Abstract
To investigate the usage of functional neuroimaging as a prognostic tool for seizure recurrence and long-term outcomes in patients with multilobar resection, we recruited 90 patients who received multilobar resections between 1995 and 2013 with at least 1-year follow-up (mean 8.0 years). All patients were monitored using intracranial electroencephalography (EEG) after pre-surgical evaluation. Clinical data (demographics, electrophysiology, and neuroimaging) were reviewed retrospectively. Surgical outcomes were evaluated at 1, 2, 5 years after surgery, and at the end of the study. After 1 year, 56 patients (62.2%) became Engel class I and at the last follow-up, 47 patients (52.2%) remained seizure-free. Furthermore, non-localized 18F-fluorodeoxyglucose positron emission tomography (PET), identifying hypometabolic areas not concordant with ictal onset zones, significantly correlated with seizure recurrence after 1 year. Non-lesional magnetic resonance imaging (MRI) and left-sided resection correlated with poor outcomes. In the last follow-up, non-localized PET and left-sided resection significantly correlated with seizure recurrence. Both localized PET and ictal-interictal SPECT subtraction co-registered to MR (SISCOM) predicted good surgical outcomes in the last follow-up (69.2%, Engel I). This study suggests that PET and SISCOM may predict postoperative outcomes for patients after multilobar epilepsy and shows comparable long-term surgical outcomes after multilobar resection.
Highlights
Intractable localization-related epilepsy (LRE) patients have potential to eliminate seizures by resection surgery for epilepsy
Functional Neuroimaging with Multilobar Epilepsy Surgery factor of surgical outcomes in patients with focal cortical dysplasia [1] and extra-temporal lobe epilepsy.[5,6]
Interictal positron emission tomography (PET) was done in 79 patients (79/90, 87.7%) and SISCOM with interictal and ictal SPECT was performed in 75 patients (75/90, 83.3%)
Summary
Intractable localization-related epilepsy (LRE) patients have potential to eliminate seizures by resection surgery for epilepsy. Surgical outcomes for multilobar resection are worse than single lobe resections.[1,2,3,4] multilobar resection is regarded to be a poor prognostic. Functional Neuroimaging with Multilobar Epilepsy Surgery factor of surgical outcomes in patients with focal cortical dysplasia [1] and extra-temporal lobe epilepsy.[5,6] Previous studies have reported that 41% of patients undergoing multilobar resection were seizure-free after 10 years.[7] A recent study showed even better results where 60.6% of patients with two or more lobe resections (54/89) had good outcomes (Engel I-III).[3] the duration of follow-up was short (2 years) and the range of ‘good outcomes’ was broader than other reports
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