Medically Refractory Frontal Lobe Epilepsy: The Experience at a Single Epilepsy Center
Abstract number :
3.239
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2022
Submission ID :
2204916
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Stephanie Bustros, MD – University of Texas in Houston; Nicole Bentley, MD – University of Alabama at Birmingham; Zeenat Jaisani, MD – University of Alabama at Birmingham; Manmeet Kaur, MD – University of Alabama at Birmingham; Kristen Riley, MD – University of Alabama at Birmingham; Elizabeth Ritchey, NP – University of Alabama at Birmingham; Jerzy Szaflarski, MD, PhD – University of Alabama at Birmingham
Rationale: We aimed to present seizure outcomes at the last follow-up in medically refractory frontal lobe epilepsy patients who received either resection, laser interstitial thermal ablation (LiTT), or neuromodulation in a single level 4 comprehensive epilepsy center.
Methods: We retrospectively reviewed 115 medically refractory focal epilepsy patients who had work-up done in our center between January 2014 and February 2022. Twenty-two (19%) patients had frontal lobe epilepsy. Patient demographics, seizure characteristics, non-invasive interventions, and intracranial monitoring methods were presented. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification in patients who underwent resection/LiTT and more than or less than 50% seizure reduction in patients who received neuromodulation.
Results: Fourteen (64%) patients underwent stereoelectroencephalography (SEEG), four (18%) had GRIDs, and three (14%) received both SEEG and GRIDs as part of their invasive monitoring. One (4%) patient had a frontal lobe encephalomalacia on brain MRI and was offered resection directly after non-invasive evaluation. Fifteen (68%) patients had frontal lobe epilepsy only, and seven (32%) had epilepsy in two or more locations including the frontal lobe. The mean duration of epilepsy was 20.8 years, and the mean post-surgical follow-up was 31 months (range, 4-66 months). Ten (45%) patients had non-lesional brain MRI, and twelve (55%) had lesional MRI. Eleven (50%) patients underwent surgical resection, one (5%) had thermal interstitial ablation (LiTT), and ten (45%) received neuromodulation. Four (40%) non-lesional patients and eight (66.67%) lesional patients were offered surgical resection or LiTT. Six (60 %) non-lesional patients and four (33.33%) lesional patients received neuromodulation. Of the twelve patients who underwent resection or LiTT, nine (75%) patients had Engel I seizure outcome, and three (25%) patients had Engel II seizure outcome at the last follow-up. Pathology in this group showed focal cortical dysplasia (n=5), gliosis (n=3), vascular anomalies (n=2), and normal brain tissue (n=1). Of the ten patients who received neuromodulation, five (50%) patients achieved 50% or more seizure reduction at the last follow-up.
Conclusions: We presented seizure outcomes at the last follow-up in medically refractory frontal lobe epilepsy patients in a single level 4 comprehensive epilepsy center. Our data showed that 55% of the cohort were offered resection/LiTT vs. 45% of the patients who were denied surgical resection and were offered neuromodulation. Seventy-five (75%) of the patients who received resection/LiTT were seizure free or had focal aware seizures only at the last follow-up. These results should aid the epileptologists when setting appropriate goals and expectations during patient discussion.
Funding: None
Clinical Epilepsy