Do auras predict seizure outcome after temporal lobe epilepsy surgery?
•Significance of auras on surgical outcome in drug-resistant temporal lobe epilepsy was studied.•Presence or absence of auras had no bearing on surgical outcome after anterior temporal lobectomy.•Auditory and vertiginous auras are red herrings while selecting candidates for ATL.•Ictal onset zone sho...
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| Veröffentlicht in: | Epilepsy research 2018-11, Vol.147, p.109-114 |
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| creator | Ashalatha, Radhakrishnan Menon, Ramshekhar N. Chandran, Anuvitha Thomas, Sanjeev V. Vilanilam, George Abraham, Mathew Menon, Deepak Soumya, V.C. Thomas, Bejoy Kesavadas, Chandrashekharan Cherian, Ajith Sarma, Sankara P. |
| description | •Significance of auras on surgical outcome in drug-resistant temporal lobe epilepsy was studied.•Presence or absence of auras had no bearing on surgical outcome after anterior temporal lobectomy.•Auditory and vertiginous auras are red herrings while selecting candidates for ATL.•Ictal onset zone should be delineated in patients with auditory and vertiginous auras before ATL.
The success of epilepsy surgery lies in identifying the ictal onset zone accurately. The significance of auras has little been explored on surgical outcome in drug-resistant epilepsy. This study focuses on the clinicopathological correlation of aura(s) and its role in predicting surgical outcome in drug-resistant temporal lobe epilepsy (TLE). We compared surgical outcome in TLE between patients with and without aura and identified the clinico-pathological, radiological and surgical differences between the two groups.
Consecutive patients who underwent presurgical evaluation from January 2009 to December 2014 for drug-resistant TLE who underwent anterior temporal lobectomy (ATL) were included. Patients were followed up at 3months, 12 months and then annually.
Among 456 patients, 344(75%) had aura. Multivariate logistic regression showed that prototype EEG pattern at ictal onset (OR 2.12, 95% CI 1.18–3.06, p = 0.012) and right sided epileptogenic zone (OR 1.82 95% CI 1.18–3.78, p = 0.007) were significantly associated with presence of aura. There was no difference in surgical outcome between those with and without aura. But patients with auditory aura (OR 7.28, CI 2.80–18.95, p = 0.0002) and vertiginous aura (OR 3.01, CI 1.55–7.85, p = 0.028) had a poor surgical outcome. Bivariate analysis showed that normal MRI (p = 0.028) and normal/indeterminate pathology (p = 0.001) were significantly more common with auditory/vertiginous auras.
Mere presence of aura does not affect outcome after TLE surgery. However, auditory and vertiginous auras are predictors of poor surgical outcome. These patients require more extensive screening for an ictal onset zone beyond standard limits of ATL before surgery. |
| doi_str_mv | 10.1016/j.eplepsyres.2018.08.006 |
| format | Article |
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The success of epilepsy surgery lies in identifying the ictal onset zone accurately. The significance of auras has little been explored on surgical outcome in drug-resistant epilepsy. This study focuses on the clinicopathological correlation of aura(s) and its role in predicting surgical outcome in drug-resistant temporal lobe epilepsy (TLE). We compared surgical outcome in TLE between patients with and without aura and identified the clinico-pathological, radiological and surgical differences between the two groups.
Consecutive patients who underwent presurgical evaluation from January 2009 to December 2014 for drug-resistant TLE who underwent anterior temporal lobectomy (ATL) were included. Patients were followed up at 3months, 12 months and then annually.
Among 456 patients, 344(75%) had aura. Multivariate logistic regression showed that prototype EEG pattern at ictal onset (OR 2.12, 95% CI 1.18–3.06, p = 0.012) and right sided epileptogenic zone (OR 1.82 95% CI 1.18–3.78, p = 0.007) were significantly associated with presence of aura. There was no difference in surgical outcome between those with and without aura. But patients with auditory aura (OR 7.28, CI 2.80–18.95, p = 0.0002) and vertiginous aura (OR 3.01, CI 1.55–7.85, p = 0.028) had a poor surgical outcome. Bivariate analysis showed that normal MRI (p = 0.028) and normal/indeterminate pathology (p = 0.001) were significantly more common with auditory/vertiginous auras.
