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Chapter 22 - Surgical Therapies for Epilepsy

Published online by Cambridge University Press:  11 October 2019

By
Rushna Ali  and
Ellen L. Air
Edited by
Vibhangini S. Wasade  and
Marianna V. Spanaki
Vibhangini S. Wasade
Affiliation:
Henry Ford Medical Group HFHS, Michigan
Marianna V. Spanaki
Affiliation:
Wayne State University, Michigan
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Summary

The International League Against Epilepsy (ILAE) put forth the definition for intractable epilepsy as the persistence of seizures despite “adequate trials of two tolerated, appropriately chosen and used antiseizure drug [ASD] schedules (whether as monotherapies or in combination).”1 The definition of medically refractory epilepsy has been debated for many years,2 and expert opinion remains divergent from common practice.3 It has been well-documented that the chances of achieving seizure freedom are minimal with additional trials of ASDs and that increased duration of seizures before surgery is associated with decreased chance of long-term seizure freedom.4 The American Association of Neurology 2015 Epilepsy Quality Measures recommend that each patient should have their diagnosis and treatment plan evaluated, and a referral for presurgical evaluation should be considered to a level 4 epilepsy center for those who are medically refractory about once every 2 years.5 As part of this referral and reassessment, surgery should be considered.

Type
Chapter
Information
Understanding Epilepsy
A Study Guide for the Boards
 , pp. 417 - 431
Publisher: Cambridge University Press
Print publication year: 2019

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References

Kwan, P, Arzimanoglou, A, Berg, AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc task torce of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–1077.CrossRefGoogle Scholar
Tellez-Zenteno, JF, Hernandez-Ronquillo, L, Buckley, S, Zahagun, R, Rizvi, S. A validation of the new definition of drug-resistant epilepsy by the International League Against Epilepsy. Epilepsia. 2014;55(6):829–834.CrossRefGoogle ScholarPubMed
Wasade, VS, Spanaki, M, Iyengar, R, Barkley, GL, Schultz, L. AAN Epilepsy Quality Measures in clinical practice: a survey of neurologists. Epilepsy Behav. 2012;24(4):468–473.Google Scholar
Yoon, HH, Kwon, HL, Mattson, RH, Spencer, DD, Spencer, SS. Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery. Neurology. 2003;61(4):445–450.Google Scholar
Fountain, NB, Van Ness, PC, Bennett, A, et al. Quality improvement in neurology: Epilepsy Update Quality Measurement Set. Neurology. 2015;84(14):1483–1487.Google Scholar
Berg, AT, Vickrey, BG, Testa, FM, et al. How long does it take for epilepsy to become intractable?: a prospective investigation. Ann Neurol. 2006;60(1):73–79.Google Scholar
Kaiboriboon, K, Malkhachroum, AM, Zrik, A, et al. Epilepsy surgery in the United States: analysis of data from the National Association of Epilepsy Centers. Epilepsy Res. 2015;116:105–109.CrossRefGoogle Scholar
Harden, C, Tomson, T, Gloss, D, et al. Practice guideline summary: sudden unexpected death in epilepsy incidence rates and risk factors. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017;88(17):1674–1680.Google Scholar
Jones, LA, Thomas, RH. Sudden death in epilepsy: insights from the last 25 years. Seizure. 2017;44:232–236.Google Scholar
Rayner, G, Jackson, GD, Wilson, SJ. Mechanisms of memory impairment in epilepsy depend on age at disease onset. Neurology. 2016;87(16):1642–1649.Google Scholar
