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3_tesla_in_epilepsy

With 3 Tesla, the volumetry of CA4/Dentate gyrus (DG) was associated with the pathological changes in DG in mesial temporal lobe epilepsy (MTLE) patients. The volumetry of CA4/DG with preoperative 3T MRI could predict the postoperative seizure outcomes in those patients 1).

Case series

A retrospective study comprises 26 patients (11 males/15 females, mean age 34±12years, range 13-50 years) with 3 Tesla MRI-negative focal epilepsies who underwent resective epilepsy surgery. Non-invasive and invasive presurgical diagnostic modalities, type and localization of resection, clinical and epileptological outcome with a minimum follow-up of 1year (range 1-11 years, mean 2.5±2.3years) after surgery as well as outcome predictors were evaluated.

All patients underwent invasive video-EEG monitoring after implantation of intracerebral depth and/or subdural electrodes. Ten patients received temporal and 16 extratemporal or multilobar (n=4) resections. There was no perioperative death or permanent morbidity. Overall, 12 of 26 patients (46%) were completely seizure-free (Engel IA) and 65% had a favorable outcome (Engel I-II). In particular, seizure-free ratio was 40% in the temporal and 50% in the extratemporal group. In the temporal group, long duration of epilepsy correlated with poor seizure outcome, whereas congruent unilateral FDG-PET hypometabolism correlated with a favorable outcome.

In almost two thirds of temporal and extratemporal epilepsies defined as “non-lesional” by 3 Tesla MRI criteria, a favorable postoperative seizure outcome (Engel I-II) can be achieved with accurate multimodal presurgical evaluation including intracranial EEG recordings. In the temporal group, most favorable results were obtained when FDG-PET displayed congruent unilateral hypometabolism 2).

1)
Na M, Liu Y, Shi C, Gao W, Ge H, Wang Y, Wang H, Long Y, Shen H, Shi C, Lin Z. Prognostic value of CA4/DG volumetry with 3T magnetic resonance imaging on postoperative outcome of epilepsy patients with dentate gyrus pathology. Epilepsy Res. 2014 Oct;108(8):1315-25. doi: 10.1016/j.eplepsyres.2014.06.005. Epub 2014 Jul 7. PubMed PMID: 25085233.
2)
Kogias E, Klingler JH, Urbach H, Scheiwe C, Schmeiser B, Doostkam S, Zentner J, Altenmüller DM. 3 Tesla MRI-negative focal epilepsies: Presurgical evaluation, postoperative outcome and predictive factors. Clin Neurol Neurosurg. 2017 Oct 31;163:116-120. doi: 10.1016/j.clineuro.2017.10.038. [Epub ahead of print] PubMed PMID: 29101859.
3_tesla_in_epilepsy.txt · Last modified: 2017/11/05 14:15 by administrador