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Michael R. Sperling - One of the best experts on this subject based on the ideXlab platform.
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Employment after anterior Temporal Lobectomy.
Epilepsia, 2011Co-Authors: Katherine Zarroli, Joseph I. Tracy, Ashwini Sharan, Michael R. SperlingAbstract:Summary Purpose: To explore the effect of anterior Temporal Lobectomy on employment and define demographic and clinical predictors of postoperative employment in a large cohort with a prolonged observational period. Methods: Subjects had an anterior Temporal Lobectomy for refractory epilepsy. All had an assessment period of 4 years or more with documentation of demographic factors, employment status, and seizure frequency prospectively registered in a database at surgery and at each contact after surgery. McNemar chi-square and a Wilcoxon matched pairs test were used to compare employment status before and after surgery. A multiple logistic regression assessed independent predictors of postoperative employment status based on preoperative employment status. Key Findings: Three hundred sixty-nine patients were evaluated. Employment levels were higher and unemployment levels were lower after surgery (McNemar χ2 = 3.96; p = 0.047). Working before surgery (Wald’s χ2 = 22.69, p
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functional mri predicts post surgical memory following Temporal Lobectomy
Brain, 2004Co-Authors: Marcie L Rabin, Michael R. Sperling, Jacqueline A French, Guila Glosser, Joseph I. Tracy, Veena M Narayan, Daniel Y Kimberg, Daniel Casasanto, John A DetreAbstract:Temporal Lobectomy is an effective therapy for medically refractory Temporal lobe epilepsy (TLE), but may be complicated by amnestic syndromes. Therefore, pre-surgical evaluation to assess the risk/benefit ratio for surgery is required. Intracarotid amobarbital testing (IAT) is currently the most widely used method for assessing pre-surgical memory lateralization, but is relatively invasive. Over the past decade functional MRI (fMRI) has been shown to correlate with IAT for language lateralization, and also for memory lateralization in a small number of patients. This study was carried out to compare fMRI during memory encoding with IAT testing for memory lateralization, and to assess the predictive value of fMRI during memory encoding for post-surgical memory outcome. Thirty-five patients with refractory TLE undergoing pre-surgical evaluation for Temporal Lobectomy and 30 normal subjects performed a complex visual scene-encoding task during fMRI scanning at 1.5 T using a 10-min protocol. Encoding performance was evaluated with subsequent recognition testing. Twenty-three patients also completed the same task again outside the scanner, an average of 6.9 months following surgery. A region of interest (ROI) analysis was used to quantify activation within hippocampal and a larger mesial Temporal lobe ROI consisting of hippocampus, parahippocampus and fusiform gyrus (HPF) as defined by a published template. Normal subjects showed almost symmetrical activation within these ROI. TLE patients showed greater asymmetry. Asymmetry ratios (ARs) from the HPF ROI correlated significantly with memory lateralization by intracarotid amobarbital testing. HPF ARs also correlated significantly with memory outcome, as determined by a change in scene recognition between pre-surgical and post-surgical trials. When absolute activation within the HPF ROI was considered, a significant inverse correlation between activation ipsilateral to Temporal Lobectomy and memory outcome was observed, with no significant correlation in the contralateral HPF ROI. Although further technical improvements and prospective clinical validation are required, these results suggest that mesial Temporal memory activation detected by fMRI during complex visual scene encoding correlates with post-surgical memory outcome and supports the notion that this approach will ultimately contribute to patient management.
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Mania following Temporal Lobectomy
Neurology, 2003Co-Authors: M. A. Carran, Christian G. Kohler, Michael J. O'connor, Warren B. Bilker, Michael R. SperlingAbstract:Objective: To determine clinical and diagnostic variables that predict the development of mania after Temporal Lobectomy for treatment of refractory epilepsy. Methods: From a large surgical database, 16 patients with new-onset mania after Temporal Lobectomy were identified. Mania patients were frequency matched for age, gender, and laterality of surgery to 16 Temporal Lobectomy patients with no postoperative mood disorder. These groups were compared on pre- and postoperative clinical and diagnostic data with each other and with 30 patients with depression after Temporal Lobectomy. Posthoc analyses compared mania and depression groups with the general surgical database matched for gender and laterality of surgery. Results: Preoperative evaluations in postoperative mania patients, in particular EEG, were more likely to yield findings of brain dysfunction localizing to the hemisphere contralateral to Temporal Lobectomy. Right Temporal Lobectomy was more common in the postoperative mania group. Duration of manic episodes was usually transient, and all but one case remitted within 1 year after onset. In comparison with the control group, mania and depression groups had a higher likelihood for preoperative generalized tonic–clonic seizures and lack of seizure freedom following surgery. Conclusions: A limitation of this study was the relatively small number of patients. Despite this, clinical features that distinguish patients at risk for postoperative mania from those with depression and those with no psychiatric illness include bihemispheric abnormalities, in particular biTemporal EEG activity, and right Temporal Lobectomy.
