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Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter?
J Neurosurg Pediatr 2019; :1-9JN

Abstract

OBJECTIVE

There is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy.

METHODS

Children who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates.

RESULTS

One hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2-8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis.

CONCLUSIONS

A lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.

Authors+Show Affiliations

1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center. 2Department of Pediatrics, University of Cincinnati College of Medicine.3Division of Pediatric Neurosurgery and.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.4Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center. 2Department of Pediatrics, University of Cincinnati College of Medicine.1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center. 2Department of Pediatrics, University of Cincinnati College of Medicine.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31151097

Citation

Arya, Ravindra, et al. "Long-term Seizure Outcomes After Pediatric Temporal Lobectomy: Does Brain MRI Lesion Matter?" Journal of Neurosurgery. Pediatrics, 2019, pp. 1-9.
Arya R, Mangano FT, Horn PS, et al. Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter? J Neurosurg Pediatr. 2019.
Arya, R., Mangano, F. T., Horn, P. S., Kaul, S. K., Kaul, S. K., Roth, C., ... Greiner, H. M. (2019). Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter? Journal of Neurosurgery. Pediatrics, pp. 1-9. doi:10.3171/2019.4.PEDS18677.
Arya R, et al. Long-term Seizure Outcomes After Pediatric Temporal Lobectomy: Does Brain MRI Lesion Matter. J Neurosurg Pediatr. 2019 May 31;1-9. PubMed PMID: 31151097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter? AU - Arya,Ravindra, AU - Mangano,Francesco T, AU - Horn,Paul S, AU - Kaul,Sabrina K, AU - Kaul,Serena K, AU - Roth,Celie, AU - Leach,James L, AU - Turner,Michele, AU - Holland,Katherine D, AU - Greiner,Hansel M, Y1 - 2019/05/31/ PY - 2018/11/06/received PY - 2019/04/04/accepted PY - 2019/6/1/pubmed PY - 2019/6/1/medline PY - 2019/6/1/entrez KW - AED = antiepileptic drug KW - FSIQ = full-scale intelligence quotient KW - GLMM = generalized linear mixed model KW - HS = hippocampal sclerosis KW - ILAE = International League Against Epilepsy KW - MEG = magnetoencephalography KW - PET = positron emission tomography KW - SISCOM = subtraction ictal SPECT co-registered to MRI KW - SOZ = seizure-onset zone KW - SPECT = single-photon emission CT KW - TLE = temporal lobe epilepsy KW - drug-resistant epilepsy KW - epilepsy surgery KW - temporal lobe epilepsy SP - 1 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr N2 - OBJECTIVE: There is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy. METHODS: Children who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates. RESULTS: One hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2-8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis. CONCLUSIONS: A lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/31151097/Long_term_seizure_outcomes_after_pediatric_temporal_lobectomy:_does_brain_MRI_lesion_matter L2 - https://thejns.org/doi/10.3171/2019.4.PEDS18677 DB - PRIME DP - Unbound Medicine ER -