Surgical Results in Temporal Lobe Epilepsies Due to Structural Lesions

Objective:Temporal lobe epilepsy (TLE) is the most common localization-related epilepsy syndrome in adults. The aim of this study was to determine the long-term efficacy of epilepsy surgery in patients with TLE with focal lesions and to evaluate the predictive factors for seizure-free status after surgery.Methods:Among 109 patients aged more than 17 years, 26 cases with a postoperative follow-up period of at least 2 years and who underwent anterior temporal lobectomy and lesionectomy were included in the study. Each patient was evaluated with a detailed history, video-electroencephalography (EEG), neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom.Results:Patients with chronic TLE (n=26) associated with structural lesions were included in the study. According to Engel’s classification, the seizure freedom rate was found to be 92.3% in the first year and 80.8% in the second year after surgery. At the postoperative 2nd year, demographic parameters, disease duration before surgery, mean age of patients, presence of focus to bilateral tonic-clonic seizure, EEG, video EEG monitoring, clinical lateralization, scanning results, surgical technique, and histopathological diagnosis did not demonstrate a significant difference between the seizure-free (Engel’s class I) and non-seizure-free groups (Engel’s class II, III, IV) (p>0.05).Conclusion:Refractory epilepsy surgery for temporal lobe tumors often offers complete seizure freedom. Complete surgical excision of the epileptogenic region is of great importance for achieving seizure-freeness

The effects of Covid-19 on physical medicine and rehabilitation in Turkey in the first month of pandemic

Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians

Comparison of Compliance Rates and Classification of Epileptic Seizures with ILAE 1981, Lüders, ILAE 2001 Epilepsy Classification Systems, Before and After Their Monitorization

Objectives:Epileptic seizures diagnosed wth clinical and electroencephalographic (EEG) signs were classified according to ILAE 1981, Lüders, and ILAE 2001 systems in the present study, the aim of which was to compare classification systems by means of preictal and postictal consistency, and to determine deficiencies of the classification systems.Methods:In the present study, 50 patients who had epileptic seizures during monitorization were evaluated by a single observer at the Gazi University Medical Faculty Long-Term Video-EEG Monitorization Unit between March 2003 and September 2004. Seizures were classified by their anamnesis according to ILAE 1981, Lüders, and ILAE 2001 classification systems. After monitorizing patients with video-EEG, each seizure was classified with these systems by a single observer. During classification, EEG results and magnetic resonance imaging (MRI) information were not evaluated, and syndromic classification was not performed.Results:According to ILAE 1981, the classifications of 37 out of 50 patients (74%) were consistent with pre- and post-monitorization classification. According to ILAE 2001, 36 classifications (72%) were consistent, and according to Lüders classification, 39 classifications (78%) were consistent.Conclusion:Comparison performed by a single observer revealed no significant difference among the 3 classification systems before and after monitorization

Surgery for intractable temporal lobe epilepsy: experience of a single institution

WOS: 000343068800025PubMed ID: 25539559Background/aim: In the treatment of epilepsy, encouraging results have been achieved with surgical treatment, especially for temporal lobe epilepsy (TLE). Drug resistance must be diagnosed as early as possible, because the ensuing seizures can be eliminated surgically via temporal lobe surgery in a high percentage (70%-90%) of patients. In this study we share our experience, in a single institution, of surgical treatment of intractable TLE. Materials and methods: Between March 2006 and November 2010 we performed 127 corticoamygdalohippocampectomy (CAH) procedures. All CAN surgical procedures were done as described by Niemeyer's technique. Resection lengths were 4-4.5 cm from the temporal pole. Results: At the end of 24 months, 79.7% (n = 94) patients were still on antiepileptic medications, with 55 of them on a decreased number or dose of drugs, and 20.3 (n = 24) patients were antiepileptic drug-free. Postoperative Engel's classes were 1, 2, and 3 in 87.2%, 5.08%, and 7.6%, respectively. There was no mortality in follow-up, and dysphasia in 1 patient (0.84%) was the only morbidity. Conclusion: In our series we found that the outcome of surgery is associated with careful patient selection, which requires a detailed investigation of the patients. Our final conclusion is that outcome scores are independent of age, pathology, or sex but are dependent on correct patient selection

Comparative Lateralizing Ability of Multimodality MRI in Temporal Lobe Epilepsy.

Purpose. The objective is to compare lateralizing ability of three quantitative MR (qMRI) modalities to depict changes of hippocampal architecture with clinical entities in temporal lobe epilepsy. Methods. We evaluated 14 patients with clinical and EEG proven diagnosis of unilateral TLE and 15 healthy volunteers. T1-weighted 3D dataset for volumetry, single-voxel 1H MR spectroscopy (MRS), and diffusion tensor imaging (DTI) were performed for bilateral hippocampi of all subjects. Results. Individual volumetric measurements provided accurate lateralization in 85% of the patients, spectroscopy in 57%, and DTI in 57%. Higher lateralization ratios were acquired combining volumetry-spectroscopy (85%), spectroscopy-DTI (85%), and volumetry-DTI (100%). Significantly decreased NAA/(Cho+Cr) ratios (p = 0.002) and increased FA (p = 0.001) values were obtained in ipsilateral to epileptogenic hippocampus. Duration of epilepsy and FA values showed a significant negative correlation (p = 0.016, r = -0.847). The history of febrile convulsion associated with ipsilateral increased ADC values (p = 0.015, r = 0.851) and reduced NAA/(Cho+Cr) ratios (p = 0.047, r = -761). Conclusion. Volumetry, MRS, and DTI studies provide complementary information of hippocampal pathology. For lateralization of epileptogenic focus and preoperative examination, volumetry-DTI combination may be indicative of diagnostic accuracy

