Ictal EEG remains the prominent predictor of seizure-free outcome after temporal lobectomy in epileptic patients with normal brain MRI

William O. Tatum IV, Selim R. Benbadis, Aatif Hussain, Sam Al-Saadi, Brett Kaminski, Leanne S. Heriaud, Fernando Vale Diaz

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose: While an abnormal pre-operative high-resolution brain MRI portends a favorable outcome in patients undergoing resective epilepsy surgery for medically intractable localization-related epilepsy (LRE), a normal MRI is less favorable. Ascertaining desirable pre-operative predictors for successful anterior temporal lobectomy (ATL) in LRE patients with a normal brain MRI is essential to better anticipate surgical outcome. Methods: Patients with LRE and normal temporal structures on MRI underwent ATL at two epilepsy centers in the southeastern US (FL and NC). Outcome was separated into those patients that were seizure free (SF), and those that were not seizure free (NSF), and those NSF were stratified in accordance with the Engel classification system. Those with a pre-operative history of clinical risk factors, unilateral anterior temporal interictal epileptiform discharges (IEDs), well localized scalp ictal EEG with rhythmic temporal theta at onset, localized PET/ictal SPECT, and Wada asymmetry with >2.5/8, were evaluated for the purpose of predicting outcome. Where appropriate, data is presented as a median (mean ± S.D.). Results: Thirty-nine patients, median age 33 years, were followed up 2 years (3 ± 1.2) after ATL. Overall, 22/39 (56.4%) patients were identified as SF, and 17/39 (43.6%) patients were NSF. Ictal EEG with rhythmic temporal theta at onset was the only predictive measure of seizure-free outcome ( p = 0.001, Fisher's exact test), and also favorably correlated with seizure reduction ( p = 0.0001, r 2 = 0.34, multiple regression analysis). None of the other predictors examined added greater predictive value. Conclusions: ATL is a favorable option for patients with LRE even when high-resolution brain MRI reveals normal temporal structures. Normal brain MRI patients with localizing pre-operative scalp ictal EEG, have better outcomes following ATL.

Original languageEnglish (US)
Pages (from-to)631-636
Number of pages6
JournalSeizure
Volume17
Issue number7
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

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Electroencephalography
Anterior Temporal Lobectomy
Seizures
Stroke
Brain
Partial Epilepsy
Scalp
Epilepsy
Single-Photon Emission-Computed Tomography
Regression Analysis

Keywords

  • Ictal EEG
  • Intractable epilepsy
  • Lobectomy
  • Normal MRI
  • Predictor

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Ictal EEG remains the prominent predictor of seizure-free outcome after temporal lobectomy in epileptic patients with normal brain MRI. / Tatum IV, William O.; Benbadis, Selim R.; Hussain, Aatif; Al-Saadi, Sam; Kaminski, Brett; Heriaud, Leanne S.; Vale Diaz, Fernando.

In: Seizure, Vol. 17, No. 7, 01.01.2008, p. 631-636.

Research output: Contribution to journalArticle

Tatum IV, William O. ; Benbadis, Selim R. ; Hussain, Aatif ; Al-Saadi, Sam ; Kaminski, Brett ; Heriaud, Leanne S. ; Vale Diaz, Fernando. / Ictal EEG remains the prominent predictor of seizure-free outcome after temporal lobectomy in epileptic patients with normal brain MRI. In: Seizure. 2008 ; Vol. 17, No. 7. pp. 631-636.
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T1 - Ictal EEG remains the prominent predictor of seizure-free outcome after temporal lobectomy in epileptic patients with normal brain MRI

AU - Tatum IV, William O.

AU - Benbadis, Selim R.

AU - Hussain, Aatif

AU - Al-Saadi, Sam

AU - Kaminski, Brett

AU - Heriaud, Leanne S.

AU - Vale Diaz, Fernando

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AB - Purpose: While an abnormal pre-operative high-resolution brain MRI portends a favorable outcome in patients undergoing resective epilepsy surgery for medically intractable localization-related epilepsy (LRE), a normal MRI is less favorable. Ascertaining desirable pre-operative predictors for successful anterior temporal lobectomy (ATL) in LRE patients with a normal brain MRI is essential to better anticipate surgical outcome. Methods: Patients with LRE and normal temporal structures on MRI underwent ATL at two epilepsy centers in the southeastern US (FL and NC). Outcome was separated into those patients that were seizure free (SF), and those that were not seizure free (NSF), and those NSF were stratified in accordance with the Engel classification system. Those with a pre-operative history of clinical risk factors, unilateral anterior temporal interictal epileptiform discharges (IEDs), well localized scalp ictal EEG with rhythmic temporal theta at onset, localized PET/ictal SPECT, and Wada asymmetry with >2.5/8, were evaluated for the purpose of predicting outcome. Where appropriate, data is presented as a median (mean ± S.D.). Results: Thirty-nine patients, median age 33 years, were followed up 2 years (3 ± 1.2) after ATL. Overall, 22/39 (56.4%) patients were identified as SF, and 17/39 (43.6%) patients were NSF. Ictal EEG with rhythmic temporal theta at onset was the only predictive measure of seizure-free outcome ( p = 0.001, Fisher's exact test), and also favorably correlated with seizure reduction ( p = 0.0001, r 2 = 0.34, multiple regression analysis). None of the other predictors examined added greater predictive value. Conclusions: ATL is a favorable option for patients with LRE even when high-resolution brain MRI reveals normal temporal structures. Normal brain MRI patients with localizing pre-operative scalp ictal EEG, have better outcomes following ATL.

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