Csilla Gyimesi

Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

OBJECT The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome. METHODS This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan-Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes. RESULTS Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52-58% at 0.5 years), 54.5% (95% CI 50-58%) at 1 year, and 51.1% (95% CI 48-54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78-98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic-clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002). CONCLUSIONS Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.

Outcome of extratemporal epilepsy surgery experience of a single center.

OBJECTIVEOur aim was to determine the surgical outcome in adult patients with intractable extratemporal epilepsy and follow it over time. METHODSWe retrospectively studied the operative outcome in 218 consecutive adult patients with extratemporal lesions who underwent resective surgical treatment for intractable partial epilepsy in the Bethel Epilepsy Center, Bielefeld, Germany, between 1991 and 2005. Patients were divided into three groups according to the 5-year period in which the surgical procedure took place. RESULTSGroup I (1991–1995) consisted of 64 patients. The postoperative Engel Class I outcome was 50% at 6 months, 44.4% at 2 years, and 45.2% at 5 years. Group II (1996–2000) included 91 patients. Engel Class I outcome was 57.1% at 6 months, 53.8% at 2 years, and 53.5% at 5 years. In Group III (2001–2005), there were 63 patients. Engel Class I outcome was 65.1% at 6 months, 61.3% at 2 years, and 60.6% at 5 years. Short duration of epilepsy, surgery before 30 years of age, pathological findings of neoplasm, and well-circumscribed lesions on the preoperative magnetic resonance imaging scan were good prognostic factors. Poor prognostic factors were one or more of the following: psychic aura, generalized tonic-clonic seizure, versive seizure, history of previous surgery, and focal cortical dysplasia. On multivariate analysis, only the presence of well-circumscribed lesions on preoperative magnetic resonance imaging predicted a positive outcome (P = 0.001). CONCLUSIONOur results indicate that extratemporal epilepsy surgery at the Bethel Epilepsy Center has become more effective in the treatment of extratemporal epilepsy patients over the years, ensuring continuous improvement in outcome. This improvement can be attributed mainly to more restrictive patient selection.

Peri-ictal vegetative symptoms in temporal lobe epilepsy

We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.

Secondarily generalized seizures in temporal lobe epilepsy

Purpose:  Secondarily generalized tonic–clonic seizure (SGTCS) may occur rarely in temporal lobe epilepsy (TLE), but SGTCS is the major risk factor for sudden death and for seizure‐related fatal injuries. Our aim was to investigate clinical factors associated with the occurrence of SGTCS in TLE by addressing two questions: (1) What clinical features differentiate patients with TLE who regularly had SGTCS from those who did not? (2) Is there an association of secondarily generalized seizures with preceding seizure elements and clinical data?

Unilateral hand automatisms in temporal lobe epilepsy

OBJECTIVES To analyse the lateralising value of unilateral manual automatism (UMA), its relation to contralateral dystonia and the hand by which the UMA was performed. METHODS In this retrospective study, we reviewed video recordings of 141 patients (mean age 34.1+/-10) who had consecutively undergone presurgical evaluations with ictal video-EEG recordings and high-resolution MRI, had had epilepsy surgery due to intractable medial temporal lobe epilepsy with complex partial seizures due to unilateral medial temporal lobe lesions. The video recordings were prospectively reviewed by one of the authors blinded to patients clinical data except the diagnosis of medial temporal lobe epilepsy. Altogether 310 archived seizures were analysed. RESULTS Hand automatisms occurred in 86.5% of patients. UMA occurred in 53% of patients. If UMA was accompanied by contralateral hand dystonia, it had a high lateralising value to the ipsilateral epileptic focus (EF), it was ipsilateral in 85% of patients. Conversely, if UMA occurred without contralateral dystonia, it had only a limited lateralising value because it was ipsilateral to the EF in only 63% of patients. However, we found that left-sided UMA without dystonia had a high lateralising value to the left hemisphere (ipsilateral to the EF in 82%), while right-sided UMA without dystonia has practically no lateralising value. CONCLUSIONS UMA with contralateral dystonia has a high lateralising value to the ipsilateral hemisphere. Left-sided UMA without contralateral dystonia has a lateralising value to the left hemisphere. Right-sided UMA without contralateral dystonia has no lateralising value.