Evaluating the Correlation Between Preoperative Examination Results, Prognosis, and Pathology Results in Temporal Lobe Epilepsy Patients

Objectives:This prospective study aims to compare the diagnostic value of different preoperative examinations in patients who underwent TLE surgery for treatment-resistant temporal lobe epilepsy, following histopathological evaluations, and to evaluate the seizure-freedom rates observed during the postoperative follow-up.Methods:In this study, 35 patients who were followed-up in our clinic diagnosed with drug-resistant TLE were evaluated prospectively. The epileptic focus was determined for all patients. The different preoperative, noninvasive examinations were compared to each other, and with postoperative pathology results. Patients were followed up for two years after surgery.Results:Concerning determining the epileptic focus, our findings showed that PET and cranial MRI had similar effectiveness compared to ictal EEG and semiology, which represent the gold standard in preoperative examinations. When we correlated the imaging methods with ictal EEG, PET scan had a considerably high lateralization value in determining the epileptic focus and had 100% sensitivity. In terms of detecting the epileptic focus, MRI had a sensitivity of 97%, routine EEG had a sensitivity of 82.9%, and MRS had a sensitivity of 79.4%. During the postoperative period, hippocampal sclerosis was observed in 71.4% of the patients. The postoperative seizure-free rate was 82.8% in the sixth month and in the first year, whereas this rate was 74.3% in the second year.Conclusion:In conclusion, as in the present study, each preoperative examination has an impact on localizations and prognosis; it is also important for a good surgical prognosis that results are consistent and focused on a single location

Correlation of Copeptin with N-terminal pro-brain natriuretic peptide in predicting the severity and prognosis of acute pulmonary embolism Copeptin in acute pulmonary embolism

Aim: In this study, we aimed to compare copeptin with N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I for predicting severity and 3-month mortality in acute PE in the emergency department (ED). Material and Methods: All ED patients older than 18 years who were confirmed to have acute PE within six hours of diagnostic work-up were enrolled and prospectively screened. Risk stratification was made according to the 2014 European Society of Cardiology guideline on PE. The study endpoints were defined as 3-month mortality, presence of non-low risk PE, and presence of right ventricular (RV) dysfunction. The Mann-Whitney Ll test was used for the comparison of medians. Receiver operating characteristic curves were generated and the area under the curve (AUC) was calculated to determine the best cut-off values of copeptin and NT-proBNP. A P value < 0.05 was considered statistically significant. Results: The study enrolled 82 patients. Twelve patients who died during 3 months had higher concentrations of NT-proBNP and copeptin, but not troponin I. The AUCs of NT-proBNP and copeptin to accurately predict the 3-month mortality were 0.73 +/- 0.09 (95% CI, 0.62 - 0.82; p = 0.013) and 0.78 +/- 0.09 (95% CI, 0.68 - 0.86; p = 0.003), respectively. Low-risk patients, according to Pulmonary Embolism Severity Index, had lower concentrations of copeptin and NT-proBNP compared to intermediate-high risk patients. All three markers discriminated the presence of RV dysfunction truly. Discussion: Copeptin correlates with NT-proBNP and appears beneficial for early risk stratification of acute pulmonary embolism in the ED

Comparative Lateralizing Ability of Multimodality MRI in Temporal Lobe Epilepsy

Purpose. The objective is to compare lateralizing ability of three quantitative MR (qMRI) modalities to depict changes of hippocampal architecture with clinical entities in temporal lobe epilepsy. Methods. We evaluated 14 patients with clinical and EEG proven diagnosis of unilateral TLE and 15 healthy volunteers. T1-weighted 3D dataset for volumetry, single-voxel (HMR)-H-1 spectroscopy (MRS), and diffusion tensor imaging (DTI) were performed for bilateral hippocampi of all subjects. Results. Individual volumetric measurements provided accurate lateralization in 85\% of the patients, spectroscopy in 57\%, and DTI in 57\%. Higher lateralization ratios were acquired combining volumetry-spectroscopy (85\%), spectroscopy-DTI (85\%), and volumetry-DTI (100\%). Significantly decreased NAA/(Cho+Cr)ratios (p = 0.002) and increased FA (p = 0.001) values were obtained in ipsilateral to epileptogenic hippocampus. Duration of epilepsy and FA values showed a significant negative correlation (p = 0.016,r = -0.847). The history of febrile convulsion associated with ipsilateral increased ADC values (p = 0.015,r = 0.851) and reduced NAA/(Cho+Cr) ratios (p = 0.047,r = -761). Conclusion. Volumetry, MRS, and DTI studies provide complementary information of hippocampal pathology. For lateralization of epileptogenic focus and preoperative examination, volumetry-DTI combination may be indicative of diagnostic accuracy

Electro-clinical analysis of ictal kissing automatism

31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 000365756500616