Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients
Abstract Objective To evaluate the effectiveness of frontal disconnection surgery in seizure control and related consequences in a consecutive patient series. Methods We conducted a retrospective analysis of patients who underwent frontal disconnection surgery for drug‐resistant epilepsy (DRE). Base...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-09-01
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| Series: | Epilepsia Open |
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| Online Access: | https://doi.org/10.1002/epi4.12424 |
| _version_ | 1811206666134224896 |
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| author | Hamda Kamalboor Hindi Alhindi Faisal Alotaibi Ibrahim Althubaiti Mashael Alkhateeb |
| author_facet | Hamda Kamalboor Hindi Alhindi Faisal Alotaibi Ibrahim Althubaiti Mashael Alkhateeb |
| author_sort | Hamda Kamalboor |
| collection | DOAJ |
| description | Abstract Objective To evaluate the effectiveness of frontal disconnection surgery in seizure control and related consequences in a consecutive patient series. Methods We conducted a retrospective analysis of patients who underwent frontal disconnection surgery for drug‐resistant epilepsy (DRE). Baseline epilepsy characteristics, detailed presurgical evaluation including epileptogenic zone (EZ) localization, magnetic resonance imaging (MRI) detection of epileptogenic lesion, and pathological findings were reviewed. Patients were followed postoperatively for seizure outcome at 1 year. Results A total of 16 patients were identified (six children and 10 adults). Most patients had a childhood onset of DRE with a median duration of epilepsy of 6.5 years (interquartile range 3.5‐17.5 years) before surgery. In 10 (62.5%) patients, the EZ was localized to the frontal lobe, while in six patients, the EZ involved also adjacent lobes or consisted of multiple foci. In 10 (62.5%) patients, an epileptogenic lesion was detected on presurgical MRI, four of which (40%) had all MRI abnormalities confined to the frontal lobe. Two‐thirds of the patients (11/16; 68.8%) underwent isolated frontal disconnection procedure, while remaining patients had frontal disconnection combined with resection of an adjacent lobe. Of the 12 patients in whom biopsy was taken from the disconnected frontal lobe, six (50%) had pathology‐proven focal cortical dysplasia. We observed surgical‐related complications in three (18.8%) cases, neurological deficits in other three (18.8%) patients, and worsening cognitive abilities in one (6.3%) patient. Overall, eight (50%) patients became completely seizure‐free (ILAE 1) at one‐year follow‐up. Significance Frontal disconnection surgery for DRE can result in seizure freedom in certain patients, especially when the EZ is strictly limited to the ipsilateral frontal region, and the MRI shows an epileptogenic lesion that is purely frontal in location. Frontal lobe disconnection procedure is safe and has a limited complication rate. However, further studies with larger patient population will yield more significance. |
| first_indexed | 2024-04-12T03:50:56Z |
| format | Article |
| id | doaj.art-a68b4f423e57474d9b8906604c64152c |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-04-12T03:50:56Z |
| publishDate | 2020-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-a68b4f423e57474d9b8906604c64152c2022-12-22T03:48:58ZengWileyEpilepsia Open2470-92392020-09-015347548610.1002/epi4.12424Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patientsHamda Kamalboor0Hindi Alhindi1Faisal Alotaibi2Ibrahim Althubaiti3Mashael Alkhateeb4King Faisal Specialist Hospital & Research Center Riyadh Saudi ArabiaKing Faisal Specialist Hospital & Research Center Riyadh Saudi ArabiaKing Faisal Specialist Hospital & Research Center Riyadh Saudi ArabiaKing Faisal Specialist Hospital & Research Center Riyadh Saudi ArabiaKing Faisal Specialist Hospital & Research Center Riyadh Saudi ArabiaAbstract Objective To evaluate the effectiveness of frontal disconnection surgery in seizure control and related consequences in a consecutive patient series. Methods We conducted a retrospective analysis of patients who underwent frontal disconnection surgery for drug‐resistant epilepsy (DRE). Baseline epilepsy characteristics, detailed presurgical evaluation including epileptogenic zone (EZ) localization, magnetic resonance imaging (MRI) detection of epileptogenic lesion, and pathological findings were reviewed. Patients were followed postoperatively for seizure outcome at 1 year. Results A total of 16 patients were identified (six children and 10 adults). Most patients had a childhood onset of DRE with a median duration of epilepsy of 6.5 years (interquartile range 3.5‐17.5 years) before surgery. In 10 (62.5%) patients, the EZ was localized to the frontal lobe, while in six patients, the EZ involved also adjacent lobes or consisted of multiple foci. In 10 (62.5%) patients, an epileptogenic lesion was detected on presurgical MRI, four of which (40%) had all MRI abnormalities confined to the frontal lobe. Two‐thirds of the patients (11/16; 68.8%) underwent isolated frontal disconnection procedure, while remaining patients had frontal disconnection combined with resection of an adjacent lobe. Of the 12 patients in whom biopsy was taken from the disconnected frontal lobe, six (50%) had pathology‐proven focal cortical dysplasia. We observed surgical‐related complications in three (18.8%) cases, neurological deficits in other three (18.8%) patients, and worsening cognitive abilities in one (6.3%) patient. Overall, eight (50%) patients became completely seizure‐free (ILAE 1) at one‐year follow‐up. Significance Frontal disconnection surgery for DRE can result in seizure freedom in certain patients, especially when the EZ is strictly limited to the ipsilateral frontal region, and the MRI shows an epileptogenic lesion that is purely frontal in location. Frontal lobe disconnection procedure is safe and has a limited complication rate. However, further studies with larger patient population will yield more significance.https://doi.org/10.1002/epi4.12424frontaldisconnectionepilepsysurgeryoutcomes |
| spellingShingle | Hamda Kamalboor Hindi Alhindi Faisal Alotaibi Ibrahim Althubaiti Mashael Alkhateeb Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients Epilepsia Open frontal disconnection epilepsy surgery outcomes |
| title | Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients |
| title_full | Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients |
| title_fullStr | Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients |
| title_full_unstemmed | Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients |
| title_short | Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients |
| title_sort | frontal disconnection surgery for drug resistant epilepsy outcome in a series of 16 patients |
| topic | frontal disconnection epilepsy surgery outcomes |
| url | https://doi.org/10.1002/epi4.12424 |
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