Kampf, C, Walter, U, Rosche, J. The impact of anxiety, seizure severity, executive dysfunction, subjectively perceived psychological deficits, and depression on social function in patients with epilepsy. Epilepsy Behav. 2016;57(Pt A):5–8.Google Scholar
Shaefi, S, Harkness, W. Current status of surgery in the management of epilepsy. Epilepsia. 2003;44 Suppl 1:43–47.CrossRefGoogle ScholarPubMed
Willoughby, JO. Mechanisms underlying partial (focal, or lesional) epilepsy. J Clin Neurosci. 2000;7(4):291–294.Google Scholar
Tellez-Zenteno, JF, Hernandez, Ronquillo L, Moien-Afshari, F, Wiebe, S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res. 2010;89(2–3):310–318.Google Scholar
Connolly, PJ, Baltuch, GH. Temporal lobectomy and amygdalohippocampectomy. In: Baltuch, GH, Villemure, J, eds., Operative Techniques in Epilepsy Surgery. New York: Thieme Medical Publishers; 2009:33–40.Google Scholar
Wheatley, BM. Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach. Neurosurg Focus. 2008;25(3):E4.CrossRefGoogle ScholarPubMed
Adada, B. Selective amygdalohippocampectomy via the transsylvian approach. Neurosurg Focus. 2008;25(3):E5.Google Scholar
von Rhein, B, Nelles, M, Urbach, H, et al. Neuropsychological outcome after selective amygdalohippocampectomy: subtemporal versus transsylvian approach. J Neurol Neurosurg Psychiatry. 2012;83(9):887–893.Google Scholar
Josephson, CB, Dykeman, J, Fiest, KM, et al. Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery. Neurology. 2013;80(18):1669–1676.CrossRefGoogle ScholarPubMed
Hu, WH, Zhang, C, Zhang, K, et al. Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies. J Neurosurg. 2013;119(5):1089–1097.CrossRefGoogle ScholarPubMed
Joo, EY, Han, HJ, Lee, EK, et al. Resection extent versus postoperative outcomes of seizure and memory in mesial temporal lobe epilepsy. Seizure. 2005;14(8):541–551.CrossRefGoogle ScholarPubMed
Sagher, O, Thawani, JP, Etame, AB, Gomez-Hassan, DM. Seizure outcomes and mesial resection volumes following selective amygdalohippocampectomy and temporal lobectomy. Neurosurg Focus. 2012;32(3):E8.CrossRefGoogle ScholarPubMed
Stroup, E, Langfitt, J, Berg, M, et al. Predicting verbal memory decline following anterior temporal lobectomy (ATL). Neurology. 2003;60(8):1266–1273.Google Scholar
Georgiadis, I, Kapsalaki, EZ, Fountas, KN. Temporal lobe resective surgery for medically intractable epilepsy: a review of complications and side effects. Epilepsy Res Treat. 2013;2013:752195.Google Scholar
Vives, K, Lee, G, Doyle, W, Spencer, DD. Anterior temporal rexection. In: Engel, J Jr., Pedley, TA, eds., Epilepsy: A Comprehensive Textbook. 2nd edn. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008:1859–1867.Google Scholar
Schramm, J, Kral, T, Kurthen, M, Blumcke, I. Surgery to treat focal frontal lobe epilepsy in adults. Neurosurgery. 2002;51(3):644–654; discussion 654–645.Google Scholar
Roper, SN. Surgical treatment of the extratemporal epilepsies. Epilepsia. 2009;50 Suppl 8:69–74.CrossRefGoogle ScholarPubMed
Olivier, A. Surgery of epilepsy: methods. Acta Neurol Scand Suppl. 1988;117:103–113.Google Scholar
Zakaria, T, Noe, K, So, E, et al. Scalp and intracranial EEG in medically intractable extratemporal epilepsy with normal MRI. ISRN Neurol. 2012;2012:942849.Google Scholar
O’Brien, TJ, So, EL, Mullan, BP, et al. Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome. Neurology. 2000;55(11):1668–1677.Google Scholar
Comair, YG, Van Ness, PC, Chamoun, RB, Bouclaous, CH. Neocortical resections. In: Engel, J Jr., Pedley, TA, eds., Epilepsy: A Comprehensive Textbook. 2nd edn. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008:1869–1878.Google Scholar
