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Samuel Wiebe - One of the best experts on this subject based on the ideXlab platform.
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resective focal Epilepsy Surgery has selection of candidates changed a systematic review
Epilepsy Research, 2016Co-Authors: Churl Su Kwon, Samuel Wiebe, Jose F Tellezzenteno, Amy Metcalfe, Walter Hader, Jonathan Neal, Kathryn C Fitzgerald, Lizbeth Hernandezronquillo, Nathalie JetteAbstract:Abstract Objective No standard, widely accepted criteria exist to determine who should be referred for an Epilepsy surgical evaluation. As a result, indications for Epilepsy Surgery evaluation vary significantly between centers. We review the literature to assess what criteria have been used to select patients for resective Epilepsy Surgery and examine whether these have changed since the publication of the first Epilepsy Surgery randomized controlled trial in 2001. Methods A systematic review was conducted using PubMed and EMBASE, bibliographies of reviews and book chapters identifying focal Epilepsy resective series. Abstract, full text review and data abstraction (i.e. indications for Surgery) were performed independently by two reviewers. Descriptive historical analysis was done to examine indications over time. Results Out of 5061 articles related to Epilepsy Surgery, 384 articles met all eligibility criteria. Most common criteria for selecting patients for evaluation for resective Surgery were: AED resistance ( n =303, most commonly >2 AEDs=46), Epilepsy duration ( n =53, most commonly >1 year=42) and seizure frequency (most commonly at least one seizure/month, n =29). Out of the prospective studies the most notable change over time (pre-2000 vs. post-2000) was failure of ≥2 AEDs (8% vs. 43% respectively, p Conclusions Important variations between studies make it difficult to identify consistent criteria to guide surgical candidacy or changes in indications over time. With increasing evidence that earlier Surgery is associated with better outcomes, it is recommended that patients be evaluated as soon as they have failed two AEDs, consistent with the new definition of drug resistant Epilepsy. Furthermore, low seizure frequency should not be a barrier to Epilepsy Surgery. Anyone with drug resistant Epilepsy should be promptly evaluated for possible Surgery, regardless of seizure frequency.
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neurologists knowledge of and attitudes toward Epilepsy Surgery a national survey
Neurology, 2015Co-Authors: Jodie I Roberts, Samuel Wiebe, Chantelle Hrazdil, Khara M Sauro, Michelle Vautour, Natalie Wiebe, Nathalie JetteAbstract:Objectives: In the current study, we aim to assess potential neurologist-related barriers to Epilepsy Surgery among Canadian neurologists. Methods: A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to Surgery for patients with Epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders. Results: In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with Epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering Surgery, and nearly half (48.6%) failed to correctly define drug-resistant Epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to Surgery for patients with Epilepsy. Conclusions: A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for Epilepsy Surgery. Access also appears to be a significant barrier to Epilepsy Surgery and surgical evaluation. As a result, we are concerned that patients with Epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment.
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complications of Epilepsy Surgery a systematic review of focal surgical resections and invasive eeg monitoring
Epilepsia, 2013Co-Authors: Walter Hader, Samuel Wiebe, Jose F Tellezzenteno, Amy Metcalfe, Lisbeth Hernandezronquillo, Churl Su Kwon, Nathalie JetteAbstract:SummaryPurpose Underutilization of Epilepsy Surgery remains a major problem and is in part due to physicians' misconceptions about the risks associated with Epilepsy Surgery. The purpose of this study was to systematically review the literature on complications of focal Epilepsy Surgery. Methods A literature search was conducted using PubMed and Embase to identify studies examining Epilepsy Surgery complications. Abstract and full text review, along with data extraction, was done in duplicate. Minor medical and neurologic complications were defined as those that resolved completely within 3 months of Surgery, whereas major complications persisted beyond that time frame. Descriptive statistics were used to report complication proportions. Key Findings Invasive monitoring: Minor complications were reported in 7.7% of patients, whereas major complications were reported in only 0.6% of patients undergoing invasive monitoring. Resective Surgery: Minor and major medical complications were reported in 5.1% and 1.5% of patients respectively, most common being cerebrospinal fluid (CSF) leak. Minor neurologic complications occurred in 10.9% of patients and were twice as frequent in children (11.2% vs. 5.5%). Minor visual field defects were most common (12.9%). Major neurologic complications were noted in 4.7% of patients, with the most common being major visual field defects (2.1% overall). Perioperative mortality was uncommon after Epilepsy Surgery, occurring in only 0.4% of temporal lobe patients (1.2%extratemporal). Significance The majority of complications after Epilepsy Surgery are minor or temporary as they tend to resolve completely. Major permanent neurologic complications remain uncommon. Mortality as a result of Epilepsy Surgery in the modern era is rare.