Mere presence of aura does not affect outcome after TLE surgery. However, auditory and vertiginous auras are predictors of poor surgical outcome. These patients require more extensive screening for an ictal onset zone beyond standard limits of ATL before surgery.</description><identifier>ISSN: 0920-1211</identifier><identifier>EISSN: 1872-6844</identifier><identifier>DOI: 10.1016/j.eplepsyres.2018.08.006</identifier><identifier>PMID: 30166056</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Anterior Temporal Lobectomy - methods ; Aura ; Cohort Studies ; Drug Resistant Epilepsy - surgery ; Electroencephalography ; Epilepsy, Temporal Lobe - diagnostic imaging ; Epilepsy, Temporal Lobe - physiopathology ; Epilepsy, Temporal Lobe - surgery ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Predictive Value of Tests ; Predictors ; Seizure outcome ; Statistics, Nonparametric ; Surgery ; TLE ; Treatment Outcome ; Young Adult</subject><ispartof>Epilepsy research, 2018-11, Vol.147, p.109-114</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c374t-59e9305026ade09ad78c885f0b6ed44b646bc47873f8703e7aad34ec97a0322b3</citedby><cites>FETCH-LOGICAL-c374t-59e9305026ade09ad78c885f0b6ed44b646bc47873f8703e7aad34ec97a0322b3</cites><orcidid>0000-0003-3236-4215</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.eplepsyres.2018.08.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30166056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ashalatha, Radhakrishnan</creatorcontrib><creatorcontrib>Menon, Ramshekhar N.</creatorcontrib><creatorcontrib>Chandran, Anuvitha</creatorcontrib><creatorcontrib>Thomas, Sanjeev V.</creatorcontrib><creatorcontrib>Vilanilam, George</creatorcontrib><creatorcontrib>Abraham, Mathew</creatorcontrib><creatorcontrib>Menon, Deepak</creatorcontrib><creatorcontrib>Soumya, V.C.</creatorcontrib><creatorcontrib>Thomas, Bejoy</creatorcontrib><creatorcontrib>Kesavadas, Chandrashekharan</creatorcontrib><creatorcontrib>Cherian, Ajith</creatorcontrib><creatorcontrib>Sarma, Sankara P.</creatorcontrib><title>Do auras predict seizure outcome after temporal lobe epilepsy surgery?</title><title>Epilepsy research</title><addtitle>Epilepsy Res</addtitle><description>•Significance of auras on surgical outcome in drug-resistant temporal lobe epilepsy was studied.•Presence or absence of auras had no bearing on surgical outcome after anterior temporal lobectomy.•Auditory and vertiginous auras are red herrings while selecting candidates for ATL.•Ictal onset zone should be delineated in patients with auditory and vertiginous auras before ATL.
The success of epilepsy surgery lies in identifying the ictal onset zone accurately. The significance of auras has little been explored on surgical outcome in drug-resistant epilepsy. This study focuses on the clinicopathological correlation of aura(s) and its role in predicting surgical outcome in drug-resistant temporal lobe epilepsy (TLE). We compared surgical outcome in TLE between patients with and without aura and identified the clinico-pathological, radiological and surgical differences between the two groups.
Consecutive patients who underwent presurgical evaluation from January 2009 to December 2014 for drug-resistant TLE who underwent anterior temporal lobectomy (ATL) were included. Patients were followed up at 3months, 12 months and then annually.
Among 456 patients, 344(75%) had aura. Multivariate logistic regression showed that prototype EEG pattern at ictal onset (OR 2.12, 95% CI 1.18–3.06, p = 0.012) and right sided epileptogenic zone (OR 1.82 95% CI 1.18–3.78, p = 0.007) were significantly associated with presence of aura. There was no difference in surgical outcome between those with and without aura. But patients with auditory aura (OR 7.28, CI 2.80–18.95, p = 0.0002) and vertiginous aura (OR 3.01, CI 1.55–7.85, p = 0.028) had a poor surgical outcome. Bivariate analysis showed that normal MRI (p = 0.028) and normal/indeterminate pathology (p = 0.001) were significantly more common with auditory/vertiginous auras.
