Surgical Treatment of Nonlesional Neocortical Epilepsy

Kim, Dong Wook; Lee, Sang Kun; Moon, Hee Bom; Jung, Ki-Young; Chu, Kon; Chung, Chun Ki

doi:10.1001/jamaneurol.2016.4439

Cited by 41 publications

(33 citation statements)

References 40 publications

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“…Complete resection of epileptogenic zones has been identified as one of the most important predictors of postoperative seizure outcomes in patients with extratemporal lobe epilepsy . However, we found no association between the completeness of resection and seizure outcomes.…”

Section: Discussioncontrasting

confidence: 87%

“…In previous studies, changes in the postoperative seizure status were observed in >30% of patients with temporal lobe epilepsy, whereas only 10% of patients with extratemporal lobe epilepsy experienced changes in their postoperative seizure status during followup. 18,19 In the present study, changes in the postoperative seizure status were also observed in 15.4% of patients. However, the total seizure-free rate was stable for 5 years after surgery (the difference in the seizure-free rate between 3 months and 5 years after surgery was not statistically significant).…”

Section: Discussionsupporting

confidence: 67%

“…Changes in the postoperative seizure status have been reported in both patients with temporal and patients with extratemporal lobe epilepsy. In previous studies, changes in the postoperative seizure status were observed in >30% of patients with temporal lobe epilepsy, whereas only 10% of patients with extratemporal lobe epilepsy experienced changes in their postoperative seizure status during follow‐up . In the present study, changes in the postoperative seizure status were also observed in 15.4% of patients.…”

Section: Discussionsupporting

confidence: 64%

“…For patients with an epileptogenic zone involving eloquent areas that could not be completely removed, the remaining epileptogenic zone was treated with bipolar electrocoagulation; in contrast, the remaining epileptogenic zone was not treated in these previous studies. 23,39,40 Bipolar electrocoagulation of eloquent areas is similar to multiple subpial transections. It can suppress seizures by destroying the horizontal transmission of epileptic discharges.…”

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes and prognostic factors of drug‐resistant epilepsy secondary to encephalomalacia

Zhai

Guan

et al. 2019

Epilepsia

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Summary Objective To evaluate long‐term outcomes and prognostic factors in patients who underwent surgical resection for drug‐resistant epilepsy secondary to encephalomalacia. Methods A total of 143 patients with drug‐resistant epilepsy who underwent surgical resection with a follow‐up of at least 5 years were included. Seizure outcomes were evaluated based on the International League Against Epilepsy classification. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes. Results Three months after surgery, 102 of 143 (71.3%) patients had achieved favorable seizure outcomes. Five years after surgery, 107 of 143 (74.8%) patients had achieved favorable seizure outcomes. Changes in the postoperative seizure status were observed in 22 of 143 (15.4%) patients during follow‐up, but the difference in the seizure‐free rate between 3 months and 5 years after surgery was not significant. Univariate and multivariate analyses revealed that only a monthly seizure frequency of >30 seizures (odds ratio = 3.42, 95% confidence interval = 1.19‐9.76) and bilateral ictal onset rhythms (odds ratio = 4.46, 95% confidence interval = 1.61‐12.39) were independent predictors of unfavorable seizure outcomes. Significance Surgical resection is an effective treatment for patients with drug‐resistant epilepsy secondary to encephalomalacia. Knowledge of the predictors of seizure outcomes may help during preoperative counseling and selection of optimal candidates for epilepsy surgery among patients with drug‐resistant epilepsy secondary to encephalomalacia.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes and prognostic factors of drug‐resistant epilepsy secondary to encephalomalacia

Zhai

Guan

et al. 2019

Epilepsia

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“…A study of temporal excision using survival analysis found that those with normal or ‘other’ pathology, as judged by a combination of histopathology and MRI findings, had a worse outcome than those with HS or foreign tissue lesions 13. A recent study of 109 people with unremarkable MRI found 54% to be seizure free 1-year postsurgically 14. Caveats with the interpretation of this study are that a more liberal definition of seizure freedom was used (Engel group 1) than in our studies and pathologies such as focal cortical dysplasia and dysembryoplastic neuroepithelial tumour would be expected to be detected by contemporary MRI.…”

Section: Discussionmentioning

confidence: 99%