Temporal lobe surgery for intractable epilepsy in children: What to do with the hippocampus?

Benifla, Mony; Bennet-Back, Odeya; Shorer, Zamir; Noyman, Iris; Bar-Yosef, Rima; Ekstein, Dana

doi:10.1016/j.seizure.2017.09.020

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…Although this IPDMA did not find a significant association between iECoG and time to seizure recurrence in the small number of HS cases (Table 3) due to limited numbers of studies meeting the comparative inclusion criteria, current literature has supported the use of iECoG for HS 30,55,56 . For mesial temporal lobe epilepsy (mTLE), there is some preliminary evidence toward tailoring resection based on grid iECoG data, 55 and that involvement of lateral structures confers faster seizure recurrence 57 .…”

Section: Discussionmentioning

confidence: 89%

“…45,54 Although this IPDMA did not find a significant association between iECoG and time to seizure recurrence in the small number of HS cases (Table 3) due to limited numbers of studies meeting the comparative inclusion criteria, current literature has supported the use of iECoG for HS. 30,55,56 For mesial temporal lobe epilepsy (mTLE), there is some preliminary evidence toward tailoring resection based on grid iECoG data, 55 and that involvement of lateral structures confers faster seizure recurrence. 57 However, several studies have shown no benefit of iECoG over the mediobasal temporal lobe or lateral temporal neocortex to improve seizure freedom rates in patients undergoing anteromesial temporal lobectomy (ATL) specifically for HS-mTLE.…”

Section: Effect Of Iecog By Pathologymentioning

confidence: 99%

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Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta‐analysis

et al. 2022

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Despite the widespread use of intraoperative electrocorticography (iECoG) during resective epilepsy surgery, there are conflicting data on its overall efficacy and inability to predict benefit per pathology. Given the heterogeneity of iECoG use in resective epilepsy surgery, it is important to assess the utility of interictalbased iECoG. This individual patient data (IPD) meta-analysis seeks to identify the benefit of iECoG during resective epilepsy surgery in achieving seizure freedom for various pathologies. Embase, Scopus, and PubMed were searched from inception to January 31, 2021 using the following terms: "ecog", "electrocorticography", and "epilepsy". Articles were included if they reported seizure

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Section: Discussionmentioning

confidence: 89%

Section: Effect Of Iecog By Pathologymentioning

confidence: 99%

Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta‐analysis

et al. 2022

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“…The most common cause of TLE is hippocampal sclerosis. The biological function of hippocampal neurons is closely related to the pathogenesis of TLE [26]. In this study, in vitro cell experiments were further conducted to explore the effects of miR-148a-3p on the biological functions of hippocampal neuronal cells.…”

Section: Discussionmentioning

confidence: 99%

Febrile Seizure-Related miR-148a-3p Exerts Neuroprotection by Promoting the Proliferation of Hippocampal Neurons in Children with Temporal Lobe Epilepsy

Yu¹,

Du²,

Zhang³

2021

Dev Neurosci

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Temporal lobe epilepsy (TLE) is the most common epilepsy in both adult and children. Some microRNAs (miRNAs) are abnormally expressed in neurological diseases. This study aimed to investigate the expression level and clinical significance of miR-148a-3p in TLE children and explore its effect on the biological viability of hippocampal neurons. The expression level of miR-148a-3p in the serum of TLE children was examined using quantitative real-time PCR. A receiver operating characteristic curve was plotted to determine the diagnostic accuracy of miR-148a-3p in TLE. Hippocampal neurons were cultured in magnesium-free medium to construct a TLE cell model. The effects of miR-148a-3p on hippocampal neuronal viability and apoptosis rate were detected by MTT and flow cytometry, respectively. miR-148a-3p was overexpressed and correlated with seizure frequency and febrile seizure (FS) history in TLE children. miR-148a-3p was of great value in the diagnosis of TLE, and it can be used to distinguish cases with FS history. Hippocampal neurons treated with magnesium-free medium were used as an in vitro model of TLE and showed significantly increased miR-148a-3p, decreased cell viability, and increased cell apoptosis, while these changes were eliminated markedly by miR-148a-3p knockdown. miR-148a-3p is overexpressed and associated with seizure frequency and FS history and serves as a novel diagnostic biomarker in TLE. In addition, the downregulation of miR-148a-3p exerts neuroprotective role by improving hippocampal neuronal cell viability. miR-148a-3p may provide new ideas for the treatment and diagnosis of TLE.