Mere presence of aura does not affect outcome after TLE surgery. However, auditory and vertiginous auras are predictors of poor surgical outcome. These patients require more extensive screening for an ictal onset zone beyond standard limits of ATL before surgery.</description><subject>Adult</subject><subject>Anterior Temporal Lobectomy - methods</subject><subject>Aura</subject><subject>Cohort Studies</subject><subject>Drug Resistant Epilepsy - surgery</subject><subject>Electroencephalography</subject><subject>Epilepsy, Temporal Lobe - diagnostic imaging</subject><subject>Epilepsy, Temporal Lobe - physiopathology</subject><subject>Epilepsy, Temporal Lobe - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Predictors</subject><subject>Seizure outcome</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>TLE</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0920-1211</issn><issn>1872-6844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkF1LwzAUhoMobk7_guTSm9aTNkvSK_FrKgy80euQpqeS0S41aYX56-3c1EvhhXPzfnAeQiiDlAETl6sUuwa7uAkY0wyYSmEUiAMyZUpmiVCcH5IpFBkkLGNsQk5iXAGABM6PySQfSwTMxZQs7jw1QzCRdgErZ3sa0X0OAakfeutbpKbuMdAe284H09DGl0ixc9_zNA7hDcPm6pQc1aaJeLa_M_K6uH-5fUyWzw9Pt9fLxOaS98m8wCKHOWTCVAiFqaSySs1rKAVWnJeCi9JyqWReKwk5SmOqnKMtpIE8y8p8Ri52vV3w7wPGXrcuWmwas0Y_RJ1BoaRQoPhoVTurDT7GgLXugmtN2GgGektRr_QfRb2lqGEUiDF6vl8Zyhar3-APttFwszPg-OuHw6Cjdbi2I8GAtteVd_-vfAEoFokx</recordid><startdate>201811</startdate><enddate>201811</enddate><creator>Ashalatha, Radhakrishnan</creator><creator>Menon, Ramshekhar N.</creator><creator>Chandran, Anuvitha</creator><creator>Thomas, Sanjeev V.</creator><creator>Vilanilam, George</creator><creator>Abraham, Mathew</creator><creator>Menon, Deepak</creator><creator>Soumya, V.C.</creator><creator>Thomas, Bejoy</creator><creator>Kesavadas, Chandrashekharan</creator><creator>Cherian, Ajith</creator><creator>Sarma, Sankara P.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3236-4215</orcidid></search><sort><creationdate>201811</creationdate><title>Do auras predict seizure outcome after temporal lobe epilepsy surgery?</title><author>Ashalatha, Radhakrishnan ; Menon, Ramshekhar N. ; Chandran, Anuvitha ; Thomas, Sanjeev V. ; Vilanilam, George ; Abraham, Mathew ; Menon, Deepak ; Soumya, V.C. ; Thomas, Bejoy ; Kesavadas, Chandrashekharan ; Cherian, Ajith ; Sarma, Sankara P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c374t-59e9305026ade09ad78c885f0b6ed44b646bc47873f8703e7aad34ec97a0322b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Anterior Temporal Lobectomy - methods</topic><topic>Aura</topic><topic>Cohort Studies</topic><topic>Drug Resistant Epilepsy - surgery</topic><topic>Electroencephalography</topic><topic>Epilepsy, Temporal Lobe - diagnostic imaging</topic><topic>Epilepsy, Temporal Lobe - physiopathology</topic><topic>Epilepsy, Temporal Lobe - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Predictors</topic><topic>Seizure outcome</topic><topic>Statistics, Nonparametric</topic><topic>Surgery</topic><topic>TLE</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ashalatha, Radhakrishnan</creatorcontrib><creatorcontrib>Menon, Ramshekhar N.</creatorcontrib><creatorcontrib>Chandran, Anuvitha</creatorcontrib><creatorcontrib>Thomas, Sanjeev V.</creatorcontrib><creatorcontrib>Vilanilam, George</creatorcontrib><creatorcontrib>Abraham, Mathew</creatorcontrib><creatorcontrib>Menon, Deepak</creatorcontrib><creatorcontrib>Soumya, V.C.</creatorcontrib><creatorcontrib>Thomas, Bejoy</creatorcontrib><creatorcontrib>Kesavadas, Chandrashekharan</creatorcontrib><creatorcontrib>Cherian, Ajith</creatorcontrib><creatorcontrib>Sarma, Sankara P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsy research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ashalatha, Radhakrishnan</au><au>Menon, Ramshekhar N.