Outcome of Epilepsy Surgery in MRI-Negative Patients Without Histopathologic Abnormalities in the Resected Tissue

Sanders MW, Van Der Wolf I, Jansen FE, Aronica E, Helmstaedter C, Racz A, Surges R, Grote A, Becker AJ, Rheims S, Catenoix H, Duncan JS, De Tisi J, Jacques TS, Cross JH, Kalviainen R, Rauramaa T, Chassoux F, Devaux BC, Di Gennaro G, Esposito V, Bodi I, Honavar M, Bien CG, Cloppenborg T, Coras R, Hamer H, Marusic P, Kalina A, Pieper T, Kudematsch M, Hartlieb T, Von Oertzen TJ, Aichholzer M, Dorfmuller G, Chipaux M, Noachtar S, Kaufmann E, Schulze-Bonhage A, Scheiwe CF, Özkara C, Grunwald T, Koenig K, Guerrini R, Barba C, Buccoliero AM, Giordano F, Rosenow F, Menzler K, Garbelli R, Deleo F, Krsek P, Straka B, Arzimanoglou AA, Toulouse J, Van Paesschen W, Theys T, Pimentel J, Loução De Amorim IM, Specchio N, De Palma L, Feucht M, Scholl T, Rössler K, Toledano Delgado R, Gil-Nagel A, Raicevic S, Ristic AJ, Schijns O, Beckervordersandforth J, San Antonio-Arce V, Rumia J, Blümcke I, Braun KP (2024)

Publication Language: English

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 102

Article Number: e208007

Journal Issue: 4

DOI: 10.1212/WNL.0000000000208007

Abstract

Background and Objective Patients with presumed nonlesional focal epilepsy - based on either MRI or histopathologic findings - have a lower success rate of epilepsy surgery compared with lesional patients. In this study, we aimed to characterize a large group of patients with focal epilepsy who underwent epilepsy surgery despite a normal MRI and had no lesion on histopathology. Determinants of their postoperative seizure outcomes were further studied. Methods We designed an observational multicenter cohort study of MRI-negative and histopathology-negative patients who were derived from the European Epilepsy Brain Bank and underwent epilepsy surgery between 2000 and 2012 in 34 epilepsy surgery centers within Europe. We collected data on clinical characteristics, presurgical assessment, including genetic testing, surgery characteristics, postoperative outcome, and treatment regimen. Results Of the 217 included patients, 40% were seizure-free (Engel I) 2 years after surgery and one-third of patients remained seizure-free after 5 years. Temporal lobe surgery (adjusted odds ratio [AOR]: 2.62; 95% CI 1.19-5.76), shorter epilepsy duration (AOR for duration: 0.94; 95% CI 0.89-0.99), and completely normal histopathologic findings - versus nonspecific reactive gliosis - (AOR: 4.69; 95% CI 1.79-11.27) were significantly associated with favorable seizure outcome at 2 years after surgery. Of patients who underwent invasive monitoring, only 35% reached seizure freedom at 2 years. Patients with parietal lobe resections had lowest seizure freedom rates (12.5%). Among temporal lobe surgery patients, there was a trend toward favorable outcome if hippocampectomy was part of the resection strategy (OR: 2.94; 95% CI 0.98-8.80). Genetic testing was only sporadically performed. Discussion This study shows that seizure freedom can be reached in 40% of nonlesional patients with both normal MRI and histopathology findings. In particular, nonlesional temporal lobe epilepsy should be regarded as a relatively favorable group, with almost half of patients achieving seizure freedom at 2 years after surgery - even more if the hippocampus is resected - compared with only 1 in 5 nonlesional patients who underwent extratemporal surgery. Patients with an electroclinically identified focus, who are nonlesional, will be a promising group for advanced molecular-genetic analysis of brain tissue specimens to identify new brain somatic epilepsy genes or epilepsy-associated molecular pathways.

Authors with CRIS profile

Involved external institutions

Medizinische Universität Wien Austria (AT) Hospital Sant Joan de Déu Barcelona Spain (ES) Johannes Kepler Universität (JKU) Linz Austria (AT) Fondation Adolphe de Rothschild Hospital France (FR) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsspital Zürich (USZ) Switzerland (CH) Meyer Children’s Hospital Italy (IT) Goethe-Universität Frankfurt am Main Germany (DE) Foundation of the Carlo Besta Neurological Institute (IRCCS) Italy (IT) Motol University Hospital / Fakultní nemocnice v Motole Czech Republic (CZ) Hospices Civils de Lyon (CHU) France (FR) Hospital de Santa Maria Portugal (PT) Ospedale Pediatrico Bambino Gesu Italy (IT) Universitätsklinikum Bonn Germany (DE) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) University of Amsterdam Netherlands (NL) Centre hospitalier Sainte-Anne France (FR) King's College Hospital (KCH) United Kingdom (GB) Schön Klinik Vogtareuth Germany (DE) Istanbul University Cerrahpaşa / İstanbul Üniversitesi Cerrahpaşa (IUC) Turkey (TR) University Clinical Centre of Serbia / Univerzitetski Klinički Centar Srbije / Универзитетски клинички центар Србије Serbia (RS) Maastricht University Netherlands (NL) Universität Bielefeld Germany (DE) Kepler Universitätsklinikum (KUK) Austria (AT) Great Ormond Street Hospital (GOSH) United Kingdom (GB) Philipps-Universität Marburg Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Ruber International Hospital Spain (ES) National Hospital For Neurology and Neurosurgery United Kingdom (GB) Kuopio University Hospital / Pohjois-Savon sairaanhoitopiiri Finland (FI) IRCCS Istituto Neurologico Mediterraneo Neuromed Italy (IT) Maastricht University Medical Center (UMC+) Netherlands (NL)

How to cite

APA:

Sanders, M.W., Van Der Wolf, I., Jansen, F.E., Aronica, E., Helmstaedter, C., Racz, A.,... Braun, K.P. (2024). Outcome of Epilepsy Surgery in MRI-Negative Patients Without Histopathologic Abnormalities in the Resected Tissue. Neurology, 102(4). https://doi.org/10.1212/WNL.0000000000208007

MLA:

Sanders, Maurits W., et al. "Outcome of Epilepsy Surgery in MRI-Negative Patients Without Histopathologic Abnormalities in the Resected Tissue." Neurology 102.4 (2024).

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