Lilia Maria Morales Chacon*, Judith Gonzalez Gonzalez, Nelson Quintanal Cordero, Martha Rios, Manuel Dearriba Romanidy, Juan E. Bender del Busto, Aisel Santos Santos, Margarita M. Báez Martin, Sheila Berrillo Batista, Randis Garbey Fernandez, Zenaida Hernández Díaz, Karla Batista García-Ramo, Bárbara Estupiñan Diaz, Lidice Galán García, Marilyn Zaldívar Bermudez, Maite Solomon, Orestes Lopez Piloto, Lourdes Lorigados Pedre, Liana Portela, Ricardo Valdés Yerena and Abel Sánchez Coroneux
International Center for Neurological Restoration, National Epilepsy Surgery Program, CubaFulltext PDF
This paper presents an Electro clinical outcome of Extra Temporal Lobe Epilepsy (ExTLE) patients derived from a national comprehensive epilepsy surgery program in Cuba. Twenty-three patients with pharma co resistant Ext TLE underwent thorough pre surgical evaluations as well as resective and disconnective surgical procedures tailored by sequential intra operative ElectroCorticography (ECoG). Seizure outcome assessment for each patient was carried out one and two years after seizure. Logistic regression analysis was used to consider the potential predictive factors, which included demographic, presurgical and surgical variables. Resective surgical techniques were performed on frontal, occipital, pericentral and parietal lobes. Hemispherectomy was implemented in one patient for Rasmussen encephalitis. Anterior callosotomies for drop attacks were completed in two children; and focal frontal resection was carried out in one patient additionally to anterior callosotomy. About 80.9% of the surgeries were done in non-dominant hemispheres. Furthermore, surgical resection encroaching upon eloquent cortex was accomplished in 42.8% of the Ext TLE patients. During presurgical evaluation, the most common seizure types were aware and non-aware focal seizure which evolved to bilateral tonic clonic seizures. Regional interictal Electroencephalography pattern was documented in 61.5% of the patients; while 66.6% exhibited non-lateralized or bilateral interictal epileptiform discharge. Ictal EEG pattern was lateralized in 69.2% and regional in 76.9% of the cohort. Magnetic Resonance Imaging did not indicate a distinct lesion in 52.1% of the cases. After one-year follow up, 52.6% was labeled (Engel class I) and 47.3% (class II-III); at 24 months: 41.1% cases were registered class I, and 58.8% class II-IV. Clinical evolutions did not show significant modification concerning the assessed terms (Friedman ANOVA p=0.15); and there was no variation in the number of cases registered Engel class I two years after surgical treatment compared to the previous year (p=0.47 Sign test). A drop in the Absolute Spike Frequency (ASF) was observed in the post resective intra operative ECoG performed in all resective surgeries. The ASF during pre-resection ECoG was lower in patients Engels Class I one and two years after surgery (*p<0.05, Mann U test). A multivariate logistic regression analysis demonstrated that an acute postoperative seizure was the sole postoperative variable related to Engel classification. (p=0.01), odd ratio 3.88. This multi-disciplinary and multi-modal program for presurgical epilepsy workup and surgical procedures guided by sequential intra operative ECoG indicates favorable outcomes that show a safe and viable procedure with mild morbidity, and no mortality.
Extratemporal lobe epilepsy; Epilepsy surgery; Seizure outcome; Intraoperative Electrocoticography
Morales Chacón LM, González JG, Cordero NQ, Ríos M, Romanidy MD, Bender del Busto JE, et al. Presurgical Assessment and Surgical Treatment in Extra Temporal Lobe Epilepsy: A National Comprehensive Epilepsy Surgery Program in Cuba. Clin Surg. 2019; 4: 2546..