Bertrand Mathon1,2, Franck Bielle2,3, Séverine Samson4,5, Odile Plaisant4,6, Sophie Dupont2,4,7,8, Anne Bertrand2,8,9,10, Richard Miles8, Vi-Huong Nguyen-Michel4, Virginie Lambrecq2,4,8, Ana Laura Calderon-Garcidueñas3,11, Charles Duyckaerts2,3, Alexandre Carpentier1,2,8, Michel Baulac2,4,8, Philippe Cornu1,2, Claude Adam4,8, Stéphane Clemenceau1,8, Vincent Navarro2,4,8. 1. Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France. 2. Sorbonne University, UPMC University of Paris 06, Paris, France. 3. Department of Neuropathology, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France. 4. Epileptology Unit, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France. 5. PSITEC Laboratory (EA 4072), University of Lille 3, Lille, France. 6. ANCRE, URDIA EA 4465, Paris Descartes University, Sorbonne Paris Cité University, Paris, France. 7. Rehabilitation Unit, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France. 8. Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225), Paris, France. 9. Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France. 10. Inria Paris, Aramis Project Team, Paris, France. 11. Institute of Forensic Medicine, Veracruzana University, Boca del Río, Mexico.
Abstract
OBJECTIVE: The reasons for failure of surgical treatment for mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) remain unclear. This retrospective study analyzed seizure, cognitive, and psychiatric outcomes, searching for factors associated with seizure relapse or cognitive and psychiatric deterioration after MTLE-HS surgery. METHODS: Seizure, cognitive, and psychiatric outcomes were reviewed after 389 surgeries performed between 1990 and 2015 on patients aged 15-67 years at a tertiary center. Three surgical approaches were used: anterior temporal lobectomy (ATL; n = 209), transcortical selective amygdalohippocampectomy (SAH; n = 144), and transsylvian SAH (n = 36). RESULTS: With an average follow-up of 8.7 years (range = 1.0-25.2), seizure outcome was classified as Engel I in 83.7% and Engel Ia in 57.1% of patients. The histological classification of HS was type 1 for 75.3% of patients, type 2 for 18.7%, and type 3 for 1.2%. Two factors were significantly associated with seizure recurrence: past history of status epilepticus and preoperative intracranial electroencephalographic recording. In contrast, neither HS type, the presence of a dual pathology, nor surgical approach was associated with seizure outcome. Risk of cognitive impairment was 3.12 (95% confidence interval = 1.27-7.70), greater in patients after ATL than in patients after transcortical SAH. A presurgical psychiatric history and postoperative cognitive impairment were associated with poor psychiatric outcome. SIGNIFICANCE: The SAH and ATL approaches have similar beneficial effects on seizure control, whereas transcortical SAH tends to minimize cognitive deterioration after surgery. Variation in postsurgical outcome with the class of HS should be investigated further. Wiley Periodicals, Inc.
OBJECTIVE: The reasons for failure of surgical treatment for mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) remain unclear. This retrospective study analyzed seizure, cognitive, and psychiatric outcomes, searching for factors associated with seizure relapse or cognitive and psychiatric deterioration after MTLE-HS surgery. METHODS:Seizure, cognitive, and psychiatric outcomes were reviewed after 389 surgeries performed between 1990 and 2015 on patients aged 15-67 years at a tertiary center. Three surgical approaches were used: anterior temporal lobectomy (ATL; n = 209), transcortical selective amygdalohippocampectomy (SAH; n = 144), and transsylvian SAH (n = 36). RESULTS: With an average follow-up of 8.7 years (range = 1.0-25.2), seizure outcome was classified as Engel I in 83.7% and Engel Ia in 57.1% of patients. The histological classification of HS was type 1 for 75.3% of patients, type 2 for 18.7%, and type 3 for 1.2%. Two factors were significantly associated with seizure recurrence: past history of status epilepticus and preoperative intracranial electroencephalographic recording. In contrast, neither HS type, the presence of a dual pathology, nor surgical approach was associated with seizure outcome. Risk of cognitive impairment was 3.12 (95% confidence interval = 1.27-7.70), greater in patients after ATL than in patients after transcortical SAH. A presurgical psychiatric history and postoperative cognitive impairment were associated with poor psychiatric outcome. SIGNIFICANCE: The SAH and ATL approaches have similar beneficial effects on seizure control, whereas transcortical SAH tends to minimize cognitive deterioration after surgery. Variation in postsurgical outcome with the class of HS should be investigated further. Wiley Periodicals, Inc.
Authors: Piotr Słowiński; Laurent Sheybani; Christoph M Michel; Mark P Richardson; Charles Quairiaux; John R Terry; Marc Goodfellow Journal: eNeuro Date: 2019-08-12
Authors: Midhun Mohan; Simon Keller; Andrew Nicolson; Shubhabrata Biswas; David Smith; Jibril Osman Farah; Paul Eldridge; Udo Wieshmann Journal: PLoS One Date: 2018-05-16 Impact factor: 3.240