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Temporal Lobectomy.
Archives of neurology, 2002Co-Authors: Michael R. Sperling, Jennifer K SchnurAbstract:Temporal Lobectomy is the most common neurosurgical procedure performed for medically refractory epilepsy. Temporal lobe epilepsy has historically been one of the most difficult forms of epilepsy to treat, and it carries a significant psychosocial and medical burden. The inadequacy of medical therapy led to the development of effective neurosurgical procedures, and this article cites several seminal authors who pioneered the development of the field.
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Temporal Lobectomy for refractory epilepsy
JAMA, 1996Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, Carrie PlummerAbstract:Objective. —To examine the long-term effectiveness of anterior Temporal Lobectomy for refractory epilepsy with regard to seizure control and related medical and psychosocial measures and to determine how patterns of early seizure recurrence relate to long-term prognosis. Design. —A cohort of patients prospectively followed up for 5 years after surgery. Setting. —Tertiary care comprehensive epilepsy center. Patients. —Eighty-nine patients with medically refractory epilepsy who were consecutively treated with anterior Temporal Lobectomy between 1986 and 1990. All patients had noninvasive preoperative evaluations, and 31 were evaluated with intracranial electrodes prior to surgery. Main Outcome Measures. —Postoperative seizure frequency, neuropsychologic function, mortality, and postoperative employment status. Results. —Five years after surgery, 62 patients (70%) were seizure free, 8 (9%) had seizures on fewer than 3 days per year or exclusively had nocturnal seizures, 10(11 %) had greater than 80% reduction in seizure frequency, 5 (6%) had less than 80% reduction in seizure frequency, and 4 (4%) died of causes unrelated to surgery. The proportion of patients in each outcome class remained stable throughout the 5-year period. Fifty-five percent of seizure recurrences happened within 6 months of surgery, and 93% occurred within 2 years after surgery. Outcome at 1 year related only moderately well to outcome at 5 years. No significant cognitive or linguistic deficits occurred. All patients who died had persistent seizures after surgery. Underemployment and unemployment declined significantly after surgery, with improvement noted in seizure-free patients. Conclusions. —Temporal Lobectomy provides sustained seizure relief over 5 years to most patients who have surgery. Outcome at 2 years predicts long-term outcome. A seizure-free state is associated with reduced mortality and increased employment. Mere reduction in seizure frequency is not associated with improvement in those measures.
Michael J Oconnor - One of the best experts on this subject based on the ideXlab platform.
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Temporal Lobectomy for refractory epilepsy
JAMA, 1996Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, Carrie PlummerAbstract:Objective. —To examine the long-term effectiveness of anterior Temporal Lobectomy for refractory epilepsy with regard to seizure control and related medical and psychosocial measures and to determine how patterns of early seizure recurrence relate to long-term prognosis. Design. —A cohort of patients prospectively followed up for 5 years after surgery. Setting. —Tertiary care comprehensive epilepsy center. Patients. —Eighty-nine patients with medically refractory epilepsy who were consecutively treated with anterior Temporal Lobectomy between 1986 and 1990. All patients had noninvasive preoperative evaluations, and 31 were evaluated with intracranial electrodes prior to surgery. Main Outcome Measures. —Postoperative seizure frequency, neuropsychologic function, mortality, and postoperative employment status. Results. —Five years after surgery, 62 patients (70%) were seizure free, 8 (9%) had seizures on fewer than 3 days per year or exclusively had nocturnal seizures, 10(11 %) had greater than 80% reduction in seizure frequency, 5 (6%) had less than 80% reduction in seizure frequency, and 4 (4%) died of causes unrelated to surgery. The proportion of patients in each outcome class remained stable throughout the 5-year period. Fifty-five percent of seizure recurrences happened within 6 months of surgery, and 93% occurred within 2 years after surgery. Outcome at 1 year related only moderately well to outcome at 5 years. No significant cognitive or linguistic deficits occurred. All patients who died had persistent seizures after surgery. Underemployment and unemployment declined significantly after surgery, with improvement noted in seizure-free patients. Conclusions. —Temporal Lobectomy provides sustained seizure relief over 5 years to most patients who have surgery. Outcome at 2 years predicts long-term outcome. A seizure-free state is associated with reduced mortality and increased employment. Mere reduction in seizure frequency is not associated with improvement in those measures.
