Factors associated with seizure recurrence in drug-resistant temporal epilepsy surgery
Keywords:
temporal lobe epilepsy surgery, epilepsy surgery outcome, predictors.Abstract
Introduction: Temporal lobe epilepsy is the most common form of focal epilepsy, 30% of cases are drug-resistant. Surgery in these patients is cost-effective superior to medical treatment.Objective: To identify variables of the pre-surgical, trans-surgical and post-surgical phase related to seizure recurrence, one year after surgery.
Methods: A descriptive study was carried out with a series of 24 cases, evaluated and surgically intervened with drug-resistant temporal lobe epilepsy; all patients underwent a detailed clinical history, video telemetry, magnetic resonance imaging and neuropsychology. Receptive techniques and pre- and post-resection electrocorticography were used to adjust the resection site. Patients were evaluated with the Engel scale one year after surgery. Fisher's exact test was used to determine the association between the variables. The value of p≤ 0.05 was significant.
Results: Post-surgical follow-up was one year. Seizure freedom (Engel I) was obtained in 79.2% of cases. The incomplete resection of the epileptogenic zone (p= 0.028), the presence of acute postoperative seizures (p= 0.036) and seizure six months after surgery (p= 0.002), was statistically associated with seizure recurrence.
Conclusions: One year after surgery, most of the operated patients still seizure free. The incomplete resection of the epileptogenic zone, the acute postoperative seizures and the presence of seizure six months after surgery was statistically associated with seizure recurrence.
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References
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23. Widjaja E, Jain P, Demoe L, Guttmann A, Tomlinson G, Sander B. Seizure outcome of pediatric epilepsy surgery. Systematic review and meta-analyses. Neurology. 2020; 94(7):311-21. DOI: 10.1212/WNL.0000000000008966
24. Giridharan N, Horna P, Greinera H, HollandaK, Manganoc F, Aryaa R, et al. Acute postoperative seizures as predictors of seizure outcomes after epilepsy surgery. Epilepsy Research. 2016; 127:119-25. DOI: 10.1016/j.eplepsyres.2016.08.026
25. Prayson B, Floden D, Ferguson L, Kim K, Jehi L, Busch R. Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults. Epilepsy & Behavior 2017; 68:108-114. DOI: 10.1016/j.yebeh.2016.11.004
2. Jehi L, Yardi R, Chagin K, Tassi L, Lo Russo G, Cendes F, et al. Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis. Lancet Neurol. 2015 [; 14(3):283-90. DOI: 10.1016/S1474-4422(15)70011-6
3. YeounYoo L, Panov F. Identification and Treatment of Drug-Resistant Epilepsy. Continuum (MinneapMinn). 2019 [acceso: 23/11/2020]; 25(2):362-80. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27920283/
4. Jehi L, Yehia L, Peterson Ch, Niazi F, Busch R, Prayson R, et al. Preliminary report: Late seizure recurrence years after epilepsy surgery may be associated with alterations in brain tissue transcriptome. Epilepsy open. 2018; 3(2):299-304. DOI: 10.1002/epi4.12119
5. Morales L. Evaluación clínica pre y post quirúrgica. Epilepsias farmacorresistentes su tratamiento en Cuba. Habana: ECIMED; 2017.
