title: Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy.
abstract: Surgical treatment of cryptogenic neocortical epilepsy is challenging. The aim of this study was to evaluate surgical outcomes and to identify possible prognostic factors including the results of various diagnostic tools. Eighty-nine patients with neocortical epilepsy with normal magnetic resonance imaging (35 patients with frontal lobe epilepsy, 31 with neocortical temporal lobe epilepsy, 11 with occipital lobe epilepsy, 11 with parietal lobe epilepsy, and 1 with multifocal epilepsy) underwent invasive study and focal surgical resection. Patients were observed for at least 2 years after surgery. The localizing values of interictal electroencephalogram (EEG), ictal scalp EEG, interictal 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and subtraction ictal single-photon emission computed tomography were evaluated. Seventy-one patients (80.0%) had a good surgical outcome (Engel class 1-3); 42 patients were seizure free. Diagnostic sensitivities of interictal EEG, ictal scalp EEG, FDG-PET, and subtraction ictal single-photon emission computed tomography were 37.1%, 70.8%, 44.3%, and 41.1%, respectively. Localization by FDG-PET and interictal EEG was correlated with a seizure-free outcome. The localizing value of FDG-PET was greatest in neocortical temporal lobe epilepsy. The focalization of ictal onset and also ictal onset frequency in invasive studies were not related to surgical outcome. Concordance with two or more presurgical evaluations was significantly related to a seizure-free outcome.
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. sangunlee@dreamwiz.com
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Kwang-Ki
authors.initials: KK
authors.lastname: Kim
authors.forename: Kkeun-Sik
authors.initials: KS
authors.lastname: Hong
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Lee
authors.forename: Chun-Kee
authors.initials: CK
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D019690:Technetium Tc 99m Exametazime