Evangelos Kogias1, Jan-Helge Klingler2, Horst Urbach3, Christian Scheiwe2, Barbara Schmeiser2, Soroush Doostkam4, Josef Zentner2, Dirk-Matthias Altenmüller5. 1. Department of Neurosurgery, Medical Center-University of Freiburg, Germany. Electronic address: evangelos.kogias@gmail.com. 2. Department of Neurosurgery, Medical Center-University of Freiburg, Germany. 3. Department of Neuroradiology, Medical Center-University of Freiburg, Germany. 4. Institute of Neuropathology, Medical Center-University of Freiburg, Germany. 5. Epilepsy Center, Department of Neurosurgery, Medical Center-University of Freiburg, Germany.
Abstract
OBJECTIVE: To investigate presurgical diagnostic modalities, clinical and seizure outcome as well as predictive factors after resective epilepsy surgery in 3 Tesla MRI-negative focal epilepsies. PATIENTS AND METHODS: This retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated. RESULTS: All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome. CONCLUSIONS: In almost two thirds of temporal and extratemporal epilepsies defined as "non-lesional" by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism.
OBJECTIVE: To investigate presurgical diagnostic modalities, clinical and seizure outcome as well as predictive factors after resective epilepsy surgery in 3 Tesla MRI-negative focal epilepsies. PATIENTS AND METHODS: This retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated. RESULTS: All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome. CONCLUSIONS: In almost two thirds of temporal and extratemporal epilepsies defined as "non-lesional" by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism.
Authors: Katalin Borbély; Miklós Emri; István Kenessey; Márton Tóth; Júlia Singer; Péter Barsi; Zsolt Vajda; Endre Pál; Zoltán Tóth; Thomas Beyer; Tamás Dóczi; Gábor Bajzik; Dániel Fabó; József Janszky; Zsófia Jordán; Dániel Fajtai; Anna Kelemen; Vera Juhos; Max Wintermark; Ferenc Nagy; Mariann Moizs; Dávid Nagy; János Lückl; Imre Repa Journal: Biomedicines Date: 2022-04-20
Authors: Maarten Haemels; Donatienne Van Weehaeghe; Evy Cleeren; Patrick Dupont; Johan van Loon; Tom Theys; Koen Van Laere; Wim Van Paesschen; Karolien Goffin Journal: Acta Neurol Belg Date: 2021-02-05 Impact factor: 2.396