</au><au>Chandran, Anuvitha</au><au>Thomas, Sanjeev V.</au><au>Vilanilam, George</au><au>Abraham, Mathew</au><au>Menon, Deepak</au><au>Soumya, V.C.</au><au>Thomas, Bejoy</au><au>Kesavadas, Chandrashekharan</au><au>Cherian, Ajith</au><au>Sarma, Sankara P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do auras predict seizure outcome after temporal lobe epilepsy surgery?</atitle><jtitle>Epilepsy research</jtitle><addtitle>Epilepsy Res</addtitle><date>2018-11</date><risdate>2018</risdate><volume>147</volume><spage>109</spage><epage>114</epage><pages>109-114</pages><issn>0920-1211</issn><eissn>1872-6844</eissn><abstract>•Significance of auras on surgical outcome in drug-resistant temporal lobe epilepsy was studied.•Presence or absence of auras had no bearing on surgical outcome after anterior temporal lobectomy.•Auditory and vertiginous auras are red herrings while selecting candidates for ATL.•Ictal onset zone should be delineated in patients with auditory and vertiginous auras before ATL.
The success of epilepsy surgery lies in identifying the ictal onset zone accurately. The significance of auras has little been explored on surgical outcome in drug-resistant epilepsy. This study focuses on the clinicopathological correlation of aura(s) and its role in predicting surgical outcome in drug-resistant temporal lobe epilepsy (TLE). We compared surgical outcome in TLE between patients with and without aura and identified the clinico-pathological, radiological and surgical differences between the two groups.
Consecutive patients who underwent presurgical evaluation from January 2009 to December 2014 for drug-resistant TLE who underwent anterior temporal lobectomy (ATL) were included. Patients were followed up at 3months, 12 months and then annually.
Among 456 patients, 344(75%) had aura. Multivariate logistic regression showed that prototype EEG pattern at ictal onset (OR 2.12, 95% CI 1.18–3.06, p = 0.012) and right sided epileptogenic zone (OR 1.82 95% CI 1.18–3.78, p = 0.007) were significantly associated with presence of aura. There was no difference in surgical outcome between those with and without aura. But patients with auditory aura (OR 7.28, CI 2.80–18.95, p = 0.0002) and vertiginous aura (OR 3.01, CI 1.55–7.85, p = 0.028) had a poor surgical outcome. Bivariate analysis showed that normal MRI (p = 0.028) and normal/indeterminate pathology (p = 0.001) were significantly more common with auditory/vertiginous auras.
Mere presence of aura does not affect outcome after TLE surgery. However, auditory and vertiginous auras are predictors of poor surgical outcome. These patients require more extensive screening for an ictal onset zone beyond standard limits of ATL before surgery.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>30166056</pmid><doi>10.1016/j.eplepsyres.2018.08.006</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3236-4215</orcidid></addata></record> |
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| subjects | Adult Anterior Temporal Lobectomy - methods Aura Cohort Studies Drug Resistant Epilepsy - surgery Electroencephalography Epilepsy, Temporal Lobe - diagnostic imaging Epilepsy, Temporal Lobe - physiopathology Epilepsy, Temporal Lobe - surgery Female Humans Logistic Models Magnetic Resonance Imaging Male Predictive Value of Tests Predictors Seizure outcome Statistics, Nonparametric Surgery TLE Treatment Outcome Young Adult |
| title | Do auras predict seizure outcome after temporal lobe epilepsy surgery? |
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