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occupational outcome after Temporal Lobectomy for refractory epilepsy
Neurology, 1995Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, Jacqueline A French, F D RobertsAbstract:Article abstract—We evaluated employment after Temporal Lobectomy for refractory epilepsy in 86 patients (3.5 to 8 years of follow-up). Seventy-three patients qualified for the work force before and after surgery. Unemployment rates declined after surgery (18 patients [25%1 unemployed before surgery, eight patients [11%] unemployed after surgery), and underemployment also tended to diminish. Improvement in occupational status related strongly to the degree of postoperative seizure relief. Seizure-free patients fared better (no unemployment, little underemployment) than patients with some seizure-free years and some years with seizures after surgery, whose high underemployment level persisted. Patients with seizures in each year after surgery fared worst (despite reduced seizure frequency), with increased unemployment after surgery. Age at surgery also influenced vocational outcome in patients who were unemployed before surgery. Historical, educational, cognitive, and behavioral measures did not correlate with vocational outcome. Employment gains came slowly; unemployed patients took up to 6 years to obtain work after surgery. Of 13 students at the time of surgery, 11 have graduated and nine are now employed. We conclude that seizures play a large role in limiting employment, and that by alleviating seizures, Temporal Lobectomy improves employability in people with refractory epilepsy. Surgery thereby provides benefit to individuals with epilepsy by increasing financial independence and to society by reducing unemployment.
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predictors of outcome after anterior Temporal Lobectomy positron emission tomography
Neurology, 1994Co-Authors: Edward M Manno, Michael R. Sperling, Michael J Oconnor, Xinsheng Ding, Jurg L Jaggi, Abass Alavi, Martin ReivichAbstract:We assessed the relationship between Temporal lobe metabolism measured quantitatively and qualitatively with PET using [ 18 F]-fluorodeoxyglucose (FDG) and postoperative seizure frequency after anterior Temporal Lobectomy. Forty-three patients with refractory partial epilepsy had anterior Temporal Lobectomy and preoperative assessment with PET-FDG. Qualitative PET analysis was performed visually by two blinded observers, and quantitative PET analysis was performed using an anatomic template for six control and six Temporal lobe subregions, deriving an asymmetry index for each region. Seizure outcome was assessed 1 year after surgery; patients were classified as being seizure-free or as having persistent seizures. Qualitative data were analyzed using Fisher9s exact test and the t test, and quantitative data were analyzed using a repeated-measures ANOVA. Thirty-two patients (74%) were seizure-free at follow-up, and 11 had persistent seizures, although most improved. Twenty-nine of 35 patients (83%) with restricted Temporal lobe hypometabolism by visual analysis were seizure-free, compared with three of eight patients (37.5%) with normal scans or multilobar hypometabolism. Quantitative analysis revealed that an asymmetry of mesial Temporal lobe glucose consumption (uncal region) correlated with improved surgical outcome ( p
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a noninvasive protocol for anterior Temporal Lobectomy
Neurology, 1992Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, C A Phillips, Martha J Morrell, P A Bridgman, Jacqueline A French, Nicholas K GonatasAbstract:We report the results of a protocol for choosing candidates for Temporal Lobectomy using a standard battery of objective tests without intracranial electrodes. We assigned each test a level of importance, and an algorithm was used to determine whether Temporal Lobectomy could be performed. Fifty-one patients (total pool, 103 patients) met protocol requirements and had an anterior Temporal Lobectomy with a mean follow-up of 39.4 months (range, 21 to 64 months), most remaining on anticonvulsant therapy. Eighty percent are seizure free, 12% have 80% reduction in seizure frequency. One-third of patients who failed protocol criteria did not have Temporal lobe seizures when studied with intracranial electrodes. We analyzed and modified the algorithm after comparing these patients with others who were poor candidates for Temporal Lobectomy. We conclude that this protocol is effective and recommend using such an objective algorithm.
J Gordon Millichap - One of the best experts on this subject based on the ideXlab platform.