Bower, RS, Wirrell, E, Nwojo, M, et al. Seizure outcomes after corpus callosotomy for drop attacks. Neurosurgery. 2013;73(6):993–1000.CrossRefGoogle ScholarPubMed
Liang, S, Li, A, Jiang, H, et al. Anterior corpus callosotomy in patients with intractable generalized epilepsy and mental retardation. Stereotact Funct Neurosurg. 2010;88(4):246–252.Google Scholar
Graham, D, Tisdall, MM, Gill, D. Corpus callosotomy outcomes in pediatric patients: a systematic review. Epilepsia. 2016;57(7):1053–1068.Google Scholar
Malmgren, K, Rydenhag, B, Hallbook, T. Reappraisal of corpus callosotomy. Curr Opin Neurol. 2015;28(2):175–181.Google Scholar
Gates, JR, Rosenfeld, WE, Maxwell, RE, Lyons, RE. Response of multiple seizure types to corpus callosum section. Epilepsia. 1987;28(1):28–34.Google Scholar
Kasasbeh, AS, Smyth, MD, Steger-May, K, et al. Outcomes after anterior or complete corpus callosotomy in children. Neurosurgery. 2014;74(1):17–28; discussion 28.Google Scholar
Lancman, G, Virk, M, Shao, H, et al. Vagus nerve stimulation vs. corpus callosotomy in the treatment of Lennox-Gastaut syndrome: a meta-analysis. Seizure. 2013;22(1):3–8.Google Scholar
Purves, SJ, Wada, JA, Woodhurst, WB, et al. Results of anterior corpus callosum section in 24 patients with medically intractable seizures. Neurology. 1988;38(8):1194–1201.Google Scholar
Rolston, JD, Englot, DJ, Wang, DD, Garcia, PA, Chang, EF. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy Behav. 2015;51:13–17.Google Scholar
Peacock, WJ. Hemispherectomy for the treatment of intractable seizures in childhood. Neurosurg Clin N Am. 1995;6(3):549–563.Google Scholar
Oppenheimer, DR, Griffith, HB. Persistent intracranial bleeding as a complication of hemispherectomy. J Neurol Neurosurg Psychiatry. 1966;29(3):229–240.Google Scholar
Villemure, J, Daniel, RT. Functional hemispherectomy and periinsular hemispherotomy. In: Baltuch, GH, Villemure, J, eds., Operative Techniques in Epilepsy Surgery. New York: Thieme Medical Publishers; 2009:138–145.Google Scholar
Danielpour, M, von Koch, CS, Ojemann, SG, Peacock, WJ. Disconnective hemispherectomy. Pediatr Neurosurg. 2001;35(4):169–172.Google Scholar
Schusse, CM, Smith, K, Drees, C. Outcomes after hemispherectomy in adult patients with intractable epilepsy: institutional experience and systematic review of the literature. J Neurosurg. 2018;128(3):853–861.Google Scholar
Moosa, AN, Jehi, L, Marashly, A, et al. Long-term functional outcomes and their predictors after hemispherectomy in 115 children. Epilepsia. 2013;54(10):1771–1779.Google Scholar
Jonas, R, Nguyen, S, Hu, B, et al. Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology. 2004;62(10):1712–1721.Google Scholar
Morrell, F, Hanbery, JW. A new surgical technique for the treatment of focal cortical epilepsy. Electroencephalogr Clin Neurophysiol. 1969;26(1):120.Google ScholarPubMed
Morrell, F, Whisler, WW, Bleck, TP. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy. J Neurosurg. 1989;70(2):231–239.Google Scholar
Hufnagel, A, Zentner, J, Fernandez, G, et al. Multiple subpial transection for control of epileptic seizures: effectiveness and safety. Epilepsia. 1997;38(6):678–688.Google Scholar
Spencer, SS, Schramm, J, Wyler, A, et al. Multiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia. 2002;43(2):141–145.Google Scholar
Schauble, B, Cascino, GD, Pollock, BE, et al. Seizure outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations. Neurology. 2004;63(4):683–687.Google Scholar
Schrottner, O, Eder, HG, Unger, F, Feichtinger, K, Pendl, G. Radiosurgery in lesional epilepsy: brain tumors. Stereotact Funct Neurosurg. 1998;70 Suppl 1(1):50–56.Google Scholar
