Chun-Kee Chung

Surgical Outcome and Prognostic Factors of Cryptogenic Neocortical Epilepsy

Surgical treatment of cryptogenic neocortical epilepsy is challenging. The aim of this study was to evaluate surgical outcomes and to identify possible prognostic factors including the results of various diagnostic tools. Eighty‐nine patients with neocortical epilepsy with normal magnetic resonance imaging (35 patients with frontal lobe epilepsy, 31 with neocortical temporal lobe epilepsy, 11 with occipital lobe epilepsy, 11 with parietal lobe epilepsy, and 1 with multifocal epilepsy) underwent invasive study and focal surgical resection. Patients were observed for at least 2 years after surgery. The localizing values of interictal electroencephalogram (EEG), ictal scalp EEG, interictal 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET), and subtraction ictal single‐photon emission computed tomography were evaluated. Seventy‐one patients (80.0%) had a good surgical outcome (Engel class 1–3); 42 patients were seizure free. Diagnostic sensitivities of interictal EEG, ictal scalp EEG, FDG‐PET, and subtraction ictal single‐photon emission computed tomography were 37.1%, 70.8%, 44.3%, and 41.1%, respectively. Localization by FDG‐PET and interictal EEG was correlated with a seizure‐free outcome. The localizing value of FDG‐PET was greatest in neocortical temporal lobe epilepsy. The focalization of ictal onset and also ictal onset frequency in invasive studies were not related to surgical outcome. Concordance with two or more presurgical evaluations was significantly related to a seizure‐free outcome. Ann Neurol 2005

Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea

Objectives – The level of, and factors affecting the quality of life (QOL) in patients with epilepsy may be different in Korea where social prejudice toward them is still pronounced. However, these issues have not yet been addressed properly.

Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal Analysis

Summary:u2002 Purpose: Determining long‐term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis.

Pre-surgical evaluation and surgical outcome of 41 patients with non-lesional neocortical epilepsy

Pre-surgical evaluation and the surgical treatment of non-lesional neocortical epilepsy is one of the most challenging areas in epilepsy surgery. The aim of this study was to evaluate the surgical outcome and the diagnostic role of ictal scalp electroencephalography (EEG), interictal (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET), and ictal technetium-99m hexamethylpropyleneamine oxime single photon emission tomography ( (99m)Tc-HMPAO SPECT). In 41 non-lesional neocortical epilepsy patients (16 frontal lobe epilepsy, 11 neocortical temporal lobe epilepsy, seven occipital lobe epilepsy, four parietal lobe epilepsy, and three with multifocal onset) who underwent surgical treatment between December 1994 and July 1998, we evaluated the surgical outcome with a follow-up of at least 1 year. The localizing and lateralizing values of ictal scalp EEG, interictal FDG-PET, and ictal SPECT were evaluated in those patients with good surgical outcome. Ictal scalp EEG had the highest diagnostic sensitivity in the localization of epileptogenic foci (69.7% vs. 42.9% for FDG-PET and 33.3% for ictal SPECT; P= 0.027). However, no significant difference was found in the lateralization of the epileptogenic hemisphere among the three modalities (78.8% for ictal scalp EEG, 57.2% for FDG-PET, and 55.5% for ictal SPECT; P= 0.102). During a mean follow-up of 2.77 +/- 1.12 years, 33 (80.5%) showed good surgical outcome (seizure free or seizure reduction >90%), including 16 (39.0%) seizure free patients. Ictal scalp EEG was the most useful diagnostic tool in the localization of epileptogenic foci. Interictal FDG-PET and ictal SPECT were found to be useful as complementary and, sometimes, independent modalities. Many patients with non-lesional neocortical epilepsy would benefit from surgical treatment.

Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical Outcome

Summary:u2003 Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients.

Occipital Lobe Epilepsy : Clinical Characteristics, Surgical Outcome, and Role of Diagnostic Modalities

Summary:u2002 Purpose: To assess the role of various diagnostic modalities, to identify surgical prognostic factors and concordances with presurgical evaluations, and to characterize the clinical features of occipital lobe epilepsy (OLE), we studied 26 patients who were diagnosed as having OLE and underwent epilepsy surgery.

Neuroimaging Findings of Cortical Dyslamination with Cytomegaly

Summary: u2002Purpose: Our aims were to identify (a) the characteristic magnetic resonance imaging (MRI) findings of cortical dyslamination with cytomegaly, including dysplastic and destructive lesions; (b) the relationship between MRI findings and pathologic characteristics; (c) the diagnostic role of functional neuroimaging studies in patients with these pathologies.

FDG-PET Images Quantified by Probabilistic Atlas of Brain and Surgical Prognosis of Temporal Lobe Epilepsy

Summary: u2002Purpose: This study evaluated the relation between hypometabolism, diagnosed by fluorodeoxyglucose positron emission tomography (FDG‐PET), and the surgical outcome of a large and homogeneous series of cases of mesial temporal lobe epilepsy (mTLE), by using a probabilistic atlas of the human brain (statistical probabilistic anatomical maps: SPAM).

Limited utility of interictal apparent diffusion coefficient in the evaluation of hippocampal sclerosis

Objective – Quantitative measurement of diffusion has been studied as an independent parameter for the identification and characterization of abnormal hippocampi and temporal lobes in epileptic patients.

Comparison of localizing values of various diagnostic tests in non-lesional medial temporal lobe epilepsy

Though the surgical treatment for medial temporal lobe epilepsy yields a high success rate, more studies are needed in order to determine the most efficacious pre-operative algorithm. The authors studied the relationship between surgical outcome and the localization results of various pre-operative diagnostic tests to assess the predictive value. Seventy-one consecutive patients who had undergone anterior temporal lobectomy with amygdalohippocampectomy with the diagnosis of non-lesional medial temporal lobe epilepsy, who had been followed up more than 24 months, were analyzed retrospectively. Electroencephalogy (EEG), magnetic resonance imaging (MRI), proton emission tomography (PET), single photon emission computed tomography (SPECT), the Wada test, and neuropsychological testing were analyzed. There was no diagnostic test that was found to have a statistically significant relationship between Engel Class I outcome and localization results (P & 0.05). SPECT, neuropsychological testing, and the Wada test all had less predictive values (P < 0.01). EEG and PET had comparable predictive values for Engel Class I with MRI (P & 0.05). No single diagnostic test alone is sufficient to make a diagnosis of non-lesional medial temporal lobe epilepsy. MRI, EEG and PET had comparable predictive values for Engel Class I. SPECT, neuropsychological testing, and the Wada test had less predictive values.