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“…Reported favorable seizure outcome (FSO) after ioECoG-guided surgery ranges from 31% to 93%. 22 , 23 A recent patient-level meta-analyses (individual participant data meta-analysis [IPDMA]) of 18 studies showed more FSO after surgeries with than without ioECoG of and a high benefit in focal cortical dysplasia (FCD). 24 Due to the limited number of studies, they did not explore clinical variables affecting postsurgical FSO rate in patients tailored by ioECoG.…”

Section: Introductionmentioning

confidence: 99%

Seizure Outcome After Intraoperative Electrocorticography-Tailored Epilepsy Surgery

Guo,

Wang,

van 't Klooster

et al. 2024

Neurology

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Background and Objectives Tailoring epilepsy surgery using intraoperative electrocorticography (ioECoG) has been debated, and modest number of epilepsy surgery centers apply this diagnostic method. We assessed the current evidence to use ioECoG-tailored epilepsy surgery for improving postsurgical outcome. Methods PubMed and Embase were searched for original studies reporting on ≥10 cases who underwent ioECoG-tailored surgery for epilepsy, with a follow-up of at least 6 months. We used a random-effects model to calculate the overall rate of patients achieving favorable seizure outcome (FSO), defined as Engel class I, ILAE class 1, or seizure-free status. Meta-regression was used to investigate potential sources of heterogeneity. We calculated the odds ratio (OR) for estimating variables on FSO:ioECoG vs non-ioECoG-tailored surgery (if included studies contained patients with non-ioECoG-tailored surgery), ioECoG-tailored epilepsy surgery in children vs adults, temporal (TL) vs extratemporal lobe (eTL), MRI-positive vs MRI-negative, and complete vs incomplete resection of tissue that generated interictal epileptiform discharges (IEDs). A Bayesian network meta-analysis was conducted for underlying pathologies. We assessed the evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results Eighty-three studies (82 observational studies, 1 trial) comprising 3,631 patients with ioECoG-tailored surgery were included. The overall pooled rate of patients who attained FSO after ioECoG-tailored surgery was 74% (95% CI 71–77) with significant heterogeneity, which was predominantly attributed to pathologies and seizure outcome classifications. Twenty-two studies contained non–ioECoG-tailored surgeries. IoECoG-tailored surgeries reached a higher rate of FSO than non–ioECoG-tailored surgeries (OR 2.10 [95% CI 1.37–3.24]; p < 0.01; very low certainty). Complete resection of tissue that displayed IEDs in ioECoG predicted FSO better compared with incomplete resection (OR 3.04 [1.76–5.25]; p < 0.01; low certainty). We found insignificant difference in FSO after ioECoG-tailored surgery in children vs adults, TL vs eTL, or MRI-positive vs MRI-negative. The network meta-analysis showed that the odds of FSO was lower for malformations of cortical development than for tumors (OR 0.47 95% credible interval 0.25–0.87). Discussion Although limited by low-quality evidence, our meta-analysis shows a relatively good surgical outcome (74% FSO) after epilepsy surgery with ioECoG, especially in tumors, with better outcome for ioECoG-tailored surgeries in studies describing both and better outcome after complete removal of IED areas.

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Temporal lobe surgery for intractable epilepsy in children: What to do with the hippocampus?

Abstract: Sparing the hippocampus in temporal lobe epilepsy surgery is possible with excellent seizure outcome, while using the proper intraoperative technique.

Cited by 8 publications

References 34 publications

Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta‐analysis

Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta‐analysis

Febrile Seizure-Related miR-148a-3p Exerts Neuroprotection by Promoting the Proliferation of Hippocampal Neurons in Children with Temporal Lobe Epilepsy

Seizure Outcome After Intraoperative Electrocorticography-Tailored Epilepsy Surgery

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