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development of an online tool to determine appropriateness for an Epilepsy Surgery evaluation
Neurology, 2012Co-Authors: Marino Muxfeldt Bianchin, Jose F Tellezzenteno, Walter Hader, Nathalie Jette, Ana Lucia Abujamra, Hude Quan, Samuel WiebeAbstract:Objectives: Despite evidence that Epilepsy Surgery is more effective than medical therapy, significant delays between seizure intractability and Surgery exist. We aimed to develop a new Web-based methodology to assist physicians in identifying patients who might benefit from an Epilepsy Surgery evaluation. Methods: The RAND/UCLA appropriateness method was used. Clinical scenarios were developed based on eligibility criteria from previously published surgical series. Thirteen national experts rated the scenarios for their appropriateness for an Epilepsy Surgery evaluation based on published evidence. All scenarios were rerated after a face-to-face meeting following a modified Delphi process. Appropriate scenarios were rerated for necessity to determine referral priority. Results: Of the final 2646 scenarios, 20.6% (n = 544) were appropriate, 17.2% (n = 456) uncertain, and 61.5% (n = 1626) inappropriate for a surgical evaluation. Of the appropriate cases, 55.9% (n = 306) were rated as very high priority. Not attempting AED treatment was always rated as inappropriate for a referral. Trial of 2 AEDs was usually rated as appropriate unless seizure-free or not fully investigated Based on these data, a Web-based decision tool (www.Epilepsycases.com) was created. Conclusions: Using the available evidence through 2008 and expert consensus, we developed a Web-based decision tool that provides a guide for determining candidacy for Epilepsy Surgery evaluations. The tool needs clinical validation, and will be updated and revised regularly. This rendition of the tool is most appropriate for those over age 12 years with focal Epilepsy. The Rand/UCLA appropriate methodology might be considered in the development of guidelines in other areas of Epilepsy care.
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neuropsychological outcomes after Epilepsy Surgery systematic review and pooled estimates
Epilepsia, 2011Co-Authors: Elisabeth M S Sherman, Samuel Wiebe, Taryn B Faymcclymont, Jose F Tellezzenteno, Amy Metcalfe, Lisbeth Hernandezronquillo, Walter HaderAbstract:Summary Purpose: Epilepsy Surgery is a safe surgical procedure, but it may be associated with cognitive changes. Estimates of the risk of decline in specific neuropsychological domains after Epilepsy Surgery would assist surgical decision making in clinical practice. The goal of this study was to conduct a systematic review to derive pooled estimates of the rate of losses and gains in neuropsychological functions after Epilepsy Surgery, using empirically based methods for quantifying cognitive change. Methods: An extensive literature search using PubMed, EmBase, and the Cochrane database was conducted, yielding 5,061 articles on Epilepsy Surgery, with 193 on neuropsychological outcomes (IQ, memory, language, executive functioning, attention, and subjective cognitive changes). Key Findings: Of these, 23 met final eligibility criteria, with 22 studies involving temporal Surgery only. Key aspects of inclusion criteria were N ≥ 20 and use of reliable change index or standardized regression-based change estimates. In addition to the proportion of patients experiencing losses and gains in each individual test, a single pooled estimate of gains and losses for each cognitive domain was derived using a random effects model. Weighted estimates indicated a risk to verbal memory with left-sided temporal Surgery of 44%, twice as high as the rate for right-sided Surgery (20%). Naming was reduced in 34% of left-sided temporal patients, with almost no patients with gains (4%). Pooled data on IQ, executive functioning, and attention indicated few patients show declines post Surgery, but a substantial rate of improvement in verbal fluency with left-sided temporal Surgery (27%) was found. Self-reported cognitive declines after Epilepsy Surgery were uncommon, and gains were reported in some domains where losses were found on objective tests (i.e., verbal memory and language). Variations in surgical techniques did not appear to have a large effect on cognitive outcomes, except for naming outcomes, which appeared better with more conservative resections. Sensitivity to postoperative changes differed across visual memory tests, but not verbal memory tests. Few conclusions could be made regarding cognitive risks and benefits of extratemporal Epilepsy Surgery, or of Epilepsy Surgery in children. Significance: In sum, Epilepsy Surgery is associated with specific cognitive changes, but may also improve cognition in some patients. The results provide base rate estimates of expected cognitive gains and losses associated with Epilepsy Surgery that may prove useful in clinical settings.
