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  • 1
    Online Resource
    Online Resource
    Development of an online calculator for the prediction of seizure freedom following pediatric hemispherectomy using HOPS
    Wiley ; 2023
    In:  Epilepsia
    Details
    In: Epilepsia, Wiley
    Abstract: Although hemispheric surgeries are among the most effective procedures for drug‐resistant epilepsy (DRE) in the pediatric population, a large variability in outcomes remains. Identifying ideal hemispherectomy candidates is imperative to maximize the potential for seizure freedom. The objective was to develop an online, freely‐accesible tool that accurately predicts the probability of seizure freedom for any patient at 1‐, 2‐, and 5‐years post‐hemispherectomy to provide clinicians accessible and reliable prognostic information to complement clinical judgement. Methods Retrospective data of all pediatric patients with DRE and seizure outcome data from the original Hemispherectomy Outcome Prediction Scale (HOPS) study were included. The primary outcome of interest was time‐to‐seizure recurrence. A multivariate Cox proportional‐hazards regression model was developed to predict the likelihood of post‐hemispheric surgery seizure freedom duration based on a combination of variables identified by clinical judgement and inferential statistics as predictive of the primary outcome. The final model from this study was encoded in a publicly accessible online calculator on the (iNEST) website . Results The selected variables for inclusion in the final model included the 5 original HOPS variables (age at seizure onset, etiologic substrate, seizure semiology, prior non‐hemispheric resective surgery, and contralateral FDG‐PET hypometabolism) and 3 additional variables (age at surgery, history of infantile spasms, and magnetic resonance (MR) imaging lesion). Predictors of shorter time‐to‐seizure recurrence included younger age at seizure onset, older age at surgery, prior resective surgery, generalized seizure semiology, FDG‐PET hypometabolism contralateral to side of surgery, contralateral MR imaging lesion, non‐lesional MR imaging, non‐stroke etiologies, and history of infantile spasms. The area under the curve (AUC) of the final model was 73.0%. Significance Online calculators are efficient, cost‐free tools that can facilitate physicians in risk‐estimation and inform joint decision‐making with families, potentially leading to greater satisfaction. Although the HOPS data was previously validated in the first analysis, the authors encourage prospective external validation of this new tool.
    Type of Medium: Online Resource
    ISSN: 0013-9580 , 1528-1167
    URL: Article
    DOI: 10.1111/epi.17689
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2002194-X
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  • 2
    Online Resource
    Online Resource
    Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis
    Wiley ; 2023
    In:  Epilepsia Open Vol. 8, No. 1 ( 2023-03), p. 12-31
    Details
    In: Epilepsia Open, Wiley, Vol. 8, No. 1 ( 2023-03), p. 12-31
    Abstract: Insular epilepsy (IE) is an increasingly recognized cause of drug‐resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE. We performed a systematic review and individual participant data meta‐analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow‐up duration was 2.58 years (range, 0‐17 years), and 206 (66.7%) patients were seizure‐free at last follow‐up. Younger age at surgery (≤18 years; HR = 1.70, 95% CI = 1.09‐2.66, P  = .022) and invasive EEG monitoring (HR = 1.97, 95% CI = 1.04‐3.74, P  = .039) were significantly associated with shorter time to seizure recurrence. Performing MR‐guided laser ablation or radiofrequency ablation instead of open resection (OR = 2.05, 95% CI = 1.08‐3.89, P  = .028) was independently associated with suboptimal or poor seizure outcome (Engel II‐IV) at last follow‐up. Postoperative neurological complications occurred in 42.5% of patients, most commonly motor deficits (29.9%). Permanent neurological complications occurred in 7.8% of surgeries, including 5% and 1.4% rate of permanent motor deficits and dysphasia, respectively. Resection of the frontal operculum was independently associated with greater odds of motor deficits (OR = 2.75, 95% CI = 1.46‐5.15, P  = .002). Dominant‐hemisphere resections were independently associated with dysphasia (OR = 13.09, 95% CI = 2.22‐77.14, P  = .005) albeit none of the observed language deficits were permanent. Surgery for IE is associated with a good efficacy/safety profile. Most patients experience seizure freedom, and neurological deficits are predominantly transient. Pediatric patients and those requiring invasive monitoring or undergoing stereotactic ablation procedures experience lower rates of seizure freedom. Transgression of the frontal operculum should be avoided if it is not deemed part of the epileptogenic zone. Well‐selected candidates undergoing dominant‐hemisphere resection are more likely to exhibit transient language deficits; however, the risk of permanent deficit is very low.
    Type of Medium: Online Resource
    ISSN: 2470-9239 , 2470-9239
    URL: Issue
    URL: Article
    DOI: 10.1002/epi4.v8.1
    DOI: 10.1002/epi4.12663
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2863427-5
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  • 3
    Online Resource
    Online Resource
    Magnetic resonance‐guided laser interstitial thermal therapy for drug‐resistant epilepsy: A systematic review and individual participant data meta‐analysis
    Wiley ; 2023
    In:  Epilepsia Vol. 64, No. 8 ( 2023-08), p. 1957-1974
    Details
    In: Epilepsia, Wiley, Vol. 64, No. 8 ( 2023-08), p. 1957-1974
    Abstract: Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug‐resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta‐analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms “MR‐guided ablation therapy” and “epilepsy”. Multivariable mixed‐effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow‐up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure‐free at last follow‐up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p  = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p  = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p   〈  .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p  = .011) were independently associated with greater odds of seizure freedom at last follow‐up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p  = .012) and nonlesional MRI studies (OR = 3.25, p  = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p  = .006) and invasive electroencephalographic monitoring (OR = 4.83, p  = .003). Overall, MRgLITT is particularly effective in treating patients with well‐circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
    Type of Medium: Online Resource
    ISSN: 0013-9580 , 1528-1167
    URL: Article
    DOI: 10.1111/epi.17560
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2002194-X
    Location Call Number Limitation Availability
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