TY - JOUR
T1 - Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”
T2 - A retrospective nationwide Italian study
AU - Giulioni, Marco
AU - Marucci, Gianluca
AU - Pelliccia, Veronica
AU - Gozzo, Francesca
AU - Barba, Carmen
AU - Didato, Giuseppe
AU - Villani, Flavio
AU - Di Gennaro, Giancarlo
AU - Quarato, Pier Paolo
AU - Esposito, Vincenzo
AU - Consales, Alessandro
AU - Martinoni, Matteo
AU - Vornetti, Gianfranco
AU - Zenesini, Corrado
AU - Efisio Marras, Carlo
AU - Specchio, Nicola
AU - De Palma, Luca
AU - Rocchi, Raffaele
AU - Giordano, Flavio
AU - Tringali, Giovanni
AU - Nozza, Paolo
AU - Colicchio, Gabriella
AU - Rubboli, Guido
AU - Lo Russo, Giorgio
AU - Guerrini, Renzo
AU - Tinuper, Paolo
AU - Cardinale, Francesco
AU - Cossu, Massimo
AU - the Commission for Epilepsy Surgery of the Italian League Against Epilepsy
PY - 2017/11
Y1 - 2017/11
N2 - Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. Results: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). Significance: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.
AB - Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. Results: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). Significance: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.
KW - Focal cortical dysplasia
KW - Glioneuronal tumors
KW - Low-grade glial tumors
KW - Neuropsychological outcome
KW - Seizure outcome
U2 - 10.1111/epi.13866
DO - 10.1111/epi.13866
M3 - Journal article
C2 - 28804898
AN - SCOPUS:85032746240
SN - 0013-9580
VL - 58
SP - 1832
EP - 1841
JO - Epilepsia
JF - Epilepsia
IS - 11
ER -