JNNP: Multimodal prognostic features of seizures in epilepsy surgery

Epilepsy surgery can cure focal drug-resistant epilepsy, but in more than half of patients, the epilepsy recurs
.

Postoperative outcomes included seizures, antiepileptic drug discontinuation, and neuropsychological and psychiatric outcomes

Quality of life prognostic features may be related to patient characteristics (eg, age, seizure characteristics, variability of seizures, and genetics), findings (focal lesions on MRI and localization of epileptic activity on EEG), surgical factors (resection margins or technique) and a combination of the above factors (concordance between imaging and neurophysiology)

This article was published in the Journal of Neurology, Neurosurgery & Psychiatry .

PubMed and Cochrane were searched using free-text and Medical Subject Heading (MeSH) terms according to reporting items for systematic reviews and meta-analyses
.

This study is registered with PROSPERO

Research flow chart

46 traits were found in 38 meta-analyses over 22 years
.

The following had consistent outcomes across meta-analyses: febrile seizures, hippocampal sclerosis, focal abnormal MRI, MRI-related single photon emission computed tomography (SPECT), focal seizure/interictal EEG, EEG -MRI concordance, temporal lobectomy, complete resection, histopathological lesions, tumor and focal cortical dysplasia type IIb

Potential variables for postoperative seizures

Prognostic imaging features included hippocampal sclerosis (RR 1.
17 (1.
12 to 1.
23)) and abnormal single-photon emission computed tomography (SPECT) co-recorded with MRI (ROES 2.
44–3.
28 (1.
34 to 5.
67))
.

Across 10 meta-analyses, abnormal MRI was consistently a predictor of prognosis, with the greatest impact in children with hemispherectomy

child

Significant prognostic features were: (1) presence of tumor (RR 1.
23 (1.
14 to 1.
32)), (2) focal cortical dysplasia type IIb (FCD) (ROES or 1.
38-1.
92 (1.
01 to 3.
57)), (3) Presence of any focal pathological lesions (ROES or 1.
08-3.
2 (1.
02 to 5.
3))
.

However, a meta-analysis showed no significant focal histopathology in MRI-negative temporal lobe epilepsy (TLE), suggesting that histopathological abnormalities are the basis for good outcomes in individuals with focal imaging abnormalities

Significant prognostic features are: Significant prognostic features are: 15 non-prognostic features include 15 non-prognostic features include

Epilepsy surgery has not improved seizure-free outcomes for decades, and despite many models, none can accurately predict it
.

The multimodal prognostic features of this study can be used for epileptic seizure feature prediction

Alim-Marvasti  A ,  Vakharia  VN ,  Duncan JS Alim-Marvasti  AAlim-Marvasti Vakharia  VNVakharia Duncan JSDuncanMultimodal prognostic features of seizure freedom in epilepsy surgeryJournal of Neurology, Neurosurgery & Psychiatry  Published Online First:  04 March 2022.
 Published Online First : doi:  10.
1136/jnnp-2021-327119doi:leave a message here