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Sang Kun Lee - One of the best experts on this subject based on the ideXlab platform.
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relationship between cortical resection and visual function after occipital lobe epilepsy surgery
Journal of Neurosurgery, 2017Co-Authors: Won Heo, Chunkee Chung, June Sic Kim, Sang Kun LeeAbstract:OBJECTIVE In this study, the authors investigated long-term clinical and visual outcomes of patients after occipital lobe epilepsy (OLE) surgery and analyzed the relationship between visual cortical resection and visual function after OLE surgery. METHODS A total of 42 consecutive patients who were diagnosed with OLE and underwent occipital lobe resection between June 1995 and November 2013 were included. Clinical, radiological, and histopathological data were reviewed retrospectively. Seizure outcomes were categorized according to the Engel Classification. Visual function after surgery was assessed using the National Eye Institute Visual Functioning Questionnaire 25. The relationship between the resected area of the visual cortex and visual function was demonstrated by multivariate linear regression models. RESULTS After a mean follow-up period of 102.2 months, 27 (64.3%) patients were seizure free, and 6 (14.3%) patients had an Engel Class II outcome. Nineteen (57.6%) of 33 patients had a normal visual field or quadrantanopia after surgery (normal and quadrantanopia groups). Patients in the normal and quadrantanopia groups had better vision-related quality of life than those in the hemianopsia group. The resection of lateral occipital areas 1 and 2 of the occipital lobe was significantly associated with difficulties in general vision, peripheral vision, and vision-specific roles. In addition, the resection of intraparietal sulcus 3 or 4 was significantly associated with decreased social functioning. CONCLUSIONS The authors found a favorable seizure control rate (Engel Class I or II) of 78.6%, and 57.6% of the subjects had good visual function (normal vision or quadrantanopia) after OLE surgery. Lateral occipital cortical resection had a significant effect on visual function despite preservation of the visual field.
Chunkee Chung - One of the best experts on this subject based on the ideXlab platform.
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relationship between cortical resection and visual function after occipital lobe epilepsy surgery
Journal of Neurosurgery, 2017Co-Authors: Chunkee ChungAbstract:OBJECTIVEIn this study, the authors investigated long-term clinical and visual outcomes of patients after occipital lobe epilepsy (OLE) surgery and analyzed the relationship between visual cortical resection and visual function after OLE surgery.METHODSA total of 42 consecutive patients who were diagnosed with OLE and underwent occipital lobe resection between June 1995 and November 2013 were included. Clinical, radiological, and histopathological data were reviewed retrospectively. Seizure outcomes were categorized according to the Engel Classification. Visual function after surgery was assessed using the National Eye Institute Visual Functioning Questionnaire 25. The relationship between the resected area of the visual cortex and visual function was demonstrated by multivariate linear regression models.RESULTSAfter a mean follow-up period of 102.2 months, 27 (64.3%) patients were seizure free, and 6 (14.3%) patients had an Engel Class II outcome. Nineteen (57.6%) of 33 patients had a normal visual field...
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relationship between cortical resection and visual function after occipital lobe epilepsy surgery
Journal of Neurosurgery, 2017Co-Authors: Won Heo, Chunkee Chung, June Sic Kim, Sang Kun LeeAbstract:OBJECTIVE In this study, the authors investigated long-term clinical and visual outcomes of patients after occipital lobe epilepsy (OLE) surgery and analyzed the relationship between visual cortical resection and visual function after OLE surgery. METHODS A total of 42 consecutive patients who were diagnosed with OLE and underwent occipital lobe resection between June 1995 and November 2013 were included. Clinical, radiological, and histopathological data were reviewed retrospectively. Seizure outcomes were categorized according to the Engel Classification. Visual function after surgery was assessed using the National Eye Institute Visual Functioning Questionnaire 25. The relationship between the resected area of the visual cortex and visual function was demonstrated by multivariate linear regression models. RESULTS After a mean follow-up period of 102.2 months, 27 (64.3%) patients were seizure free, and 6 (14.3%) patients had an Engel Class II outcome. Nineteen (57.6%) of 33 patients had a normal visual field or quadrantanopia after surgery (normal and quadrantanopia groups). Patients in the normal and quadrantanopia groups had better vision-related quality of life than those in the hemianopsia group. The resection of lateral occipital areas 1 and 2 of the occipital lobe was significantly associated with difficulties in general vision, peripheral vision, and vision-specific roles. In addition, the resection of intraparietal sulcus 3 or 4 was significantly associated with decreased social functioning. CONCLUSIONS The authors found a favorable seizure control rate (Engel Class I or II) of 78.6%, and 57.6% of the subjects had good visual function (normal vision or quadrantanopia) after OLE surgery. Lateral occipital cortical resection had a significant effect on visual function despite preservation of the visual field.
Casey H Halpern - One of the best experts on this subject based on the ideXlab platform.
