Navegando por Palavras-chave "Surgical outcome"
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- ItemSomente MetadadadosAre psychiatric disorders exclusion criteria for video-EEG monitoring and epilepsy surgery in patients with mesial temporal sclerosis?(Elsevier B.V., 2013-05-01) Conceicao, Priscila Oliveira da [UNIFESP]; Nascimento, Pedro Paulo [UNIFESP]; Mazetto, Lenon [UNIFESP]; Alonso, Neide Barreira [UNIFESP]; Targas Yacubian, Elza Marcia [UNIFESP]; Araujo Filho, Gerardo Maria de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Epilepsy surgery (ES) is a treatment option for patients with refractory temporal lobe epilepsy (TLE). However, psychiatric disorders (PDs) have been a contraindication for presurgical evaluation in many epilepsy centers. the aim of this study was to evaluate the safety of video-EEG (VEEG) and surgical outcome in patients with refractory TLE and mesial temporal sclerosis (TLE-MTS) associated with PDs. We retrospectively analyzed the clinical, sociodemographic, and VEEG data and surgery outcome of patients with refractory TLE-MTS who underwent ES over the period of 2002 to 2011 and compared data between those with and without PDs. Psychiatric evaluation was performed through DSM-IV and ILAE criteria. Safety during presurgical evaluation was analyzed by the rate of adverse events (AEs). Patients' quality of life (QOL) was measured through ESI-55 and the surgical outcome through Engel's classification. Data from 145 patients were included. the mean VEEG length (93 h) was not affected by PDs. Among patients with PDs, 4.91% (3/61) had AEs, and 13.11% (8/61) had psychogenic nonepileptic seizures (PNESs). Among patients without PDs, 4.76% (4/84) had AEs, and 5.95% (5/84) had PNESs. in the first two follow-up years, of the 94 patients who underwent ES, 65.85% (27/41) with PDs and 67.92% (36/53) without PDs became free of disabling seizures (Engel I). No significant differences were observed in the patients' QOL between both groups after surgery. the rate of AEs and seizure outcome did not differ significantly between both groups, reinforcing the idea that PDs should not be absolute exclusion criteria for VEEG monitoring and epilepsy surgery among patients with TLE-MTS. (C) 2013 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosDoes the patient's hand hold the key to preventing secondary generalization in mesial temporal lobe epilepsy?(Elsevier B.V., 2013-07-01) Pedroso Uchida, Carina Goncalves [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Sales Ferreira Caboclo, Luis Otavio [UNIFESP]; Araujo Filho, Gerardo Maria de [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Targas Yacubian, Elza Marcia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This study aimed to analyze the impact of ictal dystonic posturing (DP) in postoperative seizure outcome and to assess the influence of DP in generalized tonic clonic seizure (GTCS) occurrence during video-EEG monitoring of patients with temporal lobe epilepsy with mesial temporal sclerosis. the impact of DP on surgical outcome remains controversial. Moreover, DP has been recently associated with brain networks avoiding GTCS occurrence.Five hundred twenty-seven seizures of 171 patients who were submitted to standard anterior temporal lobectomy (ATL) between 2002 and 2010, with at least one year of post-surgical follow-up, were retrospectively analyzed and classified as with or without DP and as evolving or not to GTCS. the ictal semiologic correlates of DP, timing elapsed since precedent seizure and antiepileptic drug (AED) intake before each seizure were evaluated. Seizure outcome after ATL was assessed according to Engel's scale.Fifty-eight out of 171 patients (34%) exhibited ictal DP, of which 91.5% were always unilateral and contralateral to the operated side. DP was related to shorter seizures (p = 0.007) and a much lower likelihood of the seizure evolving to GTCS (p = 0.001), even during AED withdrawal (p = 0.002). There was no association between DP and prognosis regarding seizure control as the result of the surgical resection, either in patients with shorter or in those with longer period of follow-up. Our data support the hypothesis that DP reflects a brain network activation that helps avoid GTCS, even during AED withdrawal. (C) 2013 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosHippocampal atrophy on MRI is predictive of histopathological patterns and surgical prognosis in mesial temporal lobe epilepsy with hippocampal sclerosis(Elsevier Science Bv, 2016) Jardim, Anaclara Prada [UNIFESP]; Corso, Jeana Torres [UNIFESP]; Garcia, Maria Teresa Fernandes Castilho [UNIFESP]; Gaca, Larissa Botelho [UNIFESP]; Comper, Sandra Mara [UNIFESP]; Penteado Lancellotti, Carmen Lucia; Centeno, Ricardo Silva [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Scorza, Carla Alessandra [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]Purpose: To correlate hippocampal volumes obtained from brain structural imaging with histopathological patterns of hippocampal sclerosis (HS), in order to predict surgical outcome. Methods: Patients with mesial temporal lobe epilepsy (MTLE) with HS were selected. Clinical data were assessed pre-operatively and surgical outcome in the first year post surgery. One block of mid hippocampal body was