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ObjectiveDespite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K.MethodsThis a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom.ResultsWe included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1–27). Kaplan-Meier estimates showed that 47% (95% CI 40–58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31–45) at 10 years after surgery. 74% (95% CI 69–80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64–77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years.ConclusionThe vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with hippocampal sclerosis or those who had anterior temporal lobe resections.

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the objective was to study fibre orientation in the cerebral white matter of a patient with a brain tumour using diVusion tensor imaging (DTI).A patient with a mild left hemiparesis and a tumour in the right frontal lobe and 20 healthy volunteers were scanned with a DTI sequence. The scans were spatially normalised and the fibre orientation in the patient compared with the fibre orientation in normal controls.DTI disclosed a change of the orientation of fibres in the patient compared with normal controls. In the normal appearing white matter adjacent to the tumour fibres deviated from the normal superior inferior orientation in the corona radiata by about 30 o . This finding was consistent with a displacement by distant mass eVect rather than a destruction of fibres, in agreement with the neurological examination.In conclusion, DTI demonstrated a deviation of fibres in normal appearing white matter adjacent to a tumour. The technique will improve understanding of the eVects of structural abnormalities on fibres. This will assist the interpretation of clinical findings and functional imaging studies and guide neurosurgical interventions. (J Neurol Neurosurg Psychiatry 2000;68:501-503) Keywords: diVusion tensor imaging; brain tumoursIn the nervous system, myelinated tracts connect diVerent brain regions together, and the brain with the spinal cord. Studying connections in normal and abnormal brains plays an important part in our understanding of brain function. Standard magnetic resonance 1 and FLAIR 2 imaging techniques have been used to demonstrate tracts. However, information on the orientation of fibres within the tract is unobtainable with these methods. DiVusion imaging now provides an opportunity to study fibre orientation in vivo. In the white matter of the brain diVusion is directional (anisotropic) because water molecules diVuse predominantly parallel to tracts. The principal eigenvector represents the principal direction of diVusion corresponding to the fibre tract axis. We used DTI in combination with spatial normalisation and a multiplanar representation of the principal eigenvector to demonstrate the directional organisation of human white matter in vivo ("tractography"). In this study we have investigated the fibre orientation in normal appearing white matter adjacent to a tumour. MethodsWe studied a 47 year old right handed man who developed partial epilepsy at the age of 38. On examination, he had only a mild paresis aVecting the left leg (power 4/5) and impaired fine finger movements of the left side. Standard MRI with T1 weighted and T2 weighted sequences showed a large tumour in the right frontal lobe extending to the level of the corpus callosum. The long history of epilepsy and the appearance of the tumour on standard MRI were compatible with a low grade glioma. DIFFUSION TENSOR IMAGING VARIABLESWe scanned the patient and 20 healthy volunteers (mean age 30 years) with a 1.5T GE scanner (GE, Milwaukee, USA, maximum gradient strength=22 mT/m, slew rate=120 T/m/s). DiVusion tensor i...

Summary:Purpose: To investigate changes in hippocampal volume.Methods: We used serial magnetic resonance imaging (MRI) in a patient who developed chronic epilepsy after having generalized tonic-clonic status epilepticus (SE). Five MRI investigations were performed during SE and a 58-month follow-up period. Hippocampal volumetric measurements and coregistration of scans were performed to detect hippocampal atrophy.Results: During status both mesiotemporal regions returned a high signal on T,-weighted images. Two months after the onset of SE, bilateral hippocampal atrophy was detected. Further progressive hippocampal atrophy was detected in the subsequent 58 months by both hippocampal volumetric measurements and coregistration of scans. Conclusions: Our findings suggest that hippocampal atrophy is a process that may continue after the end of the SE. Key Words: Status epilepticus-Encephalitis-HippocampusSerial magnetic resonance imaging.Status epilepticus (SE) can be associated with hippocampal atrophy (1). However, whether chronic epilepsy is associated with progressive hippocampal atrophy is not known. With serial magnetic resonance imaging (MRI), this question can be addressed. With serial MRI scans, changes occurring in the brain over time can be monitored. Coregistration and substraction of serial MRI scans may help clinicians detect subtle changes (2-4). The hippocampal volume can be quantified on MRI images (5). We performed a serial MRI study for almost 5 years to investigate hippocampal volume changes in a patient who developed chronic epilepsy after having tonic-clonic SE. CASE REPORTA 30-year-old woman developed generalized tonicclonic SE in September 1991 after having low-grade fever for 1 week. Two days after onset of SE, cerebrospinal fluid (CSF) examination showed pleocytosis of 72 cells/ pl, normal blood sugar, and oligoclonal bands against HSV1. The serum HSVl antibody titer increased from 20 to 160 during the third to fourth weeks of the illness.Chest radiograph and results of brain computed tomography (CT), and intravenous digital substraction angiography (DSA) and muscle biopsy were normal. SE persisted for 2 weeks despite intensive therapy including intravenous thiopentone. Two months after the onset of the illness, the patient was well enough to begin neurorehabilitation, but she had developed memory deficits and habitual epilepsy with frequent secondarily generalized seizures that remained refractory to medical treatment. The seizure semiology was compatible with frontal onset with secondary spread to the temporal lobes. There was evidence of continuing neuropsychological decline; her score on the Warrington recognition test for words and faces decreased from 46/50 and 46/50, respectively, to 37/50 and 35/50 in the 4 years after her illness. The IQ (79) was unchanged.

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