https://orcid.org/0000-0002-2753-821X
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ABSTRACT
Objective
We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT).
Methods
We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher’s exact test to compare categorical variables, while a t-test was used for continuous variables.
Results
There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49).
Significance
In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethical Statement
We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Authors contributions
All authors had substantial contributions to the work. Zeenat Jaisani came with the main theme of the manuscript. Zeenat Jaisani and Stephanie Bustros worked on how to organize the subject and the flow of work. Stephanie Bustros, Manmeet Kaur, and Elizabeth Ritchey collected and organized the data. Jerzy P Szaflarski, Kristen Riley, and Nicole Bentley helped with the acquisition of the data. Jerzy P Szaflarski had valuable contributions on how to approach the topic and made valuable edits to the initial draft. Kristen Riley and Nicole Bentley provided the perspective of the surgeon when addressing surgical techniques. Gerald McGwin and Adeel Memon helped with the data analysis and interpretation. Stephanie Bustros wrote the initial draft for the manuscript. The draft was sent to every other author who critically revised it and added his/her edits and modifications. Stephanie Bustros and Zeenat Jaisani included all the authors’ comments and finalized the version of the manuscript to be published. This final version was emailed to all the authors who approved it and agreed to be accountable for all aspects of the work.