selected for HS classification according to ILAE criteria. NeuN-immunoreactive cell bodies were counted within hippocampal subfields, in four randomly visual fields, and cell densities were transformed into z-score values. FreeSurfer processing of 1.5 T brain structural images was used for subcortical and cortical volumetric estimation of the ipsilateral hippocampus. Univariate analysis of variance and Pearson's correlation test were applied for statistical analyses. Results: Sixty-two cases (31 female, 32 right HS) were included. ILAE type 1 HS was identified in 48 patients, type 2 in eight, type 3 in two, and four had no-HS. Better results regarding seizure control, i.e. ILAE 1, were achieved by patients with type 1 HS (58.3%). Patients with types 1 and 2 had smaller hippocampal volumes compared to those with no-HS (p<0.001 and p=0.004, respectively). Positive correlation was encountered between hippocampal volumes and CA1, CA3, CA4, and total estimated neuronal densities. CA2 was the only sector which did not correlate its neuronal density with hippocampal volume (p = 0.390). Conclusion: This is the first study correlating hippocampal volume on MRI submitted to FreeSurfer processing with ILAE patterns of HS and neuronal loss within each hippocampal subfield, a fundamental finding to anticipate surgical prognosis for patients with drug-resistant MTLE and HS. (C) 2016 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosMorphometric MRI features and surgical outcome in patients with epilepsy related to hippocampal sclerosis and low intellectual quotient(Academic Press Inc Elsevier Science, 2018) Gaça, Larissa Botelho [UNIFESP]; Garcia, Maria Teresa Fernandes Castilho [UNIFESP]; Sandim, Gabriel Barbosa [UNIFESP]; Leme, Idaiane Batista Assumption; Noffs, Maria Helena Silva [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Sato, Joao Ricardo [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]Objective: The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. Material and methods: Patients (n = 106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MILE): 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower (<80) and higher IQ (90-109) levels. Results: In the whole series, 42.45% of patients were SF (Engel Class la
- ItemSomente MetadadadosMorphometric MRI features are associated with surgical outcome in mesial temporal lobe epilepsy with hippocampal sclerosis(Elsevier Science Bv, 2017) Fernandes Castilho Garcia, Maria Teresa [UNIFESP]; Gaca, Larissa Botelho [UNIFESP]; Sandim, Gabriel Barbosa [UNIFESP]; Assuncao Leme, Idaiane Batista; Carrete Junior, Henrique [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Sato, Joao Ricardo; Targas Yacubian, Elza Marcia [UNIFESP]Purpose: Corticoamygdalohippocampectomy (CAH) improves seizure control, quality of life, and decreases mortality for refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). One-third of patients continue having seizures, and it is pivotal to determine structural abnormalities that might influence the postoperative outcome. Studies indicate that nonhippocampal regions may play a role in the epileptogenic network in MTLE-HS and could generate seizures postoperatively. The aim of this study is to analyze areas of atrophy, not always detected on routine MRI, comparing patients who became seizure free (SF) with those non seizure free (NSF) after CAH, in an attempt to establish possible predictors of surgical outcome. Methods:105 patients with refractory MTLE-HS submitted to CAH (59 left MTLE
- ItemAcesso aberto (Open Access)Safety of video-EEG monitoring and surgical outcome in patients with mesial temporal sclerosis and psychosis of epilepsy(W B Saunders Co Ltd, 2012-10-01) Conceição, Priscila Oliveira da [UNIFESP]; Araujo Filho, Gerardo Maria de [UNIFESP]; Mazetto, Lenon [UNIFESP]; Alonso, Neide Barreira [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: Cortico-amygdalohippocampectomy (CAH) has become an important treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS); it has resulted in a 60-70% seizure remission rate and significant quality of life (QOL) improvements. Video-electroencephalography (VEEG) monitoring has been widely used in epilepsy centers for pre-surgical evaluation. A major concern in epilepsy surgery is whether to consider CAH treatment in patients with psychosis of epilepsy (POE). This study analyzed the safety and adverse events (AEs) of VEEG monitoring and the post-surgical outcomes of patients with refractory TLE-MTS and POE who underwent CAH.Method: Clinical, sociodemographic and VEEG data from 18 patients with TLE-MTS and POE were analyzed. Psychiatric evaluations were performed using DSM-IV and ILAE criteria. the seizure outcome was evaluated using Engel's criteria.Results: Two patients (11.2%) presented AEs that did not result in increased lengths of hospitalization. of the 10 patients (55.5%) who underwent CAH, 6 (60%) became free of disabling seizures (Engel I). the psychiatric and QOL evaluations revealed improvements of psychotic symptoms (p = 0.01) and in Physical Health (p = 0.01) following surgery.Conclusion: These data reinforce that VEEG monitoring is a safe method to evaluate patients with refractory TLE-MTS and POE in epilepsy centers. (C) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.