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

Yapısal Lezyonlara Bağlı Temporal Lob Epilepsilerinde Cerrahi Sonuçlar

Giriş: Epilepsinin primer tedavisi dünya çapında AEİ ile yapılmaktadır. Nöbetler birçok hastada kontrol altına alınsa da bazı ilaca dirençli epilepsisi olan hastalarda işe yaramamaktadır. Temporal lob epilepsisi bu ilaca dirençli epilepsilerin prototipini oluşturmaktadır. Cerrahi tedaviyle temporal lob epilepsisi olan hastalarda %80&#8223;lere varan oranlarda nöbetsizlik sağlanmaktadır. Biz bu çalışmada yapısal lezyon ilişkili kronik temporal lob epilepsili hastalarda prognostik faktörlerin, görüntüleme sonuçlarının, patoloji sonuçlarının cerrahi başarı oranlarına etkisini inceledik. Gereç ve Yöntem: Bu çalışma, retrospektif -arşiv taraması çalışması- olarak düzenlendi. 2010-2015 yılları arasında Gazi Üniversitesi Tıp Fakültesi Epilepsi Merkezinde dirençli TLE tanısı alan ve cerrahi uygulanan hastalar incelendi. 17 yaş üstü, postoperatif takip süresi en az 2 yıl olan 26 olgu çalışmaya alındı. Tüm hastalara cerrahi öncesi aynı inceleme protokolleri uygulandı. Hastaların demografik özellikleri, görüntüleme sonuçları, uygulanan cerrahi prosedür, patoloji sonuçları ve Engel sınıflaması not edildi. Veri analizinde SPSS for Windows 21 (SPSS Inc.®, Chiago, USA) kullanıldı. İstatistiksel anlamlılık düzeyi p<0,05 kabul edildi. Bulgular: Çalışmaya dahil edilen 26 dirençli TLE hastasının yaş ortalaması 32,31±7,72 olarak hesaplandı. Hastaların 14&#8223;ü (%53,8) kadındı. Bu hastaların %80,8&#8223;inin ikinci yıl Engel sınıflaması 1&#8223;di. Hastaların demografik özellikleri, görüntüleme sonuçları, uygulanan cerrahi teknik ve patoloji sonuçları ile Engel sınıflaması arasında anlamlı bir ilişki saptanmadı (hepsinde p>0,05). Sonuç: Epilepsi cerrahisi, ilaca dirençli TLE hastalarında tercih edilebilecek tedavi yöntemidir. Cerrahi sonuçları etkileyen prognostik faktörler için daha fazla çalışma yapılmalıdır.&#288;ntroduction: All around the World, epilepsy&#8223;s primary treatment is anti-epileptic drugs. Even if most of seizures are controlled by AED, useless on some of the drug-resistant epilepsy patients. Temporal lobe epilepsy is the prototype of drug-resistant epilepsies. After epilepsy surgery, 80 % of patients have seizure-free episodes. In this study, we aimed to investigate the relationship between demographic characteristics, risk factors, imaging results, pathology results and surgery outcome on structural lesions related intractable temporal lobe epilepsy patients. Material Method: This study designed as retrospective archive research. The patients were investigated, diagnosed intractable temporal lobe epilepsy and performed surgery between 2010-2015 at Gazi Univercity Medical School Epilepsy Center. >17 years old 26 patients were included. The same research protochols were performed for all patients. Patients&#8223; demographic characteristics, risk factors, imaging results, pathology results, surgery technique and Engel classification was noted. All the statistical analyses were performed using the SPSS for Windows 21 (SPSS Inc.®, Chiago, USA). P values <0.05 were considered significant. Results: Included 26 patients&#8223; median age was 32,31±7,72. 53,8 % of them was women. 80.8% of the patients are Engel class 1 at second year. There is no significant relation between demographic characteristics, risk factors, imaging results, pathology results, surgery technique and Engel classification. Conclusion: Epilepsy surgery is a good choise treatment strategy for intractable drug-resistant temporal lobe epilepsy patients. More studies are needed for prognostic factors affecting the surgical outcome

IVIg-induced headache: prospective study of a large cohort with neurological disorders

Background: Intravenous immune globulin (IVIg) is frequently used in some neurological diseases and is also the first-line therapy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. We aimed to evaluate the frequency and characteristics of headaches, which is one of the most common side effects of IVIg treatment. Methods: Patients who received IVIg treatment for neurological diseases were prospectively enrolled in 23 centers. Firstly, the characteristics of patients with and without IVIg-induced headaches were analyzed statistically. Then, patients with IVIg-induced headaches were classified into three subgroups determined by their history: no primary headache, tension-type headache (TTH), and migraine. Results: A total of 464 patients (214 women) and 1548 IVIg infusions were enrolled between January and August 2022. The frequency of IVIg-related headaches was 27.37% (127/464). A binary logistic regression analysis performed with significant clinical features disclosed that female sex and fatigue as a side effect were statistically more common in the IVIg-induced headache group. IVIg-related headache duration was long and affected daily living activities more in patients with migraine compared to no primary headache and TTH groups (p = 0.01, respectively). Conclusion: Headache is more likely to occur in female patients receiving IVIg and those who develop fatigue as a side effect during the infusion. Clinicians’ awareness of IVIg-related headache characteristics, especially in patients with migraine, may increase treatment compliance

The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy