Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Seizure Control in Patients with Extratemporal Lobe Epilepsy

  • Park, Seung-Soo (Department of Neurosurgery, Chonbuk National University Medical School/Hospital) ;
  • Koh, Eun-Jeong (Department of Neurosurgery, Chonbuk National University Medical School/Hospital) ;
  • Oh, Young-Min (Department of Neurosurgery, Chonbuk National University Medical School/Hospital) ;
  • Lee, Woo-Jong (Department of Neurosurgery, Chonbuk National University Medical School/Hospital) ;
  • Eun, Jong-Pil (Department of Neurosurgery, Chonbuk National University Medical School/Hospital) ;
  • Choi, Ha-Young (Department of Neurosurgery, Chonbuk National University Medical School/Hospital)
  • Published : 2007.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study was designed to analyze seizure outcome and to investigate the prognostic factors for predicting seizure outcome according to the preoperative evaluations, surgical procedures, topectomy sites and histopathological findings in patients with extratemporal lobe epilepsy [ETLE]. Methods : This study comprised 63 patients with ETLE who underwent surgery. Preoperative evaluations included semiologic analysis, chronic video-EEG monitoring, and neuroimaging studies. Surgical procedures consisted of topectomy in 51 patients, corpus callosotomy in 9, functional hemispherectomy in 2, and vagus nerve stimulation [VNS] in 1. Histopathological findings were reviewed. Postoperative seizure outcomes were assessed by Engel's classification at the average follow up period of 66.8 months. Chi-square test was used for statistics. Results : Total postoperative seizure outcomes were class I in 51 [80%] patients, class II in 6 [10%], class III in 6 [10%]. Patients with structural abnormalities on neuroimaging study showed class I in 49 [88%] patients [p<0.05]. Patients with focal and regional ictal EEG onset revealed class I in 47 [90%] patients [p<0.05]. Semiologic findings, surgical procedures, topectomy sites and histopathological findings did not show statistical correlation with seizure outcome [p<0.05]. Conclusion : A good seizure outcome was obtained in patients with ETLE. The factors for favorable seizure outcome are related to the presence of structural abnormalities on neuroimaging study, and focal and regional ictal EEG onset.

Keywords

References

  1. Award IA, Rosenfeld J, Ahl J, Hahn JF, Luders H : Intractable epilelpsy and structural lesions of the brain : mapping, resection strategies, and seizure outcome. Epilepsia 32 : 179-186, 1991 https://doi.org/10.1111/j.1528-1157.1991.tb05242.x
  2. Cascino GD : Surgical treatment for extratemporal epilepsy. Cur Treat Options Neurol 6 : 257-262, 2004 https://doi.org/10.1007/s11940-004-0017-4
  3. Cascino GD, Sharbrough FW, Trenerry MR, Marsh WR, Kelly PJ, So E : Extratemporal cortical resections and lesionectomies for partial epilepsy : Complications of surgical treatment. Epilepsia 35 : 1085- 1090, 1994 https://doi.org/10.1111/j.1528-1157.1994.tb02559.x
  4. Chung CK, Lee SK, Kim KJ : Surgical outcome of epilepsy caused by cortical dysplasia. Epilepsia 46 (Suppl 1) : 25-29, 2005 https://doi.org/10.1111/j.0013-9580.2005.461008.x
  5. Drzezga A, Arnold S, Minoshima S, Noachtar S, Szecsi J, Winkler P, et al : 18F-FDG PET studies in patients with extratemporal and temporal epilepsy : evaluation of an observer-independent analysis. J Nucl Med 40 : 737-746, 1999
  6. Guenot M : Surgical treatment of epilepsy : outcome of various surgical procedures in adults and children. Rev Neurol (Paris) 160 Spec No 1 : 5S 171-174, 2004 https://doi.org/10.1016/S0035-3787(04)71196-0
  7. Harvey AS, Hopkins IJ, Bowe JM, Cook DJ, Shield LK, Berkovic SF : Frontal lobe epilepsy : Clinical seizure characteristics and localization with ictal 99mTc-HMPAO SPECT. Neurology 43 : 1966-1980, 1993 https://doi.org/10.1212/WNL.43.10.1966
  8. Holmes MD, Kutsy RL, Ojemann GA, Wilensky AJ, Ojemann LM : Interictal, unifocal spikes in refractory extratemporal epilepsy predict ictal origin and postsurgical outcome. Clin Neurophysiol lll : 1802- 1808, 2000
  9. Hosking PG : Surgery for frontal lobe epilepsy. Seizure 12 : 160-166, 2003 https://doi.org/10.1016/S1059-1311(02)00189-9
  10. Kim CH, Chung CK, Lee SK, Lee YK, Chi JG : Parietal lobe epilepsy : Surgical treatment and outcome. J Korean Neurosurg Soc 36 : 93- 101, 2004
  11. Lee SK, Lee SY, Kim KK, Hong KS, Lee DS, Chung CK : Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 58 : 525-532, 2005 https://doi.org/10.1002/ana.20569
  12. McLachlan RS : Vagus nerve stimulation for intractable epilepsy : a review. J Clin Neurophysiol 14 : 358-368, 1997 https://doi.org/10.1097/00004691-199709000-00002
  13. Mihara T, Matsuda K, Tottori T, Otsubo T, Baba K, Nishibayashi H, et al : Long-term seizure outcome following resective surgery at National Epilepsy Center in Shizuoka, Japan. Psychiatry Clin Neurosci 58 : S22-S25, 2004 https://doi.org/10.1111/j.1440-1819.2004.01244_6.x
  14. Mosewich RK, So EL, O'Brien TJ, Cascino GD, Sharbrough FW, Marsh WR, et al : Factors predictive of the outcome of frontal lobe epilepsy surgery. Epilepsia 41 : 843-849, 2000 https://doi.org/10.1111/j.1528-1157.2000.tb00251.x
  15. Schramm J, Kral T, Blumcke I, Elger CE : Surgery for neocortical temporal and frontal epilepsy. Adv Neurol 84 : 595-604, 2000
  16. Seo JS, Lee JJ, Lee JK, Kang JG, Lee SA, Ko TS : The outcome of corpus callosotomy for intractable epilepsy : 10 years experience of corpus callosotomy. J Korean Neurosurg Soc 39 : 16-19, 2006
  17. Shukla G, Bhatia M, Singh VP, Jaiswal A, Tripathi M, Gaikwad S, et al : Successful selection of patients with intractable extratemporal epilepsy using noninvasive investigations. Seizure 12 : 573-576, 2003 https://doi.org/10.1016/S1059-1311(03)00084-0
  18. Siegel AM, Jobst BC, Thadani VM, Rhodes CH, Lewis PJ, Roberts DW, et al : Medically intractable, localization-related epilepsy with normal MRI : presurgical evaluation and surgical outcome in 43 patients. Epilesia 42 : 883-888, 2001 https://doi.org/10.1046/j.1528-1157.2001.042007883.x
  19. Siegel AM : Presurgical evaluation and surgical treatment of medically refractory epilepsy. Neurosurg Rev 27 : 1-18, 2004 https://doi.org/10.1007/s10143-003-0305-6
  20. Tellez-Zenteno JF, Dhar R, Wiebe S : Long term seizure outcomes following epilepsy surgery : a systemic review and meta-analysis. Brain 128 : 1188-1198, 2005 https://doi.org/10.1093/brain/awh449
  21. Zentner J, Hufnagel A, Ostertun B, Wolf HK, Behrens E, Campos MG, et al : Surgical treatment of extratemporal epilepsy : clinical, radiologic, and histopathologic findings in 60 patients. Epilepsia 37 : 1072-1080, 1996 https://doi.org/10.1111/j.1528-1157.1996.tb01027.x