Epilepsy surgery of "low grade epilepsy associated neuroepithelial tumors": A retrospective nationwide Italian study

Marco Giulioni, Gianluca Marucci, Veronica Pelliccia, Francesca Gozzo, Carmen Barba, Giuseppe Didato, Flavio Villani, Giancarlo Di Gennaro, Pier Paolo Quarato, Vincenzo Esposito, Alessandro Consales, Matteo Martinoni, Gianfranco Vornetti, Corrado Zenesini, Carlo Efisio Marras, Nicola Specchio, Luca De Palma, Raffaele Rocchi, Flavio Giordano, Giovanni TringaliPaolo Nozza, Gabriella Colicchio, Guido Rubboli, Giorgio Lo Russo, Renzo Guerrini, Paolo Tinuper, Francesco Cardinale, Massimo Cossu, Commission for Epilepsy Surgery of the Italian League Against Epilepsy

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalEpilepsia
DOIs
Publication statusE-pub ahead of print - Aug 14 2017

Fingerprint

Neuroepithelial Neoplasms
Epilepsy
Malformations of Cortical Development
Seizures
Neoplasms
Multivariate Analysis
Retrospective Studies
Odds Ratio
Demography
Pediatrics

Keywords

  • Journal Article

Cite this

Giulioni, M., Marucci, G., Pelliccia, V., Gozzo, F., Barba, C., Didato, G., ... Commission for Epilepsy Surgery of the Italian League Against Epilepsy (2017). Epilepsy surgery of "low grade epilepsy associated neuroepithelial tumors": A retrospective nationwide Italian study. Epilepsia. https://doi.org/10.1111/epi.13866

Epilepsy surgery of "low grade epilepsy associated neuroepithelial tumors" : A retrospective nationwide Italian study. / Giulioni, Marco; Marucci, Gianluca; Pelliccia, Veronica; Gozzo, Francesca; Barba, Carmen; Didato, Giuseppe; Villani, Flavio; Di Gennaro, Giancarlo; Quarato, Pier Paolo; Esposito, Vincenzo; Consales, Alessandro; Martinoni, Matteo; Vornetti, Gianfranco; Zenesini, Corrado; Efisio Marras, Carlo; Specchio, Nicola; De Palma, Luca; Rocchi, Raffaele; Giordano, Flavio; Tringali, Giovanni; Nozza, Paolo; Colicchio, Gabriella; Rubboli, Guido; Lo Russo, Giorgio; Guerrini, Renzo; Tinuper, Paolo; Cardinale, Francesco; Cossu, Massimo; Commission for Epilepsy Surgery of the Italian League Against Epilepsy.

In: Epilepsia, 14.08.2017.

Research output: Contribution to journalArticle

Giulioni, M, Marucci, G, Pelliccia, V, Gozzo, F, Barba, C, Didato, G, Villani, F, Di Gennaro, G, Quarato, PP, Esposito, V, Consales, A, Martinoni, M, Vornetti, G, Zenesini, C, Efisio Marras, C, Specchio, N, De Palma, L, Rocchi, R, Giordano, F, Tringali, G, Nozza, P, Colicchio, G, Rubboli, G, Lo Russo, G, Guerrini, R, Tinuper, P, Cardinale, F, Cossu, M & Commission for Epilepsy Surgery of the Italian League Against Epilepsy 2017, 'Epilepsy surgery of "low grade epilepsy associated neuroepithelial tumors": A retrospective nationwide Italian study', Epilepsia. https://doi.org/10.1111/epi.13866
Giulioni, Marco ; Marucci, Gianluca ; Pelliccia, Veronica ; Gozzo, Francesca ; Barba, Carmen ; Didato, Giuseppe ; Villani, Flavio ; Di Gennaro, Giancarlo ; Quarato, Pier Paolo ; Esposito, Vincenzo ; Consales, Alessandro ; Martinoni, Matteo ; Vornetti, Gianfranco ; Zenesini, Corrado ; Efisio Marras, Carlo ; Specchio, Nicola ; De Palma, Luca ; Rocchi, Raffaele ; Giordano, Flavio ; Tringali, Giovanni ; Nozza, Paolo ; Colicchio, Gabriella ; Rubboli, Guido ; Lo Russo, Giorgio ; Guerrini, Renzo ; Tinuper, Paolo ; Cardinale, Francesco ; Cossu, Massimo ; Commission for Epilepsy Surgery of the Italian League Against Epilepsy. / Epilepsy surgery of "low grade epilepsy associated neuroepithelial tumors" : A retrospective nationwide Italian study. In: Epilepsia. 2017.
@article{a86e835ed5ff406d8c9889d63f7b7ba4,
title = "Epilepsy surgery of {"}low grade epilepsy associated neuroepithelial tumors{"}: A retrospective nationwide Italian study",
abstract = "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.",
keywords = "Journal Article",
author = "Marco Giulioni and Gianluca Marucci and Veronica Pelliccia and Francesca Gozzo and Carmen Barba and Giuseppe Didato and Flavio Villani and {Di Gennaro}, Giancarlo and Quarato, {Pier Paolo} and Vincenzo Esposito and Alessandro Consales and Matteo Martinoni and Gianfranco Vornetti and Corrado Zenesini and {Efisio Marras}, Carlo and Nicola Specchio and {De Palma}, Luca and Raffaele Rocchi and Flavio Giordano and Giovanni Tringali and Paolo Nozza and Gabriella Colicchio and Guido Rubboli and {Lo Russo}, Giorgio and Renzo Guerrini and Paolo Tinuper and Francesco Cardinale and Massimo Cossu and {Commission for Epilepsy Surgery of the Italian League Against Epilepsy}",
note = "Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Tinuper Paolo)",
year = "2017",
month = "8",
day = "14",
doi = "10.1111/epi.13866",
language = "English",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Blackwell Publishing Inc.",

}

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 - Commission for Epilepsy Surgery of the Italian League Against Epilepsy

N1 - Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Tinuper Paolo)

PY - 2017/8/14

Y1 - 2017/8/14

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 - Journal Article

U2 - 10.1111/epi.13866

DO - 10.1111/epi.13866

M3 - Article

C2 - 28804898

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

ER -