Barbara G Vickrey - One of the best experts on this subject based on the ideXlab platform.
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mood anxiety and incomplete seizure control affect quality of life after Epilepsy Surgery
Neurology, 2014Co-Authors: Hamada Hamid, Barbara G Vickrey, Anne T Berg, Carl W Bazil, Karen Blackmon, Xiangyu Cong, James Dziura, Lauren Y Atlas, John T LangfittAbstract:Objective: We examined the complex relationship between depression, anxiety, and seizure control and quality of life (QOL) outcomes after Epilepsy Surgery. Methods: Seven Epilepsy centers enrolled 373 patients and completed a comprehensive diagnostic workup and psychiatric and follow-up QOL evaluation. Subjects were evaluated before Surgery and then at 3, 6, 12, 24, 48, and 60 months after Surgery. Standardized assessments included the Quality of Life in Epilepsy Inventory–89, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A mixed-model repeated-measures analysis was used to analyze associations of depression, anxiety, seizure outcome, and seizure history with overall QOL score and QOL subscores (cognitive distress, physical health, mental health, Epilepsy-targeted) prospectively. Results: The groups with excellent and good seizure control showed a significant positive effect on the overall QOL compared to the groups with fair and poor seizure control. The BDI and BAI scores were both highly and negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score. Conclusions: Depression and anxiety are strongly and independently associated with worse QOL after Epilepsy Surgery. Interestingly, even partial seizure control, controlling for depression and anxiety levels, improved QOL. Management of mood and anxiety is a critical component to postsurgical care.
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expectations prior to Epilepsy Surgery an exploratory comparison of men and women
Seizure-european Journal of Epilepsy, 2009Co-Authors: C M Bower, Ron D Hays, Michael R Sperling, Susan S Spencer, Orrin Devinsky, Sheryl R Haut, Stefanie D Vassar, Barbara G VickreyAbstract:Abstract Although the clinical goal of resective Epilepsy Surgery is seizure freedom, patients have a wide set of expectations for this invasive procedure. The goal of this study was to evaluate potential gender differences in expectations among patients undergoing resective Epilepsy Surgery. Ratings of the importance of 12 potential impacts ("expectations") of resective Surgery were analyzed in a seven-center cohort study including 389 adults aged 16 and older who underwent resective Epilepsy Surgery. Men and women both ranked anticipated changes in driving and memory as the most important presurgical expectations. Women rated driving, physical activity limitations, and economic worries as less important, and fatigue and pregnancy concerns as more important than did men (p's≤0.05). Exploratory factor analysis indicated a different pattern of associations among the 12 importance items for men and women. Whether gender differences in presurgical values are associated with outcomes needs exploration.
