Conversion of MRI-negative to MRI-positive epilepsy: Detecting subtle lesions during multidisciplinary epilepsy conference
Abstract number :
2.336
Submission category :
9. Surgery / 9A. Adult
Year :
2017
Submission ID :
349574
Source :
www.aesnet.org
Presentation date :
12/3/2017 3:07:12 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Alexandra Urban, University of Pittsburgh; Jenna Robinson, University of Pittsburgh; Naoir Zaher, UPMC; Ahmed Yassin, UPMC; Arun Antony, UPMC; Gena Ghearing, University of Iowa; Mark Richardson, UPMC; Julie Pan, UPMC; Joseph Mettenburg, UPMC; and Anto Bag
Rationale: Every year, more than 2500 patients undergo resections for treatment of medically refractory epilepsy in the United States. The success of epilepsy surgery is partially dependent on finding a lesion on MRI. Frequently, lesions are subtle and missed on initial review. A dedicated epilepsy surgery conference with comprehensive data presentation can guide physicians to focus on particular brain regions where lesions with subtle radiological signs may have been missed. Methods: Retrospective data was collected as a part of a Quality Improvement Project. We reviewed all patients presented at the multidisciplinary epilepsy patient management conference (MEPMC), with current MRI scans, at the University of Pittsburgh Medical Center from January 2013 to August 2016. We determined the number of patients with non-lesional MRIs, per initial radiology report, who subsequently were found to have a brain lesion on further MRI review during the conference. These cases were further analyzed based on pathology and surgical outcome. Results: Of 276 patients presented, 83 patients (30.07%) were deemed non-lesional based on their initial MRI report. 29 of these initially non-lesional cases (34.9%) were determined to have MRI visibile lesions upon review at conference: 14 had hippocampal sclerosis and 7 cortical dysplasia. Of the 29 cases, only 3 patients had an initial 3T MRI. 19 of 29 patients (65%) had temporal lobe epilepsy and 10 patients had extratemporal (frontal or parietal lobe) epilepsy. Twenty-one patients underwent respective surgery and 3 underwent laser ablation. Pathology of 21 operated patients most commonly revealed hippocampal sclerosis (9, 42.8 %) followed by cortical dysplasia (5, 23.8%) and gliosis (4, 19%). One year following surgery, 17 patients had EngelI I outcome (70.8%), five Engell II (20.8%) and two Engell III(8.3%). Conclusions: Subtle lesions are occasionally missed during initial MRI evaluation. This study highlights the importance of a thorough review of all imaging studies during multidisciplinary epilepsy surgery conference in improving outcome. Funding: none
Surgery