Outcomes of resections that spare vs remove an MRI‐normal hippocampus
Objective To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)–normal hippocampus in patients with temporal lobe epilepsy. Methods In this retrospective cohort study, we reviewed clinical, imaging, surgical, and histopathological data on 152 indiv...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2020-11, Vol.61 (11), p.2545-2557 |
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| creator | Morita‐Sherman, Marcia Louis, Shreya Vegh, Deborah Busch, Robyn M. Ferguson, Lisa Bingaman, Justin Bulacio, Juan Najm, Imad Jones, Stephen Zajichek, Alexander Hogue, Olivia Kattan, Michael W. Blumcke, Ingmar Cendes, Fernando Jehi, Lara |
| description | Objective
To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)–normal hippocampus in patients with temporal lobe epilepsy.
Methods
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.
Results
Seizures recurred in 40% within one postoperative year, and in 63% within six postoperative years. Male gender (P = .03), longer epilepsy duration (P |
| doi_str_mv | 10.1111/epi.16694 |
| format | Article |
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To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)–normal hippocampus in patients with temporal lobe epilepsy.
Methods
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.
Results
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.
Significance
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.</description><identifier>ISSN: 0013-9580</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/epi.16694</identifier><identifier>PMID: 33063852</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Cognitive ability ; Cohort Studies ; Convulsions & seizures ; Epilepsy ; epilepsy surgery ; Epilepsy, Temporal Lobe - diagnostic imaging ; Epilepsy, Temporal Lobe - physiopathology ; Epilepsy, Temporal Lobe - surgery ; Female ; Hippocampus ; Hippocampus - diagnostic imaging ; Hippocampus - physiopathology ; Hippocampus - surgery ; Humans ; Magnetic resonance imaging ; Magnetic Resonance Imaging - trends ; Male ; Memory ; memory outcome ; Middle Aged ; neuropsychological assessment ; Patients ; Retrospective Studies ; Seizures ; Temporal lobe ; temporal lobe epilepsy ; Treatment Outcome</subject><ispartof>Epilepsia (Copenhagen), 2020-11, Vol.61 (11), p.2545-2557</ispartof><rights>2020 International League Against Epilepsy</rights><rights>2020 International League Against Epilepsy.</rights><rights>Copyright © 2020 International League Against Epilepsy</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4434-85d0394056131e573a7d10a0038c5698fb400db72c40766abacde1aea47bfb313</citedby><cites>FETCH-LOGICAL-c4434-85d0394056131e573a7d10a0038c5698fb400db72c40766abacde1aea47bfb313</cites><orcidid>0000-0002-8531-3916 ; 0000-0001-9336-9568 ; 0000-0002-5442-4912 ; 0000-0002-8041-6377</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fepi.16694$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fepi.16694$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33063852$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morita‐Sherman, Marcia</creatorcontrib><creatorcontrib>Louis, Shreya</creatorcontrib><creatorcontrib>Vegh, Deborah</creatorcontrib><creatorcontrib>Busch, Robyn M.</creatorcontrib><creatorcontrib>Ferguson, Lisa</creatorcontrib><creatorcontrib>Bingaman, Justin</creatorcontrib><creatorcontrib>Bulacio, Juan</creatorcontrib><creatorcontrib>Najm, Imad</creatorcontrib><creatorcontrib>Jones, Stephen</creatorcontrib><creatorcontrib>Zajichek, Alexander</creatorcontrib><creatorcontrib>Hogue, Olivia</creatorcontrib><creatorcontrib>Kattan, Michael W.</creatorcontrib><creatorcontrib>Blumcke, Ingmar</creatorcontrib><creatorcontrib>Cendes, Fernando</creatorcontrib><creatorcontrib>Jehi, Lara</creatorcontrib><title>Outcomes of resections that spare vs remove an MRI‐normal hippocampus</title><title>Epilepsia (Copenhagen)</title><addtitle>Epilepsia</addtitle><description>Objective
To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)–normal hippocampus in patients with temporal lobe epilepsy.
