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Prognostic factors of postoperative seizure outcome in patients with temporal lobe epilepsy and normal magnetic resonance imaging

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Abstract

Purpose

To retrospectively analyse a single-centre consecutive surgical series of patients with temporal lobe epilepsy (TLE) and negative MRI. To identify factors associated with postoperative seizure outcome among several presurgical, surgical and postsurgical variables.

Methods

Clinical records of 866 patients who received temporal lobe resections and with a minimum follow-up of 12 months were retrospectively searched for MRI-negative cases. Anamnestic, clinical, neurophysiological, surgical, histopathological and postsurgical data were collected. Seizure outcome was categorised as favourable (Engel’s class I) and unfavourable (Engel’s classes II–IV). Uni- and multivariate statistical analysis was performed to identify variables having a significant association with seizure outcome.

Results

Forty-eight patients matched the inclusion criteria. 26 (54.1%) patients required invasive EEG evaluation with Stereo-electro-encephalography (SEEG) before surgery. Histological evaluation was unremarkable in 34 cases (70.8%), revealed focal cortical dysplasias in 13 cases and hippocampal sclerosis in 2. 28 (58.3%) patients were in Engel’s class I after a mean follow-up of 82 months (SD ± 74; range 12–252). Multivariate analysis indicated auditory aura, contralateral diffusion of the discharge at Video-EEG monitoring and use of 18F-FDG PET as variables independently associated with seizure outcome.

Conclusion

Carefully selected patients with MRI-negative TLE can be good candidates for surgery. Surgery should be considered with caution in patients with clinical features of neocortical seizure onset and contralateral propagation of the discharge. Use of 18F-FDG PET may be helpful to improve SEEG and surgical strategies. The presented data help in optimising the selection of patients with MRI-negative TLE with good chances to benefit from surgery.

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Abbreviations

TLE:

Temporal lobe epilepsy

VEEG:

Video-electro-encephalography

EZ:

Epileptogenic zone

FS:

Febrile seizures

SEEG:

STEREO-electro-encephalography

HS:

Hippocampal sclerosis

APOS:

Acute postoperative seizures

FCD:

Focal cortical dysplasias

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Author notes

  1. Valeria Mariani and Martina Revay contributed equally to the preparation of the paper.

Authors and Affiliations

  1. “Claudio Munari” Epilepsy Surgery Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162, Milan, Italy

    Valeria Mariani, Martina Revay, Piergiorgio D’Orio, Michele Rizzi, Veronica Pelliccia, Laura Tassi & Massimo Cossu

  2. Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy

    Valeria Mariani

  3. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Valeria Mariani

  4. Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan, Milan, Italy

    Martina Revay

  5. Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy

    Piergiorgio D’Orio

  6. Department of Neuroscience, University of Parma, Parma, Italy

    Veronica Pelliccia

  7. Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Michele Nichelatti

  8. Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Gabriella Bottini

  9. Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy

    Gabriella Bottini

  10. Child Neuropsychiatry Unit, Istituto Giannina Gaslini, DINOGMI, University of Genova, Genoa, Italy

    Lino Nobili

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  1. Valeria Mariani
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Mariani, V., Revay, M., D’Orio, P. et al. Prognostic factors of postoperative seizure outcome in patients with temporal lobe epilepsy and normal magnetic resonance imaging. J Neurol 266, 2144–2156 (2019). https://doi.org/10.1007/s00415-019-09394-x

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