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health related quality of life over time since resective Epilepsy Surgery
Annals of Neurology, 2007Co-Authors: Susan S Spencer, Barbara G Vickrey, John T Langfitt, Michael R Sperling, Anne T Berg, Carl W Bazil, Thaddeus S Walczak, Sheryl R Haut, Orrin DevinskyAbstract:Objective Health-related quality of life (HRQOL) improves after resective Epilepsy Surgery, but data are limited to short follow-up in mostly retrospective reports, with minimal consideration of other potential factors that might influence HRQOL. Methods In a prospective multicenter study, 396 patients underwent resective Epilepsy Surgery. They completed the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) before Surgery, within 6 months, and at approximately yearly intervals after Surgery. Seizure outcome was ascertained by phone calls every 3 months, and dates of postoperative seizures were chronicled. Overall HRQOL as measured by the QOLIE-89 was evaluated with respect to seizure outcome using logistic regression. Results QOLIE-89 scores increased significantly at the first postoperative measurement (within 6 months after Surgery) in the cohort overall; subsequent changes over time were sensitive to seizure-free and aura-free status. After adjusting for baseline scores, the corresponding postsurgical QOLIE-89 overall, and four dimension scores, increased as a function of square root of time seizure-free, and independently as a function of square root of time aura free, leveling by 2 years of stable seizure (aura) status. HRQOL was not independently related to duration of Epilepsy, duration of intractable Epilepsy, or continuation of medications. Interpretation HRQOL improves early after Surgery, regardless of seizure outcome. Subsequent changes parallel length of time seizure free or aura free, stabilize after 2 years, and are unrelated to duration of Epilepsy, duration of intractable Epilepsy, or continued medication use. Ann Neurol 2007
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predicting long term seizure outcome after resective Epilepsy Surgery the multicenter study
Neurology, 2005Co-Authors: Susan S Spencer, Barbara G Vickrey, John T Langfitt, Michael R Sperling, Anne T Berg, Carl W Bazil, Shlomo Shinnar, Thaddeus S Walczak, Steven V PaciaAbstract:Background: In a seven-center prospective observational study of resective Epilepsy Surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse. Methods: Patients aged 12 years and over were enrolled at time of referral for Epilepsy Surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of Surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using χ 2 and proportional hazards analysis. Results: Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic-clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients. Conclusion: Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections.
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initial outcomes in the multicenter study of Epilepsy Surgery
Neurology, 2003Co-Authors: Susan S Spencer, Barbara G Vickrey, John T Langfitt, Michael R Sperling, Anne T Berg, Carl W Bazil, Shlomo Shinnar, Thaddeus S Walczak, Steven V Pacia, Nader EbrahimiAbstract:Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective Epilepsy Surgery. Methods: The authors characterized resective Epilepsy Surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews. Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after Surgery (p Conclusion: Resective Surgery for treatment of Epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective Epilepsy Surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of Epilepsy Surgery.
Aria Fallah - One of the best experts on this subject based on the ideXlab platform.
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Epilepsy Surgery for rasmussen encephalitis the ucla experience
Journal of Neurosurgery, 2020Co-Authors: Nikhil Bellamkonda, Gary W Mathern, Westley H Phillips, Jiashu Chen, Alexander M Tucker, Cassia Maniquis, Aria FallahAbstract:Objective Rasmussen encephalitis (RE) is a rare inflammatory neurological disorder typically involving one hemisphere and resulting in drug-resistant Epilepsy and progressive neurological decline. Here, the authors present seizure outcomes in children who underwent Epilepsy Surgery for RE at a single institution. Methods The records of consecutive patients who had undergone Epilepsy Surgery for RE at the UCLA Mattel Children's Hospital between 1982 and 2018 were retrospectively reviewed. Basic demographic information, seizure history, procedural notes, and postoperative seizure and functional outcome data were analyzed. Results The cohort included 44 patients, 41 of whom had sufficient data for analysis. Seizure freedom was achieved in 68%, 48%, and 22% of the patients at 1, 5, and 10 years, respectively. The median time to the first seizure for those who experienced seizure recurrence after Surgery was 39 weeks (IQR 11-355 weeks). Anatomical hemispherectomy, as compared to functional hemispherectomy, was independently associated with a longer time to postoperative seizure recurrence (HR 0.078, p = 0.03). There was no statistically significant difference in postoperative seizure recurrence between patients with complete hemispherectomy and those who had less-than-hemispheric Surgery. Following Surgery, 68% of the patients could ambulate and 84% could speak regardless of operative intervention. Conclusions A large proportion of RE patients will have seizure relapse after Surgery, though patients with anatomical hemispherectomies may have a longer time to postoperative seizure recurrence. Overall, the long-term data in this study suggest that hemispheric Surgery can be seen as palliative treatment for seizures rather than a cure for RE.