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Effect of Temporal Lobectomy for Epilepsy on Language Development
Pediatric Neurology Briefs, 2009Co-Authors: J Gordon MillichapAbstract:Language development was examined in 24 children (mean age 11 years; range 5.8-15.7 years) with AED intractable epilepsy before and 6, 12, and 24 months after anterior Temporal Lobectomy, in a study by the Dutch Collaborative Epilepsy Surgery Programme (DuCESP) at University Medical Center Utrecht, The Netherlands.
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Outcome after Temporal Lobectomy
Pediatric Neurology Briefs, 2002Co-Authors: J Gordon MillichapAbstract:Thirty seven patients, ages 7 to 18 years, who underwent Temporal Lobectomy for intractable seizures at the Mayo Clinic, Rochester, MN, between 1970 and 1983, were followed for a mean of 19 years (range 4 - 27 years).
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Language-Related Deficits after Temporal Lobectomy
Pediatric Neurology Briefs, 1999Co-Authors: J Gordon MillichapAbstract:Five left Temporal Lobectomy school-aged children demonstrated significant language-related cognitive declines on post-operative neuropsychological testing at the Children’s Hospital of Philadelphia, PA.
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Temporal Lobectomy for Intractable Seizures
Pediatric Neurology Briefs, 1992Co-Authors: J Gordon MillichapAbstract:The results of Temporal Lobectomy in 16 children under the age of 12 years who had intractable seizures of Temporal lobe origin are reported from the Miami Children’s Hospital, Florida.
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Temporal Lobectomy for Complex Partial Seizures
Pediatric Neurology Briefs, 1991Co-Authors: J Gordon MillichapAbstract:The results of anterior Temporal Lobectomy performed for medically intractable, complex partial seizures, with onset before 16 years of age, in 42 consecutive patients are reported from various centers.
Jacqueline A French - One of the best experts on this subject based on the ideXlab platform.
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functional mri predicts post surgical memory following Temporal Lobectomy
Brain, 2004Co-Authors: Marcie L Rabin, Michael R. Sperling, Jacqueline A French, Guila Glosser, Joseph I. Tracy, Veena M Narayan, Daniel Y Kimberg, Daniel Casasanto, John A DetreAbstract:Temporal Lobectomy is an effective therapy for medically refractory Temporal lobe epilepsy (TLE), but may be complicated by amnestic syndromes. Therefore, pre-surgical evaluation to assess the risk/benefit ratio for surgery is required. Intracarotid amobarbital testing (IAT) is currently the most widely used method for assessing pre-surgical memory lateralization, but is relatively invasive. Over the past decade functional MRI (fMRI) has been shown to correlate with IAT for language lateralization, and also for memory lateralization in a small number of patients. This study was carried out to compare fMRI during memory encoding with IAT testing for memory lateralization, and to assess the predictive value of fMRI during memory encoding for post-surgical memory outcome. Thirty-five patients with refractory TLE undergoing pre-surgical evaluation for Temporal Lobectomy and 30 normal subjects performed a complex visual scene-encoding task during fMRI scanning at 1.5 T using a 10-min protocol. Encoding performance was evaluated with subsequent recognition testing. Twenty-three patients also completed the same task again outside the scanner, an average of 6.9 months following surgery. A region of interest (ROI) analysis was used to quantify activation within hippocampal and a larger mesial Temporal lobe ROI consisting of hippocampus, parahippocampus and fusiform gyrus (HPF) as defined by a published template. Normal subjects showed almost symmetrical activation within these ROI. TLE patients showed greater asymmetry. Asymmetry ratios (ARs) from the HPF ROI correlated significantly with memory lateralization by intracarotid amobarbital testing. HPF ARs also correlated significantly with memory outcome, as determined by a change in scene recognition between pre-surgical and post-surgical trials. When absolute activation within the HPF ROI was considered, a significant inverse correlation between activation ipsilateral to Temporal Lobectomy and memory outcome was observed, with no significant correlation in the contralateral HPF ROI. Although further technical improvements and prospective clinical validation are required, these results suggest that mesial Temporal memory activation detected by fMRI during complex visual scene encoding correlates with post-surgical memory outcome and supports the notion that this approach will ultimately contribute to patient management.
