Showing papers by "John T. Langfitt published in 2018"
Indiana University – Purdue University Indianapolis1, University of Virginia2, University of California, San Francisco3, University of Rochester4, California Pacific Medical Center5, Harvard University6, University of Southern California7, University of Washington8, University College London9, University of Pittsburgh10, University of Minnesota11, University of Kentucky12, Columbia University13, University of Louisville14, University of Sheffield15, University of California, San Diego16
TL;DR: To compare stereotactic radiosurgery (SRS) versus anterior temporal lobectomy (ATL) for patients with pharmacoresistant unilateral mesial temporal lobe epilepsy (MTLE) is compared.
Abstract: Objective To compare stereotactic radiosurgery (SRS) versus anterior temporal lobectomy (ATL) for patients with pharmacoresistant unilateral mesial temporal lobe epilepsy (MTLE). Methods This randomized, single-blinded, controlled trial recruited adults eligible for open surgery among 14 centers in the USA, UK, and India. Treatment was either SRS at 24 Gy to the 50% isodose targeting mesial structures, or standardized ATL. Outcomes were seizure remission (absence of disabling seizures between 25 and 36 months), verbal memory (VM), and quality of life (QOL) at 36-month follow-up. Results A total of 58 patients (31 in SRS, 27 in ATL) were treated. Sixteen (52%) SRS and 21 (78%) ATL patients achieved seizure remission (difference between ATL and SRS = 26%, upper 1-sided 95% confidence interval = 46%, P value at the 15% noninferiority margin = .82). Mean VM changes from baseline for 21 English-speaking, dominant-hemisphere patients did not differ between groups; consistent worsening occurred in 36% of SRS and 57% of ATL patients. QOL improved with seizure remission. Adverse events were anticipated cerebral edema and related symptoms for some SRS patients, and cerebritis, subdural hematoma, and others for ATL patients. Significance These data suggest that ATL has an advantage over SRS in terms of proportion of seizure remission, and both SRS and ATL appear to have effectiveness and reasonable safety as treatments for MTLE. SRS is an alternative to ATL for patients with contraindications for or with reluctance to undergo open surgery.
72 citations
TL;DR: Findings from a prospective study that utilized a standardized protocol for psychiatric and seizure outcome assessment suggest that presurgical mood disorders have no substantial impact on postsurgical seizure outcome for up to five years after surgery.
13 citations
University of Virginia1, Indiana University – Purdue University Indianapolis2, University of California, San Francisco3, University of Rochester4, California Pacific Medical Center5, Harvard University6, University of Southern California7, University of Washington8, University College London9, University of Pittsburgh10, University of Minnesota11, University of Kentucky12, Columbia University13, University of Louisville14, University of Sheffield15, University of California, San Diego16
TL;DR: The nature of VFD was consistent with lesions of the optic radiations, and effective surgery of the mesial temporal lobe results in about a 90% incidence of typical VFD regardless of method.
Abstract: Purpose Stereotactic radiosurgery (SRS) may be an alternative to anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE). Visual field defects (VFD) occur in 9–100% of patients following open surgery for MTLE. Postoperative VFD after minimally invasive versus open surgery may differ. Methods This prospective trial randomized patients with unilateral hippocampal sclerosis and concordant video-EEG findings to SRS versus ATL. Humphries perimetry was obtained at 24 m after surgery. VFD ratios (VFDR = proportion of missing homonymous hemifield with 0 = no VFD, 0.5 = complete superior quadrantanopsia) quantified VFD. Regressions of VFDR were evaluated against treatment arm and covariates. MRI evaluated effects of volume changes on VFDR. The relationships of VFDR with seizure remission and driving status 3 years after surgery were evaluated. Results No patients reported visual changes or had abnormal bedside examinations, but 49 of 54 (91%) of patients experienced VFD on formal perimetry. Neither incidence nor severity of VFDR differed significantly by treatment arm. VFDR severity was not associated with seizure remission or driving status. Conclusion The nature of VFD was consistent with lesions of the optic radiations. Effective surgery (defined by seizure remission) of the mesial temporal lobe results in about a 90% incidence of typical VFD regardless of method.
9 citations
TL;DR: This trial confirmed conclusions from observational studies that demonstrated the effectiveness of surgery in controlling seizures in the long term with associated improvements in quality of life, as well as decreases in mortality and health care costs.
Abstract: Epilepsy surgery has traditionally been viewed as a therapy of last resort for the treatment of drug-resistant seizures. The results of a Canadian randomized trial demonstrated the superiority of surgery over continued pharmacologic therapy for short-term seizure control for patients with temporal lobe epilepsy. This trial confirmed conclusions from observational studies that demonstrated the effectiveness of surgery in controlling seizures in the long term1 with associated improvements in quality of life,2 as well as decreases in mortality3 and health care costs.4
4 citations