The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis
Abstract Background Epilepsy surgery is an established treatment for drug-resistant focal epilepsy (DRFE) that results in seizure freedom in about 60% of patients. Correctly identifying an epileptogenic lesion in magnetic resonance imaging (MRI) is challenging but highly relevant since it improves t...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Neurological Research and Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42466-023-00288-y |
| _version_ | 1827581321203941376 |
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| author | Leonhard Mann Felix Rosenow Adam Strzelczyk Elke Hattingen Laurent M. Willems Patrick N. Harter Katharina Weber Catrin Mann |
| author_facet | Leonhard Mann Felix Rosenow Adam Strzelczyk Elke Hattingen Laurent M. Willems Patrick N. Harter Katharina Weber Catrin Mann |
| author_sort | Leonhard Mann |
| collection | DOAJ |
| description | Abstract Background Epilepsy surgery is an established treatment for drug-resistant focal epilepsy (DRFE) that results in seizure freedom in about 60% of patients. Correctly identifying an epileptogenic lesion in magnetic resonance imaging (MRI) is challenging but highly relevant since it improves the likelihood of being referred for presurgical diagnosis. The epileptogenic lesion’s etiology directly relates to the surgical intervention’s indication and outcome. Therefore, it is vital to correctly identify epileptogenic lesions and their etiology presurgically. Methods We compared the final histopathological diagnoses of all patients with DRFE undergoing epilepsy surgery at our center between 2015 and 2021 with their MRI diagnoses before and after presurgical diagnosis at our epilepsy center, including MRI evaluations by expert epilepsy neuroradiologists. Additionally, we analyzed the outcome of different subgroups. Results This study included 132 patients. The discordance between histopathology and MRI diagnoses significantly decreased from 61.3% for non-expert MRI evaluations (NEMRIs) to 22.1% for epilepsy center MRI evaluations (ECMRIs; p < 0.0001). The MRI-sensitivity improved significantly from 68.6% for NEMRIs to 97.7% for ECMRIs (p < 0.0001). Identifying focal cortical dysplasia (FCD) and amygdala dysplasia was the most challenging for both subgroups. 65.5% of patients with negative NEMRI were seizure-free 12 months postoperatively, no patient with negative ECMRI achieved seizure-freedom. The mean duration of epilepsy until surgical intervention was 13.6 years in patients with an initial negative NEMRI and 9.5 years in patients with a recognized lesion in NEMRI. Conclusions This study provides evidence that for patients with DRFE—especially those with initial negative findings in a non-expert MRI—an early consultation at an epilepsy center, including an ECMRI, is important for identifying candidates for epilepsy surgery. NEMRI-negative findings preoperatively do not preclude seizure freedom postoperatively. Therefore, patients with DRFE that remain MRI-negative after initial NEMRI should be referred to an epilepsy center for presurgical evaluation. Nonreferral based on NEMRI negativity may harm such patients and delay surgical intervention. However, ECMRI-negative patients have a reduced chance of becoming seizure-free after epilepsy surgery. Further improvements in MRI technique and evaluation are needed and should be directed towards improving sensitivity for FCDs and amygdala dysplasias. |
| first_indexed | 2024-03-08T22:34:43Z |
| format | Article |
| id | doaj.art-da394ff587d14de188e7d6039caf7f0a |
| institution | Directory Open Access Journal |
| issn | 2524-3489 |
| language | English |
| last_indexed | 2024-03-08T22:34:43Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Neurological Research and Practice |
| spelling | doaj.art-da394ff587d14de188e7d6039caf7f0a2023-12-17T12:34:14ZengBMCNeurological Research and Practice2524-34892023-12-015111010.1186/s42466-023-00288-yThe impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosisLeonhard Mann0Felix Rosenow1Adam Strzelczyk2Elke Hattingen3Laurent M. Willems4Patrick N. Harter5Katharina Weber6Catrin Mann7Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe UniversityEpilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe UniversityEpilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe UniversityDepartment of Neuroradiology, University Hospital Frankfurt, Goethe University FrankfurtEpilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe UniversityNeurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe UniversityNeurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe UniversityEpilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe UniversityAbstract Background Epilepsy surgery is an established treatment for drug-resistant focal epilepsy (DRFE) that results in seizure freedom in about 60% of patients. Correctly identifying an epileptogenic lesion in magnetic resonance imaging (MRI) is challenging but highly relevant since it improves the likelihood of being referred for presurgical diagnosis. The epileptogenic lesion’s etiology directly relates to the surgical intervention’s indication and outcome. Therefore, it is vital to correctly identify epileptogenic lesions and their etiology presurgically. Methods We compared the final histopathological diagnoses of all patients with DRFE undergoing epilepsy surgery at our center between 2015 and 2021 with their MRI diagnoses before and after presurgical diagnosis at our epilepsy center, including MRI evaluations by expert epilepsy neuroradiologists. Additionally, we analyzed the outcome of different subgroups. Results This study included 132 patients. The discordance between histopathology and MRI diagnoses significantly decreased from 61.3% for non-expert MRI evaluations (NEMRIs) to 22.1% for epilepsy center MRI evaluations (ECMRIs; p < 0.0001). The MRI-sensitivity improved significantly from 68.6% for NEMRIs to 97.7% for ECMRIs (p < 0.0001). Identifying focal cortical dysplasia (FCD) and amygdala dysplasia was the most challenging for both subgroups. 65.5% of patients with negative NEMRI were seizure-free 12 months postoperatively, no patient with negative ECMRI achieved seizure-freedom. The mean duration of epilepsy until surgical intervention was 13.6 years in patients with an initial negative NEMRI and 9.5 years in patients with a recognized lesion in NEMRI. Conclusions This study provides evidence that for patients with DRFE—especially those with initial negative findings in a non-expert MRI—an early consultation at an epilepsy center, including an ECMRI, is important for identifying candidates for epilepsy surgery. NEMRI-negative findings preoperatively do not preclude seizure freedom postoperatively. Therefore, patients with DRFE that remain MRI-negative after initial NEMRI should be referred to an epilepsy center for presurgical evaluation. Nonreferral based on NEMRI negativity may harm such patients and delay surgical intervention. However, ECMRI-negative patients have a reduced chance of becoming seizure-free after epilepsy surgery. Further improvements in MRI technique and evaluation are needed and should be directed towards improving sensitivity for FCDs and amygdala dysplasias.https://doi.org/10.1186/s42466-023-00288-yEpilepsyMRIEpilepsy centerNon-expert MRIReferral |
| spellingShingle | Leonhard Mann Felix Rosenow Adam Strzelczyk Elke Hattingen Laurent M. Willems Patrick N. Harter Katharina Weber Catrin Mann The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis Neurological Research and Practice Epilepsy MRI Epilepsy center Non-expert MRI Referral |
| title | The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| title_full | The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| title_fullStr | The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| title_full_unstemmed | The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| title_short | The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| title_sort | impact of referring patients with drug resistant focal epilepsy to an epilepsy center for presurgical diagnosis |
| topic | Epilepsy MRI Epilepsy center Non-expert MRI Referral |
| url | https://doi.org/10.1186/s42466-023-00288-y |
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