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occupational outcome after Temporal Lobectomy for refractory epilepsy
Neurology, 1995Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, Jacqueline A French, F D RobertsAbstract:Article abstract—We evaluated employment after Temporal Lobectomy for refractory epilepsy in 86 patients (3.5 to 8 years of follow-up). Seventy-three patients qualified for the work force before and after surgery. Unemployment rates declined after surgery (18 patients [25%1 unemployed before surgery, eight patients [11%] unemployed after surgery), and underemployment also tended to diminish. Improvement in occupational status related strongly to the degree of postoperative seizure relief. Seizure-free patients fared better (no unemployment, little underemployment) than patients with some seizure-free years and some years with seizures after surgery, whose high underemployment level persisted. Patients with seizures in each year after surgery fared worst (despite reduced seizure frequency), with increased unemployment after surgery. Age at surgery also influenced vocational outcome in patients who were unemployed before surgery. Historical, educational, cognitive, and behavioral measures did not correlate with vocational outcome. Employment gains came slowly; unemployed patients took up to 6 years to obtain work after surgery. Of 13 students at the time of surgery, 11 have graduated and nine are now employed. We conclude that seizures play a large role in limiting employment, and that by alleviating seizures, Temporal Lobectomy improves employability in people with refractory epilepsy. Surgery thereby provides benefit to individuals with epilepsy by increasing financial independence and to society by reducing unemployment.
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a noninvasive protocol for anterior Temporal Lobectomy
Neurology, 1992Co-Authors: Michael R. Sperling, Michael J Oconnor, Andrew J Saykin, C A Phillips, Martha J Morrell, P A Bridgman, Jacqueline A French, Nicholas K GonatasAbstract:We report the results of a protocol for choosing candidates for Temporal Lobectomy using a standard battery of objective tests without intracranial electrodes. We assigned each test a level of importance, and an algorithm was used to determine whether Temporal Lobectomy could be performed. Fifty-one patients (total pool, 103 patients) met protocol requirements and had an anterior Temporal Lobectomy with a mean follow-up of 39.4 months (range, 21 to 64 months), most remaining on anticonvulsant therapy. Eighty percent are seizure free, 12% have 80% reduction in seizure frequency. One-third of patients who failed protocol criteria did not have Temporal lobe seizures when studied with intracranial electrodes. We analyzed and modified the algorithm after comparing these patients with others who were poor candidates for Temporal Lobectomy. We conclude that this protocol is effective and recommend using such an objective algorithm.
Kurtis I Auguste - One of the best experts on this subject based on the ideXlab platform.
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Seizure types and frequency in patients who "fail" Temporal Lobectomy for intractable epilepsy.
Neurosurgery, 2013Co-Authors: Dario J Englot, Kurtis I Auguste, Catherine Tsai, Cathra Halabi, Nicholas M. Barbaro, Paul A. Garcia, Edward F ChangAbstract:Temporal Lobectomy can lead to favorable seizure outcomes in medically-refractory Temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after Temporal Lobectomy, less is known about seizure semiology in patients who "fail" surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does Temporal Lobectomy influence seizure type and frequency? To characterize seizure types and frequencies before and after Temporal Lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures. We performed a retrospective longitudinal cohort study examining patients undergoing Temporal Lobectomy for epilepsy at our institution from January 1995 to August 2010. Among 241 TLE patients who received Temporal Lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P < .01), with larger reductions in consciousness-impairing seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P < .001). Simple partial seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P < .001). Favorable seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P < .5). Given important clinical and mechanistic differences between seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.
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seizure outcomes after Temporal Lobectomy in pediatric patients
Journal of Neurosurgery, 2013Co-Authors: Dario J Englot, John D Rolston, Doris D Wang, Edward F Chang, Kurtis I AugusteAbstract:Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%–20% of epilepsy cases in children. Class I evidence strongly supports the use of Temporal Lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after Temporal Lobectomy in pediatric patients. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after Temporal Lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II–IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesion...
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Effects of Temporal Lobectomy on consciousness-impairing and consciousness-sparing seizures in children
Childs Nervous System, 2013Co-Authors: Dario J Englot, Edward F Chang, Martin J. Rutkowski, Michael E. Ivan, Rachel Kuperman, Nalin Gupta, Joseph Sullivan, Kurtis I AugusteAbstract:Purpose Most children with medically refractory Temporal lobe epilepsy (TLE) become seizure free after Temporal Lobectomy, but some individuals continue to seize. As studies of Temporal Lobectomy typically focus on seizure freedom, the effect of surgery on seizure type and frequency among children with persistent seizures is poorly understood. Seizures which impair consciousness are associated with increased morbidity compared to consciousness-sparing seizures.
