| Predicting Seizure Freedom After Two or More Chronic Invasive Evaluations in Patients with Intractable Epilepsy. | |
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MedLine Citation:
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PMID: 22120351 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: In patients with intractable epilepsy, failure to localize and/or resect the epileptic focus after invasive monitoring is multifactorial. Rarely do these patients return for a second invasive evaluation, and their outcome is not clearly characterized. This study aims to determine the seizure outcome after a second invasive electroencephalographic (EEG) evaluation, and its possible predictors. METHODS: We retrospectively reviewed 30 patients who underwent two or more invasive evaluations at Cleveland Clinic between 1980 and 2007. Clinical, surgical, imaging, and pathology information was analyzed using a multivariate regression model. A favorable outcome was defined as complete seizure freedom, allowing for auras and seizures restricted to the first postoperative week. RESULTS: Ten patients (33%) became seizure free after the second operation (mean follow-up duration 3.13 years (range 6 months-17 years)). Seizure freedom was more likely in patients reporting fewer seizures per month preoperatively (mean 19 seizures/mo), and in those with a predominantly regional/lateralized scalp EEG ictal pattern (32% seizure free), as opposed to those with higher seizure frequency (mean 70 seizures/month; P = 0.02) or diffuse ictal EEGs (0% seizure free; P = 0.04). There was a significant association between acute postoperative seizures and failure of repeat surgery (P = 0.0083). In 17 of 30 patients, at least one complication was reported (57%) after the second invasive evaluation compared with a complication rate of 23% after the first invasive evaluation. CONCLUSIONS: A second invasive evaluation may lead to seizure freedom in one-third of patients. However, this must be weighed against the increased complication rate with reoperation. |
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Authors:
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Sean J Nagel; Lara E Jehi; Rebecca O'Dwyer; Dani Bidros; Girish K Hiremath; William E Bingaman |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-7 |
Journal Detail:
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Title: World neurosurgery Volume: - ISSN: 1878-8750 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101528275 Medline TA: World Neurosurg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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