lesions provide information about the etiology and localization of epilepsy, and can provide prognostic information for focal respective epilepsy surgery.…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

Shin¹,

Jewells²,

Hadar³

et al. 2014

Int J Neurorehabilitation Eng

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Epilepsy is the fourth most common neurological disorder in the US, affecting nearly 2.5 million Americans. The economic impact of epilepsy represents estimated direct and indirect costs of 12.5 billion dollars per year. Patients with this disorder experience increased morbidity and mortality with long term fatality rates of 24%. Multiple diagnostic tools are used to identify and classify the seizure type/syndrome, etiology and localization of seizures, including electroencephalogram (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), magneto encephalogram (MEG), and neuropsychiatric testing. Despite 29 different antiepileptic medications that are available in the US, one third of patients remain refractory to pharmacological treatment. In these intractable epilepsy patients, non-pharmacological treatments can be considered. Commonly used non-pharmacological treatment options for epilepsy include epilepsy surgery, neurostimulation therapy, and diet therapy. Review of Epilepsy -Etiology, Diagnostic Evaluation and Treatment

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Surgical outcomes in lesional and non-lesional epilepsy: A systematic review and meta-analysis

Cited by 692 publications

References 45 publications

The pathology of magnetic-resonance-imaging-negative epilepsy

The pathology of magnetic-resonance-imaging-negative epilepsy

Machine learning classification of mesial temporal sclerosis in epilepsy patients

Review of Epilepsy - Etiology, Diagnostic Evaluation and Treatment

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