Marco Giulioni1, Gianluca Marucci2,3, Veronica Pelliccia4, Francesca Gozzo4, Carmen Barba5, Giuseppe Didato6, Flavio Villani6, Giancarlo Di Gennaro7, Pier Paolo Quarato7, Vincenzo Esposito7,8, Alessandro Consales9, Matteo Martinoni1,10, Gianfranco Vornetti1, Corrado Zenesini11, Carlo Efisio Marras12, Nicola Specchio13, Luca De Palma13, Raffaele Rocchi14, Flavio Giordano15, Giovanni Tringali16, Paolo Nozza17, Gabriella Colicchio18, Guido Rubboli19,20, Giorgio Lo Russo4, Renzo Guerrini5,21, Paolo Tinuper20,22, Francesco Cardinale4, Massimo Cossu4. 1. Division of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy. 2. Anatomic Pathology Unit, AUSL of Bologna, Bologna, Italy. 3. Department of Neuropathology, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy. 4. "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy. 5. Pediatric Neurology Unit, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy. 6. Clinical Epileptology and Experimental Neurophysiology Unit, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy. 7. IRCCS NEUROMED, Pozzilli (IS), Italy. 8. Department of Neurosurgery, Sapienza University of Rome, Rome, Italy. 9. Department of Pediatric Neurosurgery, Giannina Gaslini Institute, Genoa, Italy. 10. Neurosurgery Unit, Department of Neurosciences, NOCSAE, Modena Hospital, Baggiovara, Modena, Italy. 11. Unit of Epidemiology and Biostatistics, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy. 12. Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. 13. Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. 14. Department of Neurology, University of Siena, Siena, Italy. 15. Neurosurgery Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy. 16. Neurosurgery Unit, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy. 17. Pathology Unit, Giannina Gaslini Institute, Genoa, Italy. 18. Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy. 19. Danish Epilepsy Center, Filadelfia/University of Copenhagen, Dianalund, Denmark. 20. IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy. 21. IRCCS Stella Maris, Pisa, Italy. 22. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVE: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of "low grade epilepsy associated neuroepithelial tumors" (LEATs). METHODS: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. RESULTS: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). SIGNIFICANCE: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted. Wiley Periodicals, Inc.
OBJECTIVE: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of "low grade epilepsy associated neuroepithelial tumors" (LEATs). METHODS: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. RESULTS: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). SIGNIFICANCE: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted. Wiley Periodicals, Inc.
Authors: Alexander A Hedaya; Kelsey C Hewitt; Ranliang Hu; Charles M Epstein; Robert E Gross; Daniel L Drane; Jon T Willie Journal: Epilepsy Behav Date: 2022-03-23 Impact factor: 3.337
Authors: Catrin Mann; Nadine Conradi; Elisabeth Neuhaus; Jürgen Konczalla; Thomas M Freiman; Andrea Spyrantis; Katharina Weber; Patrick Harter; Felix Rosenow; Adam Strzelczyk; Susanne Schubert-Bast Journal: J Clin Med Date: 2022-10-05 Impact factor: 4.964