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resective Epilepsy Surgery for tuberous sclerosis in children determining predictors of seizure outcomes in a multicenter retrospective cohort study
Neurosurgery, 2015Co-Authors: Aria Fallah, Alireza Mansouri, Orrin Devinsky, Shaun D Rodgers, Alexander G Weil, Sumeet Vadera, Mary B Connolly, Philippe Major, Howard L WeinerAbstract:Background There are no established variables that predict the success of curative resective Epilepsy Surgery in children with tuberous sclerosis complex (TSC). Objective We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective Epilepsy Surgery. Methods A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The "event" was defined as seizures after resective Epilepsy Surgery. Results Seventy-four patients (41 male) were included. The median age of the patients at the time of Surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and 2-year follow-up, respectively. On univariate analyses, younger age at seizure onset (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.03-4.00, P = .04), larger size of predominant tuber (HR: 1.03, 95% CI: 0.99-1.06, P = .12), and resection larger than a tuberectomy (HR: 1.86, 95% CI: 0.92-3.74, P = .084) were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy (HR: 2.90, 95% CI: 1.17-7.18, P = .022) was independently associated with a longer duration of seizure freedom. Conclusion In this large consecutive cohort of children with TSC and medically intractable Epilepsy, a greater extent of resection (more than just the tuber) is associated with a greater probability of seizure freedom. This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber.
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Predictors of Seizure Outcomes in Children with Tuberous Sclerosis Complex and Intractable Epilepsy Undergoing Resective Epilepsy Surgery: An Individual Participant Data Meta-Analysis
PloS one, 2013Co-Authors: Aria Fallah, Stephen D. Walter, George M. Ibrahim, Alireza Mansouri, Gordon H. Guyatt, O. Carter Snead, Shanil Ebrahim, Deven Reddy, Abhaya V. Kulkarni, Mohit BhandariAbstract:Objective To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective Epilepsy Surgery.
John T Langfitt - One of the best experts on this subject based on the ideXlab platform.
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indications and expectations for neuropsychological assessment in Epilepsy Surgery in children and adults
Epileptic Disorders, 2019Co-Authors: Sallie Baxendale, John T Langfitt, Christoph Helmstaedter, Sarah J Wilson, Gus A Baker, William B Barr, Bruce P Hermann, Gitta Reuner, Patricia Rzezak, Severine SamsonAbstract:In our first paper in this series (Epilepsia 2015; 56(5): 674-681), we published recommendations for the indications and expectations for neuropsychological assessment in routine Epilepsy care. This partner paper provides a comprehensive overview of the more specialist role of neuropsychological assessment in the pre and postoperative evaluation of Epilepsy Surgery patients. The paper is in two parts. The first part presents the framework for the mandatory role of neuropsychologists in the presurgical evaluation of Epilepsy Surgery candidates. A preoperative neuropsychological assessment should be comprised of standardised measures of cognitive function in addition to wider measures of behavioural and psychosocial function. The results from the presurgical assessment are used to: (1) establish a baseline against which change can be measured following Surgery; (2) provide a collaborative contribution to seizure characterization, lateralization and localization; (3) provide evidence-based predictions of cognitive risk associated with the proposed Surgery; and (4) provide the evidence base for comprehensive preoperative counselling, including exploration of patient expectations of surgical treatment. The second part examines the critical role of the neuropsychologist in the evaluation of postoperative outcomes. Neuropsychological changes following Surgery are dynamic and a comprehensive, long-term assessment of these changes following Surgery should form an integral part of the postoperative follow-up. The special considerations with respect to pre and postoperative assessment when working with paediatric populations and those with an intellectual disability are also discussed. The paper provides a summary checklist for neuropsychological involvement throughout the Epilepsy Surgery process, based on the recommendations discussed.
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mood anxiety and incomplete seizure control affect quality of life after Epilepsy Surgery
Neurology, 2014Co-Authors: Hamada Hamid, Barbara G Vickrey, Anne T Berg, Carl W Bazil, Karen Blackmon, Xiangyu Cong, James Dziura, Lauren Y Atlas, John T LangfittAbstract:Objective: We examined the complex relationship between depression, anxiety, and seizure control and quality of life (QOL) outcomes after Epilepsy Surgery. Methods: Seven Epilepsy centers enrolled 373 patients and completed a comprehensive diagnostic workup and psychiatric and follow-up QOL evaluation. Subjects were evaluated before Surgery and then at 3, 6, 12, 24, 48, and 60 months after Surgery. Standardized assessments included the Quality of Life in Epilepsy Inventory–89, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A mixed-model repeated-measures analysis was used to analyze associations of depression, anxiety, seizure outcome, and seizure history with overall QOL score and QOL subscores (cognitive distress, physical health, mental health, Epilepsy-targeted) prospectively. Results: The groups with excellent and good seizure control showed a significant positive effect on the overall QOL compared to the groups with fair and poor seizure control. The BDI and BAI scores were both highly and negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score. Conclusions: Depression and anxiety are strongly and independently associated with worse QOL after Epilepsy Surgery. Interestingly, even partial seizure control, controlling for depression and anxiety levels, improved QOL. Management of mood and anxiety is a critical component to postsurgical care.