6. Samuel P, Menon R, Chandran A, Thomas S, Vilanilam G, Abraham M, et al. Seizure outcome and its predictors after frontal lobe epilepsy surgery. Acta Neurol Scand. 2019 [acceso: 04/01/2021]; 140(4):259-67. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31188464/
7. Mariani V, Revay M, D'Orio P, Rizzi M, Pelliccia V, Nichelatti M, et al. Prognostic factors of postoperative seizure outcome in patients with temporal lobe epilepsy and normal magnetic resonance imaging. Journal of Neurology. 2019 [acceso: 22/12/2021]; 266(9):2144-56. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31127383/
8. Mathon B, Bielle F, Samson E, Plaisant O, Dupont S, Bertrand A, et al. Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Epilepsia. 2017; 58(8):1473-85. DOI: 10.1111/epi.13831
9. Shin JH, Joo EY, SeoDW, Shon YM, Hong SB, Hong SC. Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy. PLoS ONE. 2018; 13(10): e0206095. DOI: 10.1371/journal.pone.0206095
10. West S, Nevitt SJ, Cotton J, Gandhi S, Weston J, Sudan A, Ramirez R, Newton R. Surgery for epilepsy. Cochrane Database of Systematic Reviews. 2019; 6:1-205. DOI: 10.1002/14651858
11. Sheikh S, Kattan M, Steinmetz M, Singer M, Udeh B, Jehi L. Cost effectiveness of surgery for drug resistant temporal lobe epilepsy in the US. Neurology. 2020; 95(10):1404-16. DOI: 10.1212/WNL.0000000000010185
12. Morales Chacón LM, García Maeso I, Báez Martin MM, Bender del Busto J, García Navarro ME, Quintanal Cordero N, et al. Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program. Behav. Sci. 2018; 8:19. DOI: 10.3390/bs8020019
13. Santos-Santos A, Morales LM, Castillo N, Dearriba M, Portela L, et al. Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery. J. Neuroscience and Neurological Surgery. 2021; 9(2): [aprox. 10 p.]. DOI:10.31579/2578-8868/196
14. Scheffer Ingrid. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsy. 2017; 58:512-21. DOI: 10.1111/epi.13709
15. Boonyapisit K, Najm I, Klem G, Ying Z, Burrier C, LaPresto E, et al. Epileptogenicity of Focal Malformations Due to Abnormal Cortical Development: Direct Electrocorticographic-Histopathologic Correlations. Epilepsia. 2003; 44(1):69-76. DOI: 10.1046/j.1528-1157.2003.08102.x
16. Blümcke I. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task force of the ILAE Diagnostic Methods Commission Epilepsy. 2011; 52: 158-74. DOI: 10.1111/j.1528-116.2010.02777.x
17. Zhenxing S, Huancong Z, Dan Y, Yaxing S, Kai Z, Zhiqiang C, et al. Predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy. Exp Ther Med. 2015; 10:1896-902. DOI: 10.3892/etm.2015.2753
18. Jayalakshmi S, Vooturi S, Vadapalli R, Somayajula S, Madigubba S, Panigrahi M. Outcome of surgery for temporal lobe epilepsy in adults. A cohort study. International Journal of Surgery. 2016; 36:443-47. DOI: 10.1016%2Fj.ijsu.2015.05.006
19. Caciagli L, Bernasconi A, Wiebe S, Koepp M, Bernasconi N, Bernhardt B. A meta-analysis on progressive atrophy in intractable temporal lobe epilepsy. Time is brain? Neurology. 2017; 89(5):506-16. DOI: 10.3892/etm.2015.2753
20. Malmgren K, Edelvik A. Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. Seizure. 2017; 44:217-24. DOI: 10.1016/j.seizure.2016.10.015
21. Ngoa L, Sperling M, Skidmoreb C, Mintzer C, Nei M. Absolute spike frequency as a predictor of surgical outcome in temporal lobe epilepsy. Seizure. 2017; 47: 83-6. DOI: 10.1016/j.seizure.2017.03.008
22. Morales Chacon L, Estupiñán B, Lorigados L, Trapaga O, García Maeso I, Sánchez A, et al. Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: An electrocorticography study. Seizure. 2009; 18:593-600. DOI:10.1016/j.seizure.2009.06.008
23. Widjaja E, Jain P, Demoe L, Guttmann A, Tomlinson G, Sander B. Seizure outcome of pediatric epilepsy surgery. Systematic review and meta-analyses. Neurology. 2020; 94(7):311-21. DOI: 10.1212/WNL.0000000000008966
24. Giridharan N, Horna P, Greinera H, HollandaK, Manganoc F, Aryaa R, et al. Acute postoperative seizures as predictors of seizure outcomes after epilepsy surgery. Epilepsy Research. 2016; 127:119-25. DOI: 10.1016/j.eplepsyres.2016.08.026
25. Prayson B, Floden D, Ferguson L, Kim K, Jehi L, Busch R. Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults. Epilepsy & Behavior 2017; 68:108-114. DOI: 10.1016/j.yebeh.2016.11.004
Published
2022-11-12
How to Cite
1.
Santos Santos A, Arrieta Hernández T, Peñalver Guía AI, de Arriba Romanidy MU, Fernández González L. Factors associated with seizure recurrence in drug-resistant temporal epilepsy surgery. Rev Cubana Med Milit [Internet]. 2022 Nov. 12 [cited 2025 May 13];51(4):e02202248. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2248
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