Drees, C, Chapman, K, Prenger, E, et al. Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures. J Neurosurg. 2012;117(2):255–261.Google Scholar
Regis, J, Scavarda, D, Tamura, M, et al. Gamma knife surgery for epilepsy related to hypothalamic hamartomas. Semin Pediatr Neurol. 2007;14(2):73–79.Google Scholar
Bartolomei, F, Hayashi, M, Tamura, M, et al. Long-term efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy. Neurology. 2008;70(19):1658–1663.Google Scholar
Quigg, M, Harden, C. Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg. 2014;121 Suppl:232–240.Google Scholar
Barbaro, NM, Quigg, M, Ward, MM, et al. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: the randomized, controlled ROSE trial. Epilepsia. 2018;59(6):1198–1207.Google Scholar
Feichtinger, M, Schrottner, O, Eder, H, et al. Efficacy and safety of radiosurgical callosotomy: a retrospective analysis. Epilepsia. 2006;47(7):1184–1191.Google Scholar
Hoppe, C, Witt, JA, Helmstaedter, C, et al. Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure. 2017;48:45–52.Google Scholar
Barber, SM, Tomycz, L, George, T, Clarke, DF, Lee, M. Delayed intraparenchymal and intraventricular hemorrhage requiring surgical evacuation after MRI-guided laser interstitial thermal therapy for lesional epilepsy. Stereotact Funct Neurosurg. 2017;95(2):73–78.Google Scholar
Wicks, RT, Jermakowicz, WJ, Jagid, JR, et al. Laser interstitial thermal therapy for mesial temporal lobe epilepsy. Neurosurgery. 2016;79 Suppl 1:S83–S91.Google Scholar
Jermakowicz, WJ, Kanner, AM, Sur, S, et al. Laser thermal ablation for mesiotemporal epilepsy: analysis of ablation volumes and trajectories. Epilepsia. 2017;58(5):801–810.CrossRefGoogle ScholarPubMed
Rolston, JD, Chang, EF. Stereotactic laser ablation for hypothalamic hamartoma. Neurosurg Clin N Am. 2016;27(1):59–67.Google Scholar
Medvid, R, Ruiz, A, Komotar, RJ, et al. Current applications of MRI-guided laser interstitial thermal therapy in the treatment of brain neoplasms and epilepsy: a radiologic and neurosurgical overview. Am J Neuroradiol. 2015;36(11):1998–2006.Google Scholar
Barba, C, Rheims, S, Minotti, L, et al. Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain. 2016;139(Pt 2):444–451.Google Scholar
Najm, I, Jehi, L, Palmini, A, et al. Temporal patterns and mechanisms of epilepsy surgery failure. Epilepsia. 2013;54(5):772–782.Google Scholar
Vale, FL, Pollock, G, Benbadis, SR. Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology. Neurosurg Focus. 2012;32(3):E9.CrossRefGoogle ScholarPubMed
Grote, A, Witt, JA, Surges, R, et al. A second chance – reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications. J Neurol Neurosurg Psychiatry. 2016;87(4):379–385.Google Scholar
Fauser, S, Essang, C, Altenmuller, DM, et al. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia. 2015;56(1):66–76.Google Scholar
Ramantani, G, Strobl, K, Stathi, A, et al. Reoperation for refractory epilepsy in childhood: a second chance for selected patients. Neurosurgery. 2013;73(4):695–704; discussion 704.Google Scholar
Palmini, A, Gambardella, A, Andermann, F, et al. Intrinsic epileptogenicity of human dysplastic cortex as suggested by corticography and surgical results. Ann Neurol. 1995;37(4):476–487.Google Scholar
Bower, RS, Wirrell, EC, Eckel, LJ, et al. Repeat resective surgery in complex pediatric refractory epilepsy: lessons learned. J Neurosurg Pediatr. 2015;16(1):94–100.Google Scholar
Gonzalez-Martinez, J, Bulacio, J, Alexopoulos, A, et al. Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia. 2013;54(2):323–330.Google Scholar
