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Abstract Details

Imaging findings and prognostic implications of hippocampal sclerosis subtypes.
Epilepsy/Clinical Neurophysiology (EEG)
Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)
137
To explore the imaging and prognostic implications of the pathological subtypes of hippocampus sclerosis (HS) in patients undergoing epilepsy surgery.
There are three different subtypes of HS according to the 2013 ILAE classification. Little is known about whether this pathological distinction could be anticipated on pre-operative imaging and how it influences surgical outcomes.

We reviewed patients who underwent epilepsy surgery at Cleveland Clinic, Mayo Clinic, and University of Campinas from 2009-2019. We selected 159 cases with HS on pathology; an expert pathologist (IB) reclassified those cases into HS type 1(n=135), type 2 (n= 18) and type 3 (n= 6). For the analysis we divided the cohort into type 1 versus type 2 and 3.

We measured the pre-operative volume of the resected hippocampus (n=152) using Neuroquant®, a FDA-approved software, reporting volumes as percentiles relative to age- and gender-matched normative controls. For the quantitative PET analysis of the hippocampus (n=79), we used the software Scenium® (from the Siemens Syngo.via software package). The results were provided in standard deviation (positive values indicated hypermetabolism and negative values indicated hypometabolism compared to controls). Kaplan-Meier estimates of longitudinal seizure-recurrence rates were obtained using seizure-freedom as the primary outcome.
Patients with HS type 1 had smaller hippocampus volumes compared to type 2 and 3 (mean percentile 8.07 vs. 30; p=0.018). Quantitative PET revealed a lower glucose metabolism in the resected hippocampus in patients with HS type 1 (mean standard deviation -1.76 vs. -0.03; p<0.001). Seizure outcomes were similar across all HS subtypes (p=0.147).
Most surgical HS falls in the pathological category of HS type 1. Although this pathological sub-classification correlates with a specific imaging signature on MRI and PET, its prognostic implication remains unclear.
Authors/Disclosures
Shreya Louis, MD, MS
PRESENTER 		Dr. Louis has nothing to disclose.
Marcia E. Morita-Sherman, MD (Eisai) An immediate family member of Dr. Morita-Sherman has received personal compensation for serving as an employee of Forrester Research. Dr. Morita-Sherman has received personal compensation for serving as an employee of Eisai Inc.. An immediate family member of Dr. Morita-Sherman has stock in Forrester Research. The institution of Dr. Morita-Sherman has received research support from Cleveland Clinic.
No disclosure on file
Marina K. Alvim (Hospital Das Clinicas Unicamp) Dr. Alvim has nothing to disclose.
Clarissa L. Yasuda, MD, PhD (University of Campinas) Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for LIBBS. Prof. Yasuda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT. Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for LIBBS.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Imad M. Najm, MD (Cleveland Clinic) Dr. Najm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eisai Inc. Dr. Najm has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai Inc. Dr. Najm has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Eisai Inc.
No disclosure on file
No disclosure on file
Guiyun Wu, MD (Cleveland Clinic, Imaging Institute, JB-3) Dr. Wu has nothing to disclose.
Benjamin H. Brinkmann, PhD (Mayo Clinic) Dr. Brinkmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Dr. Brinkmann has stock in Cadence Neuroscience. The institution of Dr. Brinkmann has received research support from Epilepsy Foundation of America. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from UNEEG A/S. The institution of Dr. Brinkmann has received research support from Seer Medical Pty. The institution of Dr. Brinkmann has received research support from Neurelis Inc. Dr. Brinkmann has received intellectual property interests from a discovery or technology relating to health care.
Gregory A. Worrell, MD (Mayo Clinic College of Medicine) Dr. Worrell has received stock or an ownership interest from NeuroOne Inc.. Dr. Worrell has received stock or an ownership interest from Cadence Neuroscience Inc. The institution of Dr. Worrell has received research support from NIH. The institution of Dr. Worrell has received research support from Medtronic Inc.. The institution of Dr. Worrell has received research support from Neuropace Inc,. The institution of Dr. Worrell has received research support from Epilepsy Foundation of America. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care.
Fernando Cendes, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Departamento de Neurologia; FCM; UNICAMP) Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Biopharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for United Medical – Brazil. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Zodiac Pharma . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eurofarma – Brazil . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology - Epilepsy. The institution of Dr. Cendes has received research support from São Paulo Research Foundation - FAPESP. The institution of Dr. Cendes has received research support from Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil . The institution of Dr. Cendes has received research support from NIH.
Lara Jehi, MD (Cleveland Clinic Epilepsy Center) Dr. Jehi has nothing to disclose.