Abstract:
BACKGROUND:Surgery is an important therapeutic option in patients with medically refractory epilepsy. The combination of an extratemporal epileptic focus and nonlesional magnetic resonance imaging (MRI) was often believed to portend a poor outcome. OBJECTIVE:To investigate the outcome and analyze potential prognostic predictors in patients without lesions on MRI who underwent extratemporal resections. METHODS:Clinical, presurgical evaluation, invasive monitoring, and postoperative data of patients with high-resolution MRI that was initially reported as nonlesional were reviewed. Patients were reclassified as MRI-positive if an MRI abnormality related to the epilepsy was revealed at the multidisciplinary presurgical patient management conference, or as MRI-negative if imaging remained normal or revealed incidental findings. RESULTS:Sixty patients were identified; 72% were MRI-negative. In the original cohort, the median seizure-free duration was 1.32 years (95% confidence interval [CI], 0.16-2.0); probability of seizure freedom at 2 years was 36% (95% CI, 30%-43%). In the MRI-negative group, the median seizure-free duration was 1.52 years (95% CI, 0.12-5.17); probability of seizure freedom at 2 years was 42% (95% CI, 33%-50%). Complete resection of ictal onset areas and absence of acute postoperative seizures were significantly associated with longer seizure freedom (risk ratio 4.9, P = .004; 95% CI, 1.6-16.7 and 22.1, P < .001; 95% CI, 5.9-94.7, respectively). CONCLUSION:Among patients with medically refractory MRI nonlesional extratemporal epilepsy, detailed evaluation and subsequent resection leads to seizure freedom in 42% of patients at 2 years.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
See SJ,Jehi LE,Vadera S,Bulacio J,Najm I,Bingaman Wdoi
10.1227/01.neu.0000429839.76460.b7subject
Has Abstractpub_date
2013-07-01 00:00:00pages
68-76; discussion 76-7issue
1eissn
0148-396Xissn
1524-4040journal_volume
73pub_type
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