Valeria Mariani1,2,3, Martina Revay4,5, Piergiorgio D'Orio4,6, Michele Rizzi4, Veronica Pelliccia4,7, Michele Nichelatti8, Gabriella Bottini9,10, Lino Nobili11, Laura Tassi4, Massimo Cossu4. 1. "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy. valeria.mariani@ospedaleniguarda.it. 2. Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy. valeria.mariani@ospedaleniguarda.it. 3. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. valeria.mariani@ospedaleniguarda.it. 4. "Claudio Munari" Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy. 5. Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan, Milan, Italy. 6. Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy. 7. Department of Neuroscience, University of Parma, Parma, Italy. 8. Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 9. Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 10. Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. 11. Child Neuropsychiatry Unit, Istituto Giannina Gaslini, DINOGMI, University of Genova, Genoa, Italy.
Abstract
PURPOSE: To retrospectively analyse a single-centre consecutive surgical series of patients with temporal lobe epilepsy (TLE) and negative MRI. To identify factors associated with postoperative seizure outcome among several presurgical, surgical and postsurgical variables. METHODS: Clinical records of 866 patients who received temporal lobe resections and with a minimum follow-up of 12 months were retrospectively searched for MRI-negative cases. Anamnestic, clinical, neurophysiological, surgical, histopathological and postsurgical data were collected. Seizure outcome was categorised as favourable (Engel's class I) and unfavourable (Engel's classes II-IV). Uni- and multivariate statistical analysis was performed to identify variables having a significant association with seizure outcome. RESULTS: Forty-eight patients matched the inclusion criteria. 26 (54.1%) patients required invasive EEG evaluation with Stereo-electro-encephalography (SEEG) before surgery. Histological evaluation was unremarkable in 34 cases (70.8%), revealed focal cortical dysplasias in 13 cases and hippocampal sclerosis in 2. 28 (58.3%) patients were in Engel's class I after a mean follow-up of 82 months (SD ± 74; range 12-252). Multivariate analysis indicated auditory aura, contralateral diffusion of the discharge at Video-EEG monitoring and use of 18F-FDG PET as variables independently associated with seizure outcome. CONCLUSION: Carefully selected patients with MRI-negative TLE can be good candidates for surgery. Surgery should be considered with caution in patients with clinical features of neocortical seizure onset and contralateral propagation of the discharge. Use of 18F-FDG PET may be helpful to improve SEEG and surgical strategies. The presented data help in optimising the selection of patients with MRI-negative TLE with good chances to benefit from surgery.
PURPOSE: To retrospectively analyse a single-centre consecutive surgical series of patients with temporal lobe epilepsy (TLE) and negative MRI. To identify factors associated with postoperative seizure outcome among several presurgical, surgical and postsurgical variables. METHODS: Clinical records of 866 patients who received temporal lobe resections and with a minimum follow-up of 12 months were retrospectively searched for MRI-negative cases. Anamnestic, clinical, neurophysiological, surgical, histopathological and postsurgical data were collected. Seizure outcome was categorised as favourable (Engel's class I) and unfavourable (Engel's classes II-IV). Uni- and multivariate statistical analysis was performed to identify variables having a significant association with seizure outcome. RESULTS: Forty-eight patients matched the inclusion criteria. 26 (54.1%) patients required invasive EEG evaluation with Stereo-electro-encephalography (SEEG) before surgery. Histological evaluation was unremarkable in 34 cases (70.8%), revealed focal cortical dysplasias in 13 cases and hippocampal sclerosis in 2. 28 (58.3%) patients were in Engel's class I after a mean follow-up of 82 months (SD ± 74; range 12-252). Multivariate analysis indicated auditory aura, contralateral diffusion of the discharge at Video-EEG monitoring and use of 18F-FDG PET as variables independently associated with seizure outcome. CONCLUSION: Carefully selected patients with MRI-negative TLE can be good candidates for surgery. Surgery should be considered with caution in patients with clinical features of neocortical seizure onset and contralateral propagation of the discharge. Use of 18F-FDG PET may be helpful to improve SEEG and surgical strategies. The presented data help in optimising the selection of patients with MRI-negative TLE with good chances to benefit from surgery.
Entities:
Keywords:
Epilepsy surgery; Negative magnetic resonance imaging; Outcome predictors; Results on seizures; Temporal lobe epilepsy
Authors: Shasha Wu; Naoum P Issa; Maureen Lacy; David Satzer; Sandra L Rose; Carina W Yang; John M Collins; Xi Liu; Taixin Sun; Vernon L Towle; Douglas R Nordli; Peter C Warnke; James X Tao Journal: Front Neurol Date: 2021-05-17 Impact factor: 4.003