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laser interstitial thermal therapy litt seizure outcomes for refractory mesial temporal lobe epilepsy
Epilepsy & Behavior, 2018Co-Authors: Robert S Fisher, Kai J Miller, Jaimie M Henderson, Gerald A Grant, Kimford J Meador, Casey H HalpernAbstract:Abstract Background Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy. Objective We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE). Material and methods We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017. Primary endpoints were seizure outcomes by (1) Engel Classification and (2) reduction in baseline seizure frequency. Secondary outcomes were postablation complications. Results A total of 30 patients underwent selective amygdalohippocampotomy via LITT. Mesial temporal sclerosis (MTS) was present in 23/30 (77%) patients. Median follow-up was 18 ± 12 months (range: 6–44 months). Almost all 28/29 (97%) patients had > 50% reduction, and 22/29 (76%) patients had > 90% reduction in seizure frequency. Engel Class I outcome was achieved in 18/29 (62%) patients; with complete seizure freedom in 9/29 (31%) patients (Engel Class IA). Three (10%) patients have had only focal aware seizures (Engel Class 1B). Seizures only occurred with medication withdrawal in 6/29 (21%) patients (Engel Class ID). Class II was achieved by 6/29 (21%) and Class III by 5/29 (17%) patients. Complications included perioperative seizures in 10/29 (34%) and nonseizure complaints in 6/29 (21%) patients. Three (10%) patients had neurological deficits including one permanent superior quadrantanopsia, one transient trochlear, and one transient oculomotor nerve palsy. Conclusions Overall, Engel Class I outcome was achieved in 62% of patients with MTLE, and 97% of patients achieved > 50% seizure frequency reduction. Complications were largely temporary, though there was one persistent visual field deficit. Laser ablation is well-tolerated and offers marked seizure reduction for the majority of patients.
Norman Delanty - One of the best experts on this subject based on the ideXlab platform.
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outcome measurement after vagal nerve stimulation therapy proposal of a new Classification
Epilepsia, 2007Co-Authors: John C Mchugh, Harsh W Singh, Colin P Doherty, J Phillips, Kevin Murphy, Norman DelantyAbstract:Summary: Purpose: Vagal nerve stimulation (VNS) is an adjunctive palliative therapy for refractory epilepsy. Effects of treatment are varied and some, such as the use of an external magnet for seizure termination, are unique to VNS. No accepted standard exists for outcome measurement after VNS treatment. We present a novel Classification for outcome, which includes assessment of both seizure frequency and severity in VNS-treated patients. Methods: We devised a Classification system modeled on the Engel Classification for surgically treated patients, but tailored for use in VNS therapy, which incorporates five classes of outcome. We retrospectively reviewed VNS-treated patients in our centre, and used the data to illustrate our system and compare it with the Engel model. Results: With this system, 48 patients (mean age, 30 years) were followed up over a median of 18 months. Seventy-eight percent had partial epilepsy. Sixteen and a half percent experienced class I outcome (>80% seizure-frequency reduction). Twenty percent had class II improvement (50‐79% seizure-frequency reduction). One-third had no improvement (class V). The remaining patients comprised class III (seizure-frequency reduction <50%) or class IV (magnet benefit alone) outcomes. Class I‐III outcomes were further subdivided according to effects on ictal or postictal severity. Conclusions: We propose a new Classification, which can be used for all epilepsies and which reflects outcome measures beyond seizure-frequency reduction alone. Use of this system would allow greater comparison between future studies of VNS therapy. Key Words: Vagal nerve stimulation—Epilepsy— Outcome measurement.
Pedro Andre Kowacs - One of the best experts on this subject based on the ideXlab platform.
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patient satisfaction with temporal lobectomy selective amygdalohippocampectomy for temporal lobe epilepsy and its relationship with Engel Classification and the side of lobectomy
Epilepsy & Behavior, 2014Co-Authors: Renato Endler Iachinski, Murilo S Meneses, Cristiane Simao, Samanta Fabricio Blattes Da Rocha, Flavia De Oliveira Braga, Pedro Andre KowacsAbstract:Abstract Purpose The aim of this study was to investigate not only the effectiveness of epilepsy surgery in improving seizure control but also patient satisfaction with the result of the procedure in a sample of patients operated on at a specialized epilepsy unit. Methods Patients with temporal lobe epilepsy who had undergone epilepsy surgery (temporal lobectomy/amygdalohippocampectomy) were interviewed in a standardized telephone survey about their satisfaction with the results of the surgery. The morbidity of the surgery was also analyzed retrospectively. The initial study population consisted of 6 amygdalohippocampectomy and 102 temporal lobectomy patients and was reduced to a final sample consisting of 4 amygdalohippocampectomy and 67 lobectomy patients, as the other patients were not available for interview. Surgical results were based on the Engel Classification, and satisfaction with the surgery was assessed by asking patients to rate their result and state whether they would make the same decision (to be operated on) again. Results A significant number of patients classified as Engel I or II, who considered the surgical outcome good or excellent, said they would have the surgery again (p Discussion Patient satisfaction with the results of epilepsy surgery may depend not only on achieving seizure control but also on the temporal lobe resected. Since worse results were associated with lower satisfaction rates only for left temporal resection patients, it is possible that the cognitive consequences of this procedure compound the worse surgical result, leading to decreased satisfaction.