Epileptic Disorders最新文献

Objective: To identify long-term predictors of seizure outcome after anterior temporal lobectomy (ATL) in a large, homogeneous cohort of patients with drug-resistant temporal lobe epilepsy (TLE) and MRI-defined unilateral hippocampal sclerosis (HS), all operated on by a single neurosurgeon with extended follow-up.

Methods: We retrospectively analyzed 281 consecutive patients with unilateral HS who underwent standardized ATL performed by the same senior neurosurgeon. All patients had at least two years of follow-up (mean 10.8 ± 5.79 years). Clinical history, neuropsychological evaluation, long-term video-EEG monitoring, and 1.5T MRI constituted the preoperative dataset. Twenty-one variables were assessed as potential predictors of seizure outcome. Kaplan-Meier survival curves and univariate log-rank tests identified candidate predictors; variables with p < .10 were entered into a multivariate Cox regression model. Cognitive and quality-of-life outcomes were evaluated using standardized neuropsychological batteries and the ESI-55 questionnaire.

Results: At 10 years postoperatively, 62.6% of patients remained seizure-free (Engel I). Univariate analysis identified seven factors associated with seizure freedom, including history of focal-to-bilateral tonic-clonic seizures, history of status epilepticus, presence of psychogenic non-epileptic seizures, IED predominance or exclusivity in the operated lobe, ictal onset exclusively in the operated lobe, and a preoperative neuropsychological deficit confined to the operated temporal lobe. Multivariate analysis revealed three independent predictors of seizure outcome: history of status epilepticus (HR = 2.11; p = .002), ictal onset confined to the operated temporal lobe (HR = .57; p = .018), and preoperative neuropsychological deficit restricted to the operated temporal lobe (HR = .59; p = .040). Cognitive outcomes were generally stable; left ATL was associated with greater verbal memory decline. Quality-of-life improved significantly at 2-year follow-up (p < .001), with better outcomes among seizure-free patients.

Significance: In this large single-surgeon cohort with one of the longest follow-up durations reported, most patients with unilateral HS achieved durable seizure freedom after ATL. Status epilepticus, consistent ictal localization to the operated temporal lobe, and concordant preoperative neuropsychological deficit emerged as robust long-term predictors. These findings reinforce the value of detailed presurgical evaluation-particularly ictal EEG concordance and neuropsychological lateralization-in optimizing surgical counseling, risk stratification, and patient selection.

Epilepsy is more common in the elderly population, with a higher prevalence of epilepsy-related neurological diseases, such as stroke and traumatic brain injury. Although dementia is also known to be a potential cause of epilepsy in the elderly, estimating its accurate contribution is challenging because of its high prevalence in the general elderly population. To characterize the clinical features of patients with comorbid dementia, we compared the characteristics of these patients with those of elderly patients with post-stroke epilepsy and an unidentified etiology. Of the 494 patients who were first diagnosed with epilepsy after the age of 65 years, 194 were classified as having post-stroke epilepsy, 105 as having comorbid dementia, and 71 as having epilepsy of unidentified etiology. Patients with comorbid dementia were older at seizure onset (p < .001) and at the last treatment (p < .001) than those in the other groups. They were more likely to have depression (p = .04) and were more frequently treated with acetylcholine esterase inhibitors and memantine before the diagnosis of epilepsy (p < .001). In contrast, stroke-related risk factors, such as hypertension (p < .001) and dyslipidemia (p = .01), were more prevalent in patients with post-stroke epilepsy. Considering that stroke itself is a well-recognized risk factor for dementia and epilepsy in the elderly, our study suggests that dementia may be a major comorbidity and a risk factor for late-onset epilepsy.

Faciobrachial dystonic seizures (FBDS) are characteristic of anti-LGI1 encephalitis. The pathophysiological mechanisms underlying FBDS are unknown, with scalp EEG correlates consistent with cortical initiation and basal ganglia hypermetabolism implicating the involvement of subcortical structures. In a patient with non-encephalitic drug-resistant temporal lobe epilepsy undergoing brain mapping during a stereotactic-EEG investigation, we identified neurophysiologic evidence that lateralized movements similar to FBDS can result from direct striatal activation. Stimulation of putaminal depth electrode contacts resulted in brief contralateral dystonic movements resembling the FBDS seen in anti-LGI1 encephalitis. The evoked movements lagged stimulation initiation and outlasted stimulation, reminiscent of the delay between scalp EEG infraslow activity and FBDS in anti-LGI1 encephalitis. Unlike FBDS in anti-LGI1 encephalitis, no scalp EEG change preceded the stimulation-induced movements. These findings suggest that the putamen may be a part of the symptomatogenic zone for anti-LGI1 encephalitis-related FBDS, and that in the encephalitic scenario transient cortical epileptic discharges are ipsilaterally propagated to the striatum to cause FBDS.

Objective: Magnetic resonance image-guided laser interstitial thermal therapy (LITT) is a minimally invasive alternative to surgical resection for the treatment of drug-resistant epilepsy (DRE). Seizures arising outside of the temporal lobe can be difficult to treat due to the heterogeneity of anatomical locations and underlying pathologies. The effectiveness of LITT ablations for extratemporal lobe epilepsy (ETLE) is not well established.

