Article
The histopathological diagnosis determines the chance for favourable seizure outcome in adult epilepsy patients
Die histologische Diagnose beeinflusst maßgeblich das Anfallsoutcome bei erwachsenen Epilepsiepatienten
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Authors
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Thomas Sauvigny
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Katharina Kelm
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Franz Lennard Ricklefs
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Michael Lanz
- Evangelisches Krankenhaus Alsterdorf, Klinik für Neurologie und Epileptologie, Hamburg, Deutschland
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Jakob Matschke
- Universitätsklinikum Hamburg-Eppendorf, Institut für Neuropathologie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Tobias Martens
- Asklepios Klinik Sankt Georg, Klinik für Neurochirurgie, Hamburg, Deutschland
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: In addition to hippocampal sclerosis (HS), long-term epilepsy associated tumors (LEATs) and focal cortical dysplasias (FCDs) are the most common histological diagnoses in adult patients with drug-resistant epilepsy who require surgery. However, there are few studies comparing detailed epileptological characteristics and seizure outcome in these groups, which would be valuable for individualized therapy planning.
Methods: We evaluated the clinical and histopathological data of patients, who underwent surgery in our epilepsy center between 2009 and 2018. We stratified the patients according to the histological diagnosis in 7 groups (HS, FCD, cavernous malformation, glioneuronal tumors, diffuse gliomas, gliosis, FCD type III according to Blümcke 2011) and analyzed patient characteristics in the respective group. Statistical analyses were performed by a univariate analysis using Kruskal-Wallis test or ANOVA tests depending on the scale of the measurements and homogeneity of variances, to examine correlations between the parameters using IBM SPSS Statistics 25 (IBM Corporation, Armonk, NY, USA). A multivariate regression analysis was calculated for the entire cohort to assess parameters associated with favorable seizure outcome, which was defined as Engel I.
Results: In this period 426 patients (45.4% female) underwent epilepsy surgery of which 322 patients had the first resection and were selected for further analysis. The mean duration of epilepsy was 17.8 years, the mean age at surgery 39.4 years. Age at seizure onset differed significantly between the histological groups showing the earliest onset in the FCD group (8.7 years, p<0.001). The proportion of patients with bilateral tonic-clonic seizures was highest in the hippocampal sclerosis group (87.5%, p=0.011). The seizure outcome varied considerably, being best in the glioneuronal tumor group (with Engel Ia as median) and the FCD type III group (p=0.008). The mean follow-up interval was 31.3 months. A additional regression analysis revealed the diagnosis of a glioneuronal tumor as independent predictor for a favorable seizure outcome (p=0.021).
Conclusion: Glioneuronal tumors as important representatives of LEATs showed the best seizure outcome. Our study provides a detailed overview of histological findings in an adult surgical epilepsy patient cohort and underlines the role of accurate histological examination for prognostic assessment after epilepsy surgery.