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intracarotid amobarbital procedure for Epilepsy Surgery
Epilepsy & Behavior, 2011Co-Authors: Ashwini Sharan, John T Langfitt, Michael R SperlingAbstract:The intracarotid amobarbital procedure (IAP) has been used for more than half a century to determine language dominance and to assess risk for amnesia after anterior temporal lobectomy. However, because of the risk associated with angiography and the development of noninvasive techniques, the need for the IAP when evaluating patients for Epilepsy Surgery can now be questioned. The purpose of this review is to examine the clinical indications and efficacy of the Wada test in the preoperative evaluation of Epilepsy Surgery candidates. This article summarizes a debate that took place during the 2009 American Epilepsy Society (AES) annual course.
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health related quality of life over time since resective Epilepsy Surgery
Annals of Neurology, 2007Co-Authors: Susan S Spencer, Barbara G Vickrey, John T Langfitt, Michael R Sperling, Anne T Berg, Carl W Bazil, Thaddeus S Walczak, Sheryl R Haut, Orrin DevinskyAbstract:Objective Health-related quality of life (HRQOL) improves after resective Epilepsy Surgery, but data are limited to short follow-up in mostly retrospective reports, with minimal consideration of other potential factors that might influence HRQOL. Methods In a prospective multicenter study, 396 patients underwent resective Epilepsy Surgery. They completed the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) before Surgery, within 6 months, and at approximately yearly intervals after Surgery. Seizure outcome was ascertained by phone calls every 3 months, and dates of postoperative seizures were chronicled. Overall HRQOL as measured by the QOLIE-89 was evaluated with respect to seizure outcome using logistic regression. Results QOLIE-89 scores increased significantly at the first postoperative measurement (within 6 months after Surgery) in the cohort overall; subsequent changes over time were sensitive to seizure-free and aura-free status. After adjusting for baseline scores, the corresponding postsurgical QOLIE-89 overall, and four dimension scores, increased as a function of square root of time seizure-free, and independently as a function of square root of time aura free, leveling by 2 years of stable seizure (aura) status. HRQOL was not independently related to duration of Epilepsy, duration of intractable Epilepsy, or continuation of medications. Interpretation HRQOL improves early after Surgery, regardless of seizure outcome. Subsequent changes parallel length of time seizure free or aura free, stabilize after 2 years, and are unrelated to duration of Epilepsy, duration of intractable Epilepsy, or continued medication use. Ann Neurol 2007
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predicting long term seizure outcome after resective Epilepsy Surgery the multicenter study
Neurology, 2005Co-Authors: Susan S Spencer, Barbara G Vickrey, John T Langfitt, Michael R Sperling, Anne T Berg, Carl W Bazil, Shlomo Shinnar, Thaddeus S Walczak, Steven V PaciaAbstract:Background: In a seven-center prospective observational study of resective Epilepsy Surgery, the authors examined probability and predictors of entering 2-year remission and the risk of subsequent relapse. Methods: Patients aged 12 years and over were enrolled at time of referral for Epilepsy Surgery, and underwent standardized evaluation, treatment, and follow-up procedures. The authors defined seizure remission as 2 years completely seizure-free after hospital discharge with or without auras, and relapse as any seizures after 2-year remission. The authors examined type of Surgery, seizure, clinical and demographic variables, and localization study results with respect to prediction of seizure remission or relapse, using χ 2 and proportional hazards analysis. Results: Of 396 operated patients, 339 were followed over 2 years, and 223 (66%) experienced 2-year remission, not significantly different between medial temporal (68%) and neocortical (50%) resections. In multivariable models, only absence of generalized tonic-clonic seizures and presence of hippocampal atrophy were significantly and independently associated with remission, and only in the medial temporal resection group. Fifty-five patients relapsed after 2-year remission, again not significantly different between medial temporal (25%) and neocortical (19%) resections. Only delay to remission predicted relapse, and only in medial temporal patients. Conclusion: Hippocampal atrophy and a history of absence of generalized tonic clonic seizures were the sole predictors of 2-year remission, and only for medial temporal resections.
