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Epilepsy surgery in patients with normal or nonfocal MRI scans: Integrative strategies offer long‐term seizure relief
Author(s) -
Jayakar Prasanna,
Dunoyer Catalina,
Dean Pat,
Ragheb John,
Resnick Trevor,
Morrison Glenn,
Bhatia Sanjiv,
Duchowny Michael
Publication year - 2008
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2007.01428.x
Subject(s) - ictal interictal spect analysis by spm , ictal , electrocorticography , epilepsy surgery , epilepsy , medicine , electroencephalography , cohort , surgery , partial epilepsy , magnetic resonance imaging , scalp , radiology , psychiatry
SummaryPurpose: Excisional surgery achieves seizure freedom in a large proportion of children with intractable lesional epilepsy, but the outcome for children without a focal lesion on MRI is less clear. We report the outcome of a cohort predominantly of children with nonlesional intractable partial epilepsy undergoing resective surgery.Methods: We studied 102 patients with nonlesional intractable partial epilepsy who underwent excisional surgery. The epileptogenic region was identified by integrating clinical exam and video‐EEG data complemented by ictal SPECT (n = 40), PET (n = 10), extraoperative subdural monitoring (n = 80), and electrocorticography (n = 22). All patients had follow‐up greater than 2 years, 76 patients had 5‐year follow‐up, and 43 patients had 10‐year follow‐up.Results: A total of 66 resections were unilobar; 36 were multilobar. One patient died of causes unrelated to seizures or surgery. At 2‐year follow‐up, 44 of 101 patients were seizure‐free, 15 experienced >90% reduction, 17 had >50% reduction, and 25 were unchanged. At 5‐year follow‐up, 35 of 76 patients were seizure‐free, 12 experienced >90% reduction, 12 had >50% reduction, and 17 were unchanged. At 10‐year follow‐up, 16 of 43 patients were seizure‐free, 13 experienced >90% reduction, 7 had >50% reduction, and 7 were unchanged.Outcomes correlated with the presence of convergent focal interictal spikes (p < 0.005) on the scalp EEG and completeness of resection (p < 0.0005).Conclusions: Our findings demonstrate that excisional surgery is successful in the majority of children with nonlesional partial epilepsy. A multimodal integrative approach can minimize the size of resection and alleviate the need for invasive EEG monitoring. Focal interictal spikes and completeness of resection predict good outcome. The benefits of surgery are long‐lasting.