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Predictors and outcome surgery for posterior cortex epilepsies.

Jianguo Shi1, Zaifen Gao2, Jun Gao3

  • 1Department of Neurosurgery, Qilu Children's Hospital of Shandong University, Jinan, ShanDong, 250000, China; Department of Neurosurgery, Jinan Central Hospital affiliated to Shandong University, Jinan, ShanDong, 250014, China.

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Magnetic Resonance Imaging (MRI) and Electroencephalography (EEG) are crucial for predicting surgical success in posterior cortex epilepsies (PCES). Identifying MRI lesions significantly improves the chances of patients becoming seizure-free after PCES surgery.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Medical Imaging

Background:

  • Posterior cortex epilepsies (PCES) are a group of neurological disorders characterized by seizures originating in the posterior brain regions.
  • Surgical intervention is a potential treatment for drug-resistant PCES, but outcomes can vary.
  • Accurate preoperative assessment is vital for optimizing surgical planning and patient selection.

Purpose of the Study:

  • To determine the prognostic value of MRI and EEG in predicting surgical outcomes for PCES.
  • To characterize the clinical and pathological features associated with PCES.
  • To evaluate the effectiveness of surgical treatment for PCES.

Main Methods:

  • Retrospective analysis of 54 consecutive patients who underwent PCES surgery between April 2011 and November 2015.
  • Evaluation of electro-clinical, pathological, and surgical data.
  • Postoperative follow-up for at least one year to assess seizure freedom and overall outcome using the International League Against Epilepsy (ILAE) classification.

Main Results:

  • 59.3% of patients achieved complete seizure freedom (ILAE 1) and 74.1% had a good outcome (ILAE 1-3) post-surgery.
  • Focal cortical dysplasia was the most common pathological finding (34 patients).
  • Univariate analysis revealed that regional interictal epilepsy discharges (IEDs) on EEG, regional EEG onset, presence of an MRI lesion, and the number of recorded seizures were significantly associated with seizure freedom. Multivariate analysis confirmed MRI positivity as a significant predictor (HR=4.284).

Conclusions:

  • Surgical treatment is an effective option for patients with PCES.
  • MRI and EEG are essential tools in the presurgical evaluation of PCES, aiding in the prediction of surgical success.
  • Identifying MRI lesions is a key factor in achieving seizure freedom.