Outcomes of resections that spare vs remove an MRI-normal hippocampus.
epilepsy surgery
memory outcome
neuropsychological assessment
temporal lobe epilepsy
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
13
05
2020
revised:
24
08
2020
accepted:
24
08
2020
pubmed:
17
10
2020
medline:
4
2
2021
entrez:
16
10
2020
Statut:
ppublish
Résumé
To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)-normal hippocampus in patients with temporal lobe epilepsy. In this retrospective cohort study, we reviewed clinical, imaging, surgical, and histopathological data on 152 individuals with temporal lobe epilepsy and nonlesional hippocampi categorized into hippocampus-spared (n = 74) or hippocampus-resected (n = 78). Extra-hippocampal lesions were allowed. Pre- and postoperative cognitive data were available on 86 patients. Predictors of seizure and cognitive outcomes were identified using Cox-proportional hazard modeling followed by treatment-specific model reduction according to Akaike information criterion, and built into an online risk calculator. Seizures recurred in 40% within one postoperative year, and in 63% within six postoperative years. Male gender (P = .03), longer epilepsy duration (P < .01), normal MRI (P = .04), invasive evaluation (P = .02), and acute postoperative seizures (P < .01) were associated with a higher risk of recurrence. We found no significant difference in postoperative seizure freedom rates at 5 years between those whose hippocampus was spared and those whose hippocampus was resected (P = .17). Seizure outcome models built with pre- and postoperative data had bootstrap validated concordance indices of 0.65 and 0.72. The dominant hippocampus-spared group had lower rates of decline in verbal memory (39% vs 70%; P = .03) and naming (41% vs 79%; P = .01) compared to the hippocampus-resected group. Partial hippocampus sparing had the same risk of verbal memory decline as for complete removal. Sparing or removing an MRI-normal hippocampus yielded similar long-term seizure outcome. A more conservative approach, sparing the hippocampus, only partially shields patients from postoperative cognitive deficits. Risk calculators are provided to facilitate clinical counseling.
Identifiants
pubmed: 33063852
doi: 10.1111/epi.16694
pmc: PMC7879196
mid: NIHMS1664359
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2545-2557Subventions
Organisme : NINDS NIH HHS
ID : R01 NS097719
Pays : United States
Informations de copyright
© 2020 International League Against Epilepsy.
Références
Neurosurg Focus. 2012 Mar;32(3):E4
pubmed: 22380858
Arch Neurol. 2007 Feb;64(2):288; author reply 288-9
pubmed: 17296851
Seizure. 2018 Nov;62:116-123
pubmed: 30359865
Lancet Neurol. 2015 Mar;14(3):283-90
pubmed: 25638640
J Neurosurg. 2010 Dec;113(6):1186-94
pubmed: 20831360
Acta Neurochir (Wien). 2020 Apr;162(4):795-801
pubmed: 31997072
Brain. 2018 Jan 1;141(1):117-131
pubmed: 29253102
Epilepsy Res. 2010 May;89(2-3):310-8
pubmed: 20227852
Acta Neuropathol. 2014 Jul;128(1):55-65
pubmed: 24831066
Brain. 2005 Dec;128(Pt 12):2822-9
pubmed: 16014650
J Int Neuropsychol Soc. 1996 Nov;2(6):556-64
pubmed: 9375160
Epilepsia. 2011 Aug;52(8):1402-8
pubmed: 21740419
Neurology. 2018 Dec 4;91(23):e2144-e2152
pubmed: 30404781
Epilepsy Res. 2018 May;142:170-175
pubmed: 28964596
Epilepsy Res. 2018 May;142:161-166
pubmed: 28890320
Epilepsia. 2011 Aug;52(8):1393-401
pubmed: 21790546
Ann Neurol. 2003 Oct;54(4):425-32
pubmed: 14520652
Brain Sci. 2018 Mar 12;8(3):
pubmed: 29534521
Epilepsia. 2013 May;54(5):772-82
pubmed: 23586531
Acta Neurochir (Wien). 2017 May;159(5):757-766
pubmed: 28281007
J Neurol Neurosurg Psychiatry. 2013 Jun;84(6):630-6
pubmed: 23345282
Seizure. 2017 Nov;52:81-88
pubmed: 29017082
Neurology. 2007 Jun 5;68(23):1988-94
pubmed: 17548548
Epilepsia. 2020 Apr;61(4):725-734
pubmed: 32162320
J Neurol Neurosurg Psychiatry. 2004 May;75(5):773-5
pubmed: 15090578
Epilepsia. 2002 Dec;43(12):1551-8
pubmed: 12460258
Ann Neurol. 2005 Feb;57(2):283-8
pubmed: 15668930
Epilepsy Curr. 2015 Jul-Aug;15(4):189-91
pubmed: 26316865
Epilepsia. 2017 Feb;58(2):291-299
pubmed: 28012164
Epilepsia. 2012 Jan;53(1):51-7
pubmed: 21933181
Epilepsia. 2006 Nov;47(11):1895-903
pubmed: 17116030
Epilepsia. 2019 Jun;60(6):1171-1183
pubmed: 31112302
Epilepsy Behav. 2017 Oct;75:50-55
pubmed: 28841472
Epilepsy Behav. 2018 Jan;78:269-272
pubmed: 29117924