Methods
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.
Results
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.
Significance
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.</description><subject>Adult</subject><subject>Cognitive ability</subject><subject>Cohort Studies</subject><subject>Convulsions & seizures</subject><subject>Epilepsy</subject><subject>epilepsy surgery</subject><subject>Epilepsy, Temporal Lobe - diagnostic imaging</subject><subject>Epilepsy, Temporal Lobe - physiopathology</subject><subject>Epilepsy, Temporal Lobe - surgery</subject><subject>Female</subject><subject>Hippocampus</subject><subject>Hippocampus - diagnostic imaging</subject><subject>Hippocampus - physiopathology</subject><subject>Hippocampus - surgery</subject><subject>Humans</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - trends</subject><subject>Male</subject><subject>Memory</subject><subject>memory outcome</subject><subject>Middle Aged</subject><subject>neuropsychological assessment</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Seizures</subject><subject>Temporal lobe</subject><subject>temporal lobe epilepsy</subject><subject>Treatment Outcome</subject><issn>0013-9580</issn><issn>1528-1167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9K3UAUhwdpqVfbhS9QAm7qInom8zcboYi1FxSl6HqYTE56I0kmnUmuuPMR-ox9ko69VqrQszmL8_HxO_wI2aNwSNMc4dgeUilLvkUWVBQ6p1SqN2QBQFleCg3bZCfGWwBQUrF3ZJsxkEyLYkHOLufJ-R5j5pssYEQ3tX6I2bSyUxZHGzBbx3To_RozO2QX35a_Hn4OPvS2y1btOHpn-3GO78nbxnYRPzztXXLz5fT65Gt-fnm2PPl8njvOGc-1qIGVHISkjKJQzKqaggVg2glZ6qbiAHWlCsdTVmkr62qkFi1XVVMxynbJ8cY7zlWPtcNhCrYzY2h7G-6Nt615eRnalfnu10ZpVdJSJsGnJ0HwP2aMk-nb6LDr7IB-jqbggmpRFuoR3X-F3vo5DOm9REkJvCg0S9TBhnLBxxiweQ5DwTzWY1I95k89if34b_pn8m8fCTjaAHdth_f_N5nTq-VG-RvXD5pK</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Morita‐Sherman, Marcia</creator><creator>Louis, Shreya</creator><creator>Vegh, Deborah</creator><creator>Busch, Robyn M.</creator><creator>Ferguson, Lisa</creator><creator>Bingaman, Justin</creator><creator>Bulacio, Juan</creator><creator>Najm, Imad</creator><creator>Jones, Stephen</creator><creator>Zajichek, Alexander</creator><creator>Hogue, Olivia</creator><creator>Kattan, Michael W.</creator><creator>Blumcke, Ingmar</creator><creator>Cendes, Fernando</creator><creator>Jehi, Lara</creator><general>Wiley Subscription Services, Inc</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>7TK</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8531-3916</orcidid><orcidid>https://orcid.org/0000-0001-9336-9568</orcidid><orcidid>https://orcid.org/0000-0002-5442-4912</orcidid><orcidid>https://orcid.org/0000-0002-8041-6377</orcidid></search><sort><creationdate>202011</creationdate><title>Outcomes of resections that spare vs remove an MRI‐normal hippocampus</title><author>Morita‐Sherman, Marcia ; Louis, Shreya ; Vegh, Deborah ; Busch, Robyn M. ; Ferguson, Lisa ; Bingaman, Justin ; Bulacio, Juan ; Najm, Imad ; Jones, Stephen ; Zajichek, Alexander ; Hogue, Olivia ; Kattan, Michael W. ; Blumcke, Ingmar ; Cendes, Fernando ; Jehi, Lara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4434-85d0394056131e573a7d10a0038c5698fb400db72c40766abacde1aea47bfb313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Cognitive ability</topic><topic>Cohort Studies</topic><topic>Convulsions & seizures</topic><topic>Epilepsy</topic><topic>epilepsy surgery</topic><topic>Epilepsy, Temporal Lobe - diagnostic imaging</topic><topic>Epilepsy, Temporal Lobe - physiopathology</topic><topic>Epilepsy, Temporal Lobe - surgery</topic><topic>Female</topic><topic>Hippocampus</topic><topic>Hippocampus - diagnostic imaging</topic><topic>Hippocampus - physiopathology</topic><topic>Hippocampus - surgery</topic><topic>Humans</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - trends</topic><topic>Male</topic><topic>Memory</topic><topic>memory outcome</topic><topic>Middle Aged</topic><topic>neuropsychological assessment</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Seizures</topic><topic>Temporal lobe</topic><topic>temporal lobe epilepsy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morita‐Sherman, Marcia</creatorcontrib><creatorcontrib>Louis, Shreya</creatorcontrib><creatorcontrib>Vegh, Deborah</creatorcontrib><creatorcontrib>Busch, Robyn M.</creatorcontrib><creatorcontrib>Ferguson, Lisa</creatorcontrib><creatorcontrib>Bingaman, Justin</creatorcontrib><creatorcontrib>Bulacio, Juan</creatorcontrib><creatorcontrib>Najm, Imad</creatorcontrib><creatorcontrib>Jones, Stephen</creatorcontrib><creatorcontrib>Zajichek, Alexander</creatorcontrib><creatorcontrib>Hogue, Olivia</creatorcontrib><creatorcontrib>Kattan, Michael W.</creatorcontrib><creatorcontrib>Blumcke, Ingmar</creatorcontrib><creatorcontrib>Cendes, Fernando</creatorcontrib><creatorcontrib>Jehi, Lara</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epilepsia (Copenhagen)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morita‐Sherman, Marcia</au><au>Louis, Shreya</au><au>Vegh, Deborah</au><au>Busch, Robyn M.</au><au>Ferguson, Lisa</au><au>Bingaman, Justin</au><au>Bulacio, Juan</au><au>Najm, Imad</au><au>Jones, Stephen</au><au>Zajichek, Alexander</au><au>Hogue, Olivia</au><au>Kattan, Michael W.</au><au>Blumcke, Ingmar</au><au>Cendes, Fernando</au><au>Jehi, Lara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of resections that spare vs remove an MRI‐normal hippocampus</atitle><jtitle>Epilepsia (Copenhagen)</jtitle><addtitle>Epilepsia</addtitle><date>2020-11</date><risdate>2020</risdate><volume>61</volume><issue>11</issue><spage>2545</spage><epage>2557</epage><pages>2545-2557</pages><issn>0013-9580</issn><eissn>1528-1167</eissn><abstract>Objective
To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)–normal hippocampus in patients with temporal lobe epilepsy.
Methods
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.
Results
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.
Significance
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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33063852</pmid><doi>10.1111/epi.16694</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-8531-3916</orcidid><orcidid>https://orcid.org/0000-0001-9336-9568</orcidid><orcidid>https://orcid.org/0000-0002-5442-4912</orcidid><orcidid>https://orcid.org/0000-0002-8041-6377</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Journals; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection); Alma/SFX Local Collection |
| subjects | Adult Cognitive ability Cohort Studies Convulsions & seizures Epilepsy epilepsy surgery Epilepsy, Temporal Lobe - diagnostic imaging Epilepsy, Temporal Lobe - physiopathology Epilepsy, Temporal Lobe - surgery Female Hippocampus Hippocampus - diagnostic imaging Hippocampus - physiopathology Hippocampus - surgery Humans Magnetic resonance imaging Magnetic Resonance Imaging - trends Male Memory memory outcome Middle Aged neuropsychological assessment Patients Retrospective Studies Seizures Temporal lobe temporal lobe epilepsy Treatment Outcome |
| title | Outcomes of resections that spare vs remove an MRI‐normal hippocampus |
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