Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoper...Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.展开更多
Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perile...Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perilesional area contributes to the epileptogenicity.Case presentation In the case presented in this report,the patient,a 24-year-old Caucasian male,developed a refractory status epilepticus after a surgical attempt to remove a cerebral ganglioglioma.The postoperative magnetic resonance imaging revealed that the lesion was intact,and that inadvertently only the perilesional area and adjacent cortex had been resected.The patient underwent a new surgical procedure where the ganglioglioma was removed,and the status epilepticus cessated.Conclusions This clinical case suggests that the lesion itself plays an important role in seizure generation and propagation,and notably,that the surrounding cortex by an inhibitory action can act as a gate to seizure spread.展开更多
文摘Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.
基金Region Skane and from the Swedish state under the agreement between the Swedish government and the county councils,the ALF agreement(PI J Bengzon).
文摘Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perilesional area contributes to the epileptogenicity.Case presentation In the case presented in this report,the patient,a 24-year-old Caucasian male,developed a refractory status epilepticus after a surgical attempt to remove a cerebral ganglioglioma.The postoperative magnetic resonance imaging revealed that the lesion was intact,and that inadvertently only the perilesional area and adjacent cortex had been resected.The patient underwent a new surgical procedure where the ganglioglioma was removed,and the status epilepticus cessated.Conclusions This clinical case suggests that the lesion itself plays an important role in seizure generation and propagation,and notably,that the surrounding cortex by an inhibitory action can act as a gate to seizure spread.