Nathalie Jette - One of the best experts on this subject based on the ideXlab platform.
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missed opportunities for Epilepsy Surgery referrals in bhutan a cohort study
Epilepsy Research, 2020Co-Authors: Andrew Siyoon Ham, Nathalie Jette, Damber K Nirola, Neishay Ayub, Lhab Tshering, Ugyen Dem, Chencho Dorji, Farrah J MateenAbstract:Abstract Objective To quantify the missed opportunities for Epilepsy Surgery referral and operationalize the Canadian Appropriateness of Epilepsy Surgery (CASES) tool for use in a lower income country without neurologists. Methods People with Epilepsy were recruited from the Jigme Dorji Wangchuck National Referral Hospital from 2014-2016. Each participant was clinically evaluated, underwent at least one standard EEG, and was invited to undergo a free 1.5 T brain MRI. Clinical variables required for CASES were operationalized for use in lower-income populations and entered into the free, anonymous website tool. Findings There were 209 eligible participants (mean age 28.4 years, 56 % female, 179 with brain MRI data). Of the 179 participants with brain MRI, 43 (24.0 %) were appropriate for an Epilepsy Surgery referral, 21 (11.7 %) were uncertain, and 115 (64.3 %) were inappropriate for referral. Among the 43 appropriate referral cases, 36 (83.7 %) were “very high” and 7 (16.3 %) were “high” priorities for referral. For every unit increase in surgical appropriateness, quality of life (QoL) dropped by 2.3 points (p-value 1 antiepileptic drug prior to enrollment, 42 (61.8 %) were appropriate referrals, 14 (20.6 %) were uncertain, and 12 (17.6 %) were inappropriate. Conclusion Approximately a quarter of Bhutanese Epilepsy patients who completed evaluation in this national referral-based hospital should have been evaluated for Epilepsy Surgery, sometimes urgently. Surgical services for Epilepsy are an emerging priority for improving global Epilepsy care and should be scaled up through international partnerships and clinician support algorithms like CASES to avoid missed opportunities.
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resective focal Epilepsy Surgery has selection of candidates changed a systematic review
Epilepsy Research, 2016Co-Authors: Churl Su Kwon, Samuel Wiebe, Jose F Tellezzenteno, Amy Metcalfe, Walter Hader, Jonathan Neal, Kathryn C Fitzgerald, Lizbeth Hernandezronquillo, Nathalie JetteAbstract:Abstract Objective No standard, widely accepted criteria exist to determine who should be referred for an Epilepsy surgical evaluation. As a result, indications for Epilepsy Surgery evaluation vary significantly between centers. We review the literature to assess what criteria have been used to select patients for resective Epilepsy Surgery and examine whether these have changed since the publication of the first Epilepsy Surgery randomized controlled trial in 2001. Methods A systematic review was conducted using PubMed and EMBASE, bibliographies of reviews and book chapters identifying focal Epilepsy resective series. Abstract, full text review and data abstraction (i.e. indications for Surgery) were performed independently by two reviewers. Descriptive historical analysis was done to examine indications over time. Results Out of 5061 articles related to Epilepsy Surgery, 384 articles met all eligibility criteria. Most common criteria for selecting patients for evaluation for resective Surgery were: AED resistance ( n =303, most commonly >2 AEDs=46), Epilepsy duration ( n =53, most commonly >1 year=42) and seizure frequency (most commonly at least one seizure/month, n =29). Out of the prospective studies the most notable change over time (pre-2000 vs. post-2000) was failure of ≥2 AEDs (8% vs. 43% respectively, p Conclusions Important variations between studies make it difficult to identify consistent criteria to guide surgical candidacy or changes in indications over time. With increasing evidence that earlier Surgery is associated with better outcomes, it is recommended that patients be evaluated as soon as they have failed two AEDs, consistent with the new definition of drug resistant Epilepsy. Furthermore, low seizure frequency should not be a barrier to Epilepsy Surgery. Anyone with drug resistant Epilepsy should be promptly evaluated for possible Surgery, regardless of seizure frequency.
