Alexandra M Johnson1, Ella Sugo2, Daniela Barreto3, Anne M Cunningham4, Chee-Chung Hiew5, John A Lawson6, Ernest R Somerville7, Anne M Connolly8, Annie M E Bye9. 1. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: Alexandra.Johnson@sesiahs.health.nsw.gov.au. 2. South Eastern Area Laboratory Services, Barker St, Randwick, Sydney, NSW 2031, Australia; Prince of Wales Hospital, High St, Randwick, Sydney, NSW 2031, Australia. Electronic address: ella.sugo01@gmail.com. 3. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia. Electronic address: Daniela.e.barreto@gmail.com. 4. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: a.cunningham@unsw.edu.au. 5. Prince of Wales Hospital, High St, Randwick, Sydney, NSW 2031, Australia. Electronic address: chee-chung.hiew@sesiahs.health.nsw.gov.au. 6. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: John.Lawson@health.nsw.gov.au. 7. Prince of Wales Hospital, High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: ernest.somerville@sesiahs.health.nsw.gov.au. 8. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: a.connolly@unsw.edu.au. 9. Sydney Children's Hospitals Network (Randwick), High St, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia. Electronic address: annie.bye@health.nsw.gov.au.
Abstract
OBJECTIVES: This study utilised the revised 2011 ILAE classification of focal cortical dysplasia (FCD) (Blümcke et al., 2011) to examine pathology in a cohort of children and adults who underwent temporal lobe epilepsy (TLE) surgery, and to describe the electroclinical and imaging features associated with these pathologies. METHODS: The sample population were children (n=26) and adults (n=47) who underwent TLE surgery between 2002 and 2011 at our institutions. Neuropathology and MRI studies were re-reviewed by experts blinded to the original diagnosis. EEG and clinical data including current seizure outcome were determined by patient file review and/or patient contact. Pre-operative data, post-operative outcome and pathological diagnoses were compared. RESULTS: The commonest pathology in the adult cohort was isolated hippocampal sclerosis (HS) (n=24, 51.1%) and in the paediatric cohort, isolated tumour (n=10, 38.5%). Overall, HS with associated FCD (FCD IIIA) was the third most common pathology (n=12, 16.4%). Temporal grey matter signal changes on MRI were associated with FCD IIIA (p=0.035). FCD IIIA had the poorest post-surgical seizure outcome compared to all other pathologies (p=0.026). A history of bilateral convulsive seizures was more common in adults (n=40, p<0.0005), and was associated with failure to achieve postoperative seizure freedom (p=0.045). Postoperatively, paediatric TLE had higher rates of seizure freedom (p=0.005) and more children had ceased medication (p<0.0005). SIGNIFICANCE: FCD IIIA is a comparatively common pathological subtype in TLE, with a poor post-surgical outcome. Pre-operative recognition of FCD IIIA may be feasible through grey matter signal change on MRI. Paediatric patients had a higher rate of seizure freedom than adults. Pre-operative bilateral convulsive seizures were associated with poor outcome after surgery. Crown
OBJECTIVES: This study utilised the revised 2011 ILAE classification of focal cortical dysplasia (FCD) (Blümcke et al., 2011) to examine pathology in a cohort of children and adults who underwent temporal lobe epilepsy (TLE) surgery, and to describe the electroclinical and imaging features associated with these pathologies. METHODS: The sample population were children (n=26) and adults (n=47) who underwent TLE surgery between 2002 and 2011 at our institutions. Neuropathology and MRI studies were re-reviewed by experts blinded to the original diagnosis. EEG and clinical data including current seizure outcome were determined by patient file review and/or patient contact. Pre-operative data, post-operative outcome and pathological diagnoses were compared. RESULTS: The commonest pathology in the adult cohort was isolated hippocampal sclerosis (HS) (n=24, 51.1%) and in the paediatric cohort, isolated tumour (n=10, 38.5%). Overall, HS with associated FCD (FCD IIIA) was the third most common pathology (n=12, 16.4%). Temporal grey matter signal changes on MRI were associated with FCD IIIA (p=0.035). FCD IIIA had the poorest post-surgical seizure outcome compared to all other pathologies (p=0.026). A history of bilateral convulsive seizures was more common in adults (n=40, p<0.0005), and was associated with failure to achieve postoperative seizure freedom (p=0.045). Postoperatively, paediatric TLE had higher rates of seizure freedom (p=0.005) and more children had ceased medication (p<0.0005). SIGNIFICANCE: FCD IIIA is a comparatively common pathological subtype in TLE, with a poor post-surgical outcome. Pre-operative recognition of FCD IIIA may be feasible through grey matter signal change on MRI. Paediatric patients had a higher rate of seizure freedom than adults. Pre-operative bilateral convulsive seizures were associated with poor outcome after surgery. Crown
Authors: Alexandra M Johnson; Ella Sugo; Daniela Barreto; Chee-Chung Hiew; John A Lawson; Anne M Connolly; Ernest Somerville; Enisa Hasic; Annie Me Bye; Anne M Cunningham Journal: Mol Neurobiol Date: 2015-10-09 Impact factor: 5.590
Authors: Rupa Radhakrishnan; James L Leach; Francesco T Mangano; Michael J Gelfand; Leonid Rozhkov; Lili Miles; Hansel M Greiner Journal: Pediatr Radiol Date: 2016-04-25