TY - JOUR

T1 - Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”

T2 - A retrospective nationwide Italian study

AU - Giulioni, Marco

AU - Marucci, Gianluca

AU - Pelliccia, Veronica

AU - Gozzo, Francesca

AU - Barba, Carmen

AU - Didato, Giuseppe

AU - Villani, Flavio

AU - Di Gennaro, Giancarlo

AU - Quarato, Pier Paolo

AU - Esposito, Vincenzo

AU - Consales, Alessandro

AU - Martinoni, Matteo

AU - Vornetti, Gianfranco

AU - Zenesini, Corrado

AU - Efisio Marras, Carlo

AU - Specchio, Nicola

AU - De Palma, Luca

AU - Rocchi, Raffaele

AU - Giordano, Flavio

AU - Tringali, Giovanni

AU - Nozza, Paolo

AU - Colicchio, Gabriella

AU - Rubboli, Guido

AU - Lo Russo, Giorgio

AU - Guerrini, Renzo

AU - Tinuper, Paolo

AU - Cardinale, Francesco

AU - Cossu, Massimo

AU - the Commission for Epilepsy Surgery of the Italian League Against Epilepsy

PY - 2017/11

Y1 - 2017/11

N2 - Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. Results: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). Significance: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.

AB - Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. Results: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). Significance: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.

KW - Focal cortical dysplasia

KW - Glioneuronal tumors

KW - Low-grade glial tumors

KW - Neuropsychological outcome

KW - Seizure outcome

U2 - 10.1111/epi.13866

DO - 10.1111/epi.13866

M3 - Journal article

C2 - 28804898

AN - SCOPUS:85032746240

VL - 58

SP - 1832

EP - 1841

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 11

ER -