Engel, J Jr., Wiebe, S, French, J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy. Report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003;60(4):538–547.Google Scholar
Effectiveness, Efficiency of Surgery for Temporal Lobe Epilepsy Study Group: Wiebe, S, Blume, WT, Girvin, JP, Eliasziw, M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311–318.Google Scholar
Engel, J Jr., Van Ness, P, Rasmussen, TB, Ojemann, LM. Outcome with respect to epileptic seizures. In: Engel, J Jr., ed., Surgical Treatment of the Epilepsies. 2nd edn. New York: Raven Press; 1993:609–621.Google ScholarPubMed
Wieser, HG, Blume, WT, Fish, D, et al. ILAE Commission Report: proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42(2):282–286.CrossRefGoogle ScholarPubMed
West, S, Nolan, SJ, Cotton, J, et al. Surgery for epilepsy. Cochrane Database Syst Rev. 2015(7):CD010541.Google Scholar
Salanova, V, Markand, O, Worth, R. Longitudinal follow-up in 145 patients with medically refractory temporal lobe epilepsy treated surgically between 1984 and 1995. Epilepsia. 1999;40(10):1417–1423.Google Scholar
Fong, JS, Jehi, L, Najm, I, et al. Seizure outcome and its predictors after temporal lobe epilepsy surgery in patients with normal MRI. Epilepsia. 2011;52(8):1393–1401.Google Scholar
McIntosh, AM, Kalnins, RM, Mitchell, LA, et al. Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence. Brain. 2004;127(Pt 9):2018–2030.Google Scholar
Holmes, MD, Born, DE, Kutsy, RL, et al. Outcome after surgery in patients with refractory temporal lobe epilepsy and normal MRI. Seizure. 2000;9(6):407–411.Google Scholar
Bell, ML, Rao, S, So, EL, et al. Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI. Epilepsia. 2009;50(9):2053–2060.Google Scholar
Bien, CG, Szinay, M, Wagner, J, et al. Characteristics and surgical outcomes of patients with refractory magnetic resonance imaging-negative epilepsies. Arch Neurol. 2009;66(12):1491–1499.CrossRefGoogle ScholarPubMed
Jeha, LE, Najm, I, Bingaman, W, et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain. 2007;130(Pt 2):574–584.CrossRefGoogle ScholarPubMed
Piepgras, DG, Sundt, TM Jr., Ragoowansi, AT, Stevens, L. Seizure outcome in patients with surgically treated cerebral arteriovenous malformations. J Neurosurg. 1993;78(1):5–11.Google Scholar
Edwards, JC, Wyllie, E, Ruggeri, PM, et al. Seizure outcome after surgery for epilepsy due to malformation of cortical development. Neurology. 2000;55(8):1110–1114.Google Scholar
Kral, T, Clusmann, H, Blumcke, I, et al. Outcome of epilepsy surgery in focal cortical dysplasia. J Neurol Neurosurg Psychiatry. 2003;74(2):183–188.Google Scholar
Blume, WT, Ganapathy, GR, Munoz, D, Lee, DH. Indices of resective surgery effectiveness for intractable nonlesional focal epilepsy. Epilepsia. 2004;45(1):46–53.Google Scholar
Cascino, GD, Jack, CR Jr., Parisi, JE, et al. MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance. Epilepsy Res. 1992;11(1):51–59.Google Scholar
McIntosh, AM, Averill, CA, Kalnins, RM, et al. Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery. Epilepsia. 2012;53(6):970–978.Google Scholar
Holmes, MD, Kutsy, RL, Ojemann, GA, Wilensky, AJ, Ojemann, LM. Interictal, unifocal spikes in refractory extratemporal epilepsy predict ictal origin and postsurgical outcome. Clin Neurophysiol. 2000;111(10):1802–1808.Google Scholar
Menon, R, Rathore, C, Sarma, SP, Radhakrishnan, K. Feasibility of antiepileptic drug withdrawal following extratemporal resective epilepsy surgery. Neurology. 2012;79(8):770–776.Google Scholar

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