Rare Genetic Variation and Outcome of Surgery for Mesial Temporal Lobe Epilepsy.

Objective: Genetic factors have long been debated as a cause of failure of surgery for mesial temporal lobe epilepsy (MTLE). We investigated whether rare genetic variation influences seizure outcomes of MTLE surgery.

Methods: We performed an international, multicenter, whole exome sequencing study of patients who underwent surgery for drug-resistant, unilateral MTLE with normal magnetic resonance imaging (MRI) or MRI evidence of hippocampal sclerosis and ≥2-year postsurgical follow-up.

Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups.

Objectives: People with epilepsy have a higher prevalence of medical and psychiatric comorbidities compared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from 'First Seizure Clinics' (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures.

Extended follow-up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery.

Objective: Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up.

Diagnostic delay in focal epilepsy: Association with brain pathology and age.

Purpose: Between 16-77% of patients with newly diagnosed epilepsy report seizures before diagnosis but little is known about the risk factors for diagnostic delay. Here, we examined the association between prior seizures and neuroimaging findings in newly diagnosed focal epilepsy.

Methods: Adults diagnosed with focal epilepsy at First Seizure Clinics (FSC) at the Royal Melbourne Hospital or Austin Health, Melbourne, Australia, between 2000 and 2010 were included.

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy.

A substantial proportion of individuals with newly diagnosed epilepsy report prior seizures, suggesting a missed opportunity for early epilepsy care and management. Consideration of the causes and outcomes of diagnostic delay is needed to address this issue. We aimed to review the literature pertaining to delay to diagnosis of epilepsy, describing the components, characteristics, and risk factors for delay.

Newly diagnosed seizures assessed at two established first seizure clinics: Clinic characteristics, investigations, and findings over 11 years.

Objective: 'First seizure' clinics (FSCs) aim to achieve early expert assessment for individuals with possible new-onset epilepsy. These clinics also have substantial potential for research into epilepsy evolution, outcomes, and costs. However, a paucity of FSCs details has implications for interpretation and utilization of this research.

Predominantly nocturnal seizures post temporal lobectomy: Characteristics of an unusual outcome group.

Purpose: To describe the characteristics of a patient group who, after temporal lobectomy for predominantly diurnal seizures, experience a postoperative conversion from diurnal to predominantly nocturnal seizures, and compare this group to those who continue to have a diurnal seizure pattern postoperatively.

Methods: From a cohort of 470 surgical cases with long-term follow-up, we retrospectively identified 16 patients with a predominantly nocturnal seizure pattern, including five with nocturnal seizures only (median follow-up 21 years) and compared them with 20 predominantly diurnal seizure patients.

Results: Sustained postoperative improvement in seizure frequency was observed in 14/16 cases.

Metabolic patterns and seizure outcomes following anterior temporal lobectomy.

Objective: We investigated the relationship between the interictal metabolic patterns, the extent of resection of F-fluorodeoxyglucose positron emission tomography ( FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection.

Methods: Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant FDG-PET hypometabolism, and at least 2 years of postoperative follow-up were included in this 2-center study. The hypometabolic regions in each patient were identified with reference to 20 healthy controls (p < 0.

Familial mesial temporal lobe epilepsy and the borderland of déjà vu.

Objective: The cause of mesial temporal lobe epilepsy (MTLE) is often unknown. We ascertained to what extent newly diagnosed nonlesional MTLE actually represents familial MTLE (FMTLE).

Methods: We identified all consecutive patients presenting to the Austin Health First Seizure Clinic with MTLE and normal magnetic resonance imaging (MRI) or MRI evidence of hippocampal sclerosis over a 10-year period.

Mind the gap: Multiple events and lengthy delays before presentation with a "first seizure".

Objective: Up to half of patients assessed for suspected new-onset epileptic seizures report previous undiagnosed events. This suggests that delay to timely and expert assessment is a major issue. Very little is known about the degree of delay or nature of the undiagnosed events, impacting on our understanding of new-onset epilepsy.

Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals.

Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery.

