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The impact of pathology, type of resection, and age at surgery on the postoperative seizure and cognitive outcome in patients with temporal lobe epilepsy

dc.contributor.advisorHelmstaedter, Christoph
dc.contributor.authorTaube, Julia
dc.description.abstractIn this thesis, epilepsy- and surgery-related factors were investigated for their effects on postoperative seizure and cognitive outcome in patients with medically intractable temporal lobe epilepsy (TLE).
As a first step, Borger, Hamed, Taube, et al. (2021) evaluated various clinical factors contributing to an (un-)favorable surgical outcome in a large consecutive cohort. While seizure freedom rates and cognitive changes were comparable to those of the previously reported cohorts, this was the first study to identify the histopathological diagnosis of 'no hippocampal sclerosis with gliosis only' (GO) as a risk factor for seizure recurrence after surgery. This questions the current assumption that GO is a predecessor of the histopathological diagnosis of 'hip-pocampal sclerosis' (HS). Hence, Grote, Heiland, Taube, et al. (2022) and Taube, et al. (2022) investigated differences between GO and HS further. The later epilepsy onset, higher surgical failure rates, mild memory impairments before surgery, and greater postoperative memory losses favor the hypothesis that GO represents a distinct clinical entity. Moreover, we found evidence of transcriptomic dysregulation in GO suggestive of inflammatory processes through activation of the complement system. Our results question not only the current clinical practice in treating patients with TLE due to GO, but also emphasize the need for an investigation of inflammatory mediators at the onset of TLE.
The involvement of spatiotemporal networks in the epileptic brain exceeding the lesional epileptogenic zone (EZ) is increasingly well recognized. This has significant implications for optimal resection extent because surgically targeting these epileptic circuits may result in improved seizure outcomes. Borger, Schneider, Taube, et al. (2021) retrospectively evaluated the impact of surgically removing the piriform cortex (PIC), considered a hub for generating and spreading seizures, on postoperative outcomes. Seizure outcomes improved with larger PIC resection extent, while the risk of complications and adverse neuropsychological events did not increase. Future studies need to assess the surgical amenability of the PIC and identify how residual involved cortical and subcortical circuits contribute to surgical failures in the treatment of focal epilepsies.
The fifth study by Delev, Taube, et. al (2020) assessed the safety and efficacy of temporal lobe surgery (TLS) in late adulthood. While TLE has been linked to accelerated brain aging, the effects of TLS are inconclusive. Since seizures were controlled in the majority of our patients, TLS can counteract the contribution of epileptic dysfunction, injuries during seizures, and high drug load to cognitive impairments. The cognitive costs of TLS were comparable to those reported in younger cohorts despite evidence of more severe memory impairments already before surgery. Even though longterm outcome studies indicate no progressive memory decline beyond the immediate postoperative losses, TLS in late adulthood may nonetheless contribute to reaching a disabling level of extensive memory impairment much earlier. Especially in the light of accumulating evidence that epileptogenesis and neurodegeneration share common etiological mechanisms, patients most at risk of severe cognitive sequelae following epilepsy surgery must be identified via early investigation of cerebrospinal fluid and neuroimaging biomarkers.
The present thesis contributes to our understanding of the impact of clinical and etiological factors on postoperative cognitive and seizure outcomes. The results emphasize the importance of pathology-dependent surgical counseling and decision-making to improve individual medical care.
dc.rightsIn Copyright
dc.subject.ddc150 Psychologie
dc.subject.ddc610 Medizin, Gesundheit
dc.titleThe impact of pathology, type of resection, and age at surgery on the postoperative seizure and cognitive outcome in patients with temporal lobe epilepsy
dc.typeDissertation oder Habilitation
dc.publisher.nameUniversitäts- und Landesbibliothek Bonn
ulbbnediss.affiliation.nameRheinische Friedrich-Wilhelms-Universität Bonn
ulbbnediss.instituteMedizinische Fakultät / Kliniken : Klinik für Epileptologie
ulbbnediss.fakultaetMedizinische Fakultät
dc.contributor.coRefereeHurlemann, Rene

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