Methods: We retrospectively reviewed subjects with DRE who underwent extratemporal LITT at a single institution from 2015 to 2021. Our primary outcomes were Engel classification and reduction in baseline seizure frequency at last follow-up. Our secondary outcome was postoperative complications.

Results: Nine subjects were included. The mean age at LITT was 29.6 years and 66% (n = 6) were male. Mean follow-up was 35 months. Engel Class I outcomes were achieved in 78% (n = 7) with complete seizure freedom (Class IA) in 66% (n = 6). Engel Class III outcomes were achieved in the remaining 22% (n = 2) with worthwhile improvements to seizure activity. Two years after ablation, 78% (n = 7) of subjects experienced >90% reduction of seizures from baseline while 11% (n = 1) experienced >50% reduction from baseline. Further, 33% (n = 3) had reduction in antiseizure medications (ASMs). Postoperative complications were experienced in 22% (n = 2) and both were transient.

Significance: In our study of subjects with ETLE who underwent LITT for DRE, 78% achieved >90% reduction of seizure frequency from baseline and 78% of patients achieved a successful Engel Class I outcome after a mean follow-up of 35 months. We demonstrate LITT ablation is a safe and effective method of treatment for drug-resistant ETLE and may be considered even with heterogeneous etiologies or prior surgeries.

Objective: Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system and a known cause of focal epilepsy. Its potential role in triggering or contributing to mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is suggested, but the impact on brain volumetry remains unclear. This study aimed to assess volumetric differences in the brain, with a particular focus on the hippocampus and temporal lobes, in patients with NCC, MTLE, MTLE-HS, and their combinations.

Methods: This was an observational, cross-sectional, retrospective, single-center exploratory study including five groups: healthy controls; isolated MTLE; isolated NCC; MTLE-HS; and MTLE-HS combined with NCC (MTLE-HS plus NCC). All participants had at least one magnetic resonance imaging (MRI) examination suitable for volumetric post-processing. Volumetric analysis was performed on cerebral cortex regions (frontal, parietal, temporal, and occipital lobes), cerebellum, total and white matter limbic system, amygdala, hippocampus, and thalamus using the T1 MultiAtlas Segmentation tool (Brain GPS©). We also assessed sensitivity by estimating the minimum detectable difference from adjusted models and performed an exploratory analysis of NCC lesion topography with Welch t-tests on lobar/subcortical volumes.

Results: After adjusting for age and sex, no significant group differences were found in hippocampal or temporal lobe volumetrics (all p > .10). Effect sizes were small (partial η² ≤ .10), and MANOVA confirmed the absence of a global effect (Pillai's Trace = .114, p = .623). Adjusted means showed only modest variation with overlapping confidence intervals, indicating that differences likely reflect individual variability rather than systematic group effects.

Significance: The findings indicate that NCC, whether isolated or combined with MTLE-HS, does not cause significant alterations in brain volume. This suggests the absence of an additive or synergistic effect of NCC on brain morphostructural changes in patients with MTLE-HS. These results contribute to understanding the pathophysiology of epilepsy related to NCC and hippocampal sclerosis, supporting that volumetric brain changes may not underlie their association.

Objectives: To evaluate the clinical, electroencephalographic (EEG), neuroimaging characteristics, and treatment outcomes of patients diagnosed with eating epilepsy (EE).

Methods: This retrospective study was conducted at a tertiary care epilepsy referral center in India. Patients diagnosed with EE between 2002 and 2025, with at least one EEG and magnetic resonance imaging (MRI) available for review, were consecutively included. Clinical data and multimodal evaluation findings including video EEG, brain MRI, positron emission tomography-MRI (PET-MRI), and magnetoencephalography (MEG) were systematically collected using a structured proforma. Seizure outcomes and treatment strategies were subsequently analyzed.

Results: A total of 50 patients (35 male) were included in this cohort, with a mean age at onset of epilepsy being 11.91 ± 8.18 years. All patients had drug-refractory epilepsy. Focal impaired consciousness seizure was the commonest seizure type (90%). MRI imaging was abnormal in 25 (50%), and the commonest finding was perisylvian gliosis. Patients with a history of perinatal insult (OR = 22.15, 95% CI: 2.58-189.95, p < 0.001) and intellectual disability (OR = 5.09, 95% CI: 1.45-17.92, p = 0.009) were more likely to have MRI abnormalities. Multimodal investigations most consistently implicated the perisylvian epileptic networks, as demonstrated by Video Electro Encephlaogram (VEEG) (52%), MRI (32%), PET-MRI (38.1%), and MEG (57.9%). Approximately one-fourth of the patients were seizure-free at their last follow-up.

Significance: EE is a disabling form of reflex epilepsy with heterogeneous clinical, EEG and neuroimaging features, which are not necessarily substrate-specific. Findings from our study point to the presence of a wide epileptogenic network prominently involving perisylvian regions. Treatment outcomes in drug-refractory EE remain suboptimal, and further studies are needed for a better understanding and management of this complex entity.