Purpose: We aimed to assess long-term seizure outcome and risk factors for seizure recurrence in a cohort of patients who have undergone extratemporal resection for management of refractory seizures.

Methods: Eighty-one patients underwent extratemporal resection at Austin Health, Melbourne, Australia (1991-2004). Seizure recurrence was any postoperative disabling seizure (complex partial seizure [CPS] ± secondary generalization).

Significance of post-operative auras after temporal lobectomy: a surprising methodological trap.

We aimed to examine post-operative auras/simple partial seizures and the associated risk of seizure recurrence after temporal lobectomy. Included were 159 patients who underwent anterior temporal lobectomy (1995-2006) at Austin Health, Australia. Initial analyses used Cox regression.

Familial mesial temporal lobe epilepsy: a benign epilepsy syndrome showing complex inheritance.

Temporal lobe epilepsy is the commonest partial epilepsy of adulthood. Although generally perceived as an acquired disorder, several forms of familial temporal lobe epilepsy, with mesial or lateral seizure semiology, have been described. Descriptions of familial mesial temporal lobe epilepsy have varied widely from a benign epilepsy syndrome with prominent déjà vu and without antecedent febrile seizures or magnetic resonance imaging abnormalities, to heterogeneous, but generally more refractory epilepsies, often with a history of febrile seizures and with frequent hippocampal atrophy and high T₂ signal on magnetic resonance imaging.

Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study.

Background: Pertussis vaccination has been alleged to cause an encephalopathy that involves seizures and subsequent intellectual disability. In a previous retrospective study, 11 of 14 patients with so-called vaccine encephalopathy had Dravet syndrome that was associated with de-novo mutations of the sodium channel gene SCN1A. In this study, we aimed to establish whether the apparent association of Dravet syndrome with vaccination was caused by recall bias and, if not, whether vaccination affected the onset or outcome of the disorder.

Profiles of psychosocial outcome after epilepsy surgery: the role of personality.

Purpose: We have previously found that the developmental time frame of epilepsy onset influences adult personality traits and subsequent adjustment to intractable seizures. In the same cohort of patients we now investigate the influence of these factors on psychosocial outcome after surgical treatment.

Methods: Fifty-seven adult patients with focal epilepsy were prospectively assessed before and after surgery.

The experience of seizures after epilepsy surgery.

Postoperative seizures occur in 20-60% of patients who have epilepsy surgery. Despite this, there is limited understanding of a patient's experience of the recurrence of seizures after surgery. This study used a qualitative approach to identify key themes derived from content analysis of 15 in-depth patient interviews about the experience of seizure recurrence.

Personality development in the context of intractable epilepsy.

Objectives: To investigate the developmental time frame of epilepsy onset on adult personality traits of neuroticism and extraversion and to consider their role in adjustment to intractable epilepsy.

Design: Prospective, preoperative and postoperative survey of the psychological and psychosocial effects of intractable epilepsy and its surgical treatment. Data from the preoperative phase are reported.

What happens now? Ongoing outcome after post-temporal lobectomy seizure recurrence.

We studied outcome subsequent to the initial post-temporal lobectomy seizure recurrence (n = 202) or remission. Two years after recurrence, there was 74% (95% CI 67% to 79%) probability of further seizures. Two years after a 2-year seizure remission, there was 68% (95% CI 52% to 79%) probability of remaining seizure-free (n = 50).

Early seizures after temporal lobectomy predict subsequent seizure recurrence.

Patients are understandably anxious if seizures occur immediately after temporal lobectomy. Such "neighborhood" seizures are commonly regarded as irrelevant to seizure outcome and discounted in outcome measurement. We conducted an in-depth examination of early postoperative seizures (<28 days) and outcome.

Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence.

There is little information available relevant to long-term seizure outcome after anterior temporal lobectomy, particularly at extended postoperative periods. The aim of this study was an in-depth examination of patterns of longitudinal outcome and potential risk factors for seizure recurrence after lobectomy, utilizing a large patient sample with long follow-up. Included were 325 patients who underwent anterior temporal lobectomy between 1978 and 1998 (mean follow-up 9.