Epilepsy surgery in stroke-related epilepsy. (May 2021)

• Record Type: Journal Article
• Authors: Arévalo-Astrada, Miguel A.; McLachlan, Richard S.; Suller-Marti, Ana; Parrent, Andrew G.; MacDougall, Keith W.; Mirsattari, Seyed M.; Diosy, David; Hayman-Abello, Brent; Hayman-Abello, Susan; Miles, Ashley; Steven, David A.; Burneo, Jorge G.
• Is Part Of: Seizure. Volume 88(2021)
• Page Start: 116
• Page End: 124
• Publication Date: 2021-05
• Subjects: Stroke -- Epilepsy -- Drug-resistant -- Intracranial EEG -- Surgery; ASM anti-seizure medication -- eSAM etomidate speech and memory test -- FCD focal cortical dysplasia -- FDG-PET 18F-fluorodeoxyglucose positron emission tomography -- iEEG intracranial electroencephalography -- IO ictal onset -- MTS mesial temporal sclerosis -- SED subdural electrodes -- SEEG stereoelectroencephalography -- SPECT single-photon emission computed tomography -- SRE stroke-related epilepsy -- VNS vagus nerve stimulation; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2021.04.002
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Stroke-related epilepsy can be refractory to medical treatment. Surgery in this group of patients can be considered. Most cases in this group of patients have mesial temporal lobe epilepsy. Adequate treatment can be offered with success. Abstract: Purpose: To provide a descriptive analysis on the presurgical evaluation and surgical management of a cohort of patients with stroke related epilepsy (SRE). Methods: We retrospectively examined the clinical characteristics, results of non-invasive and invasive presurgical evaluation, surgical management and outcome of consecutive patients with drug-resistant SRE in our institution from January 1, 2013 to January 1, 2020. Results: Twenty-one of 420 patients (5%) who underwent intracranial EEG (iEEG), resective epilepsy surgery and/or vagus nerve stimulation (VNS) placement, had SRE. Of 13 patients who had iEEG, the ictal onset (IO) was exclusively within the stroke lesion in only one patient. In five patients the IO was extra-lesional and in the remaining seven patients it included the stroke lesion as well as extra-lesional structures. The IO included the mesial temporal region in 11 of the 13 patients (85%). The posterior margin of the stroke lesion was always involved. Five patients underwent surgery without iEEG. In total, 10 patients underwent resective surgery, four VNS placement and two had both corpus callosotomy and VNS placement. Of the patients who had resective surgery, nine were Engel I or II at last follow up. Conclusion: We found that seizures in patients with drug resistant SRE were more frequently originated in the mesial temporal region than in the stroke lesion itself. Despite the complex epileptic network underlying drug-resistant SRE, a thorough presurgical assessment and adequate use of surgical options can lead to excellent surgical outcomes.