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neurologists knowledge of and attitudes toward Epilepsy Surgery a national survey
Neurology, 2015Co-Authors: Jodie I Roberts, Samuel Wiebe, Chantelle Hrazdil, Khara M Sauro, Michelle Vautour, Natalie Wiebe, Nathalie JetteAbstract:Objectives: In the current study, we aim to assess potential neurologist-related barriers to Epilepsy Surgery among Canadian neurologists. Methods: A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to Surgery for patients with Epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders. Results: In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with Epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering Surgery, and nearly half (48.6%) failed to correctly define drug-resistant Epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to Surgery for patients with Epilepsy. Conclusions: A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for Epilepsy Surgery. Access also appears to be a significant barrier to Epilepsy Surgery and surgical evaluation. As a result, we are concerned that patients with Epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment.
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complications of Epilepsy Surgery a systematic review of focal surgical resections and invasive eeg monitoring
Epilepsia, 2013Co-Authors: Walter Hader, Samuel Wiebe, Jose F Tellezzenteno, Amy Metcalfe, Lisbeth Hernandezronquillo, Churl Su Kwon, Nathalie JetteAbstract:SummaryPurpose Underutilization of Epilepsy Surgery remains a major problem and is in part due to physicians' misconceptions about the risks associated with Epilepsy Surgery. The purpose of this study was to systematically review the literature on complications of focal Epilepsy Surgery. Methods A literature search was conducted using PubMed and Embase to identify studies examining Epilepsy Surgery complications. Abstract and full text review, along with data extraction, was done in duplicate. Minor medical and neurologic complications were defined as those that resolved completely within 3 months of Surgery, whereas major complications persisted beyond that time frame. Descriptive statistics were used to report complication proportions. Key Findings Invasive monitoring: Minor complications were reported in 7.7% of patients, whereas major complications were reported in only 0.6% of patients undergoing invasive monitoring. Resective Surgery: Minor and major medical complications were reported in 5.1% and 1.5% of patients respectively, most common being cerebrospinal fluid (CSF) leak. Minor neurologic complications occurred in 10.9% of patients and were twice as frequent in children (11.2% vs. 5.5%). Minor visual field defects were most common (12.9%). Major neurologic complications were noted in 4.7% of patients, with the most common being major visual field defects (2.1% overall). Perioperative mortality was uncommon after Epilepsy Surgery, occurring in only 0.4% of temporal lobe patients (1.2%extratemporal). Significance The majority of complications after Epilepsy Surgery are minor or temporary as they tend to resolve completely. Major permanent neurologic complications remain uncommon. Mortality as a result of Epilepsy Surgery in the modern era is rare.
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development of an online tool to determine appropriateness for an Epilepsy Surgery evaluation
Neurology, 2012Co-Authors: Marino Muxfeldt Bianchin, Jose F Tellezzenteno, Walter Hader, Nathalie Jette, Ana Lucia Abujamra, Hude Quan, Samuel WiebeAbstract:Objectives: Despite evidence that Epilepsy Surgery is more effective than medical therapy, significant delays between seizure intractability and Surgery exist. We aimed to develop a new Web-based methodology to assist physicians in identifying patients who might benefit from an Epilepsy Surgery evaluation. Methods: The RAND/UCLA appropriateness method was used. Clinical scenarios were developed based on eligibility criteria from previously published surgical series. Thirteen national experts rated the scenarios for their appropriateness for an Epilepsy Surgery evaluation based on published evidence. All scenarios were rerated after a face-to-face meeting following a modified Delphi process. Appropriate scenarios were rerated for necessity to determine referral priority. Results: Of the final 2646 scenarios, 20.6% (n = 544) were appropriate, 17.2% (n = 456) uncertain, and 61.5% (n = 1626) inappropriate for a surgical evaluation. Of the appropriate cases, 55.9% (n = 306) were rated as very high priority. Not attempting AED treatment was always rated as inappropriate for a referral. Trial of 2 AEDs was usually rated as appropriate unless seizure-free or not fully investigated Based on these data, a Web-based decision tool (www.Epilepsycases.com) was created. Conclusions: Using the available evidence through 2008 and expert consensus, we developed a Web-based decision tool that provides a guide for determining candidacy for Epilepsy Surgery evaluations. The tool needs clinical validation, and will be updated and revised regularly. This rendition of the tool is most appropriate for those over age 12 years with focal Epilepsy. The Rand/UCLA appropriate methodology might be considered in the development of guidelines in other areas of Epilepsy care.