Anterior temporal lobectomy for complex partial seizures

Walczak, Thaddeus S.; Radtke, Rodney A.; McNamara, J. O.; Lewis, D. V.; Luther, J. S.; Thompson, Elizabeth A.; Wilson, Wilkie A.; Friedman, Alon; Nashold, Blaine S.

doi:10.1212/wnl.40.3_part_1.413

Cited by 125 publications

(42 citation statements)

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“…Most studies (1)(2)(3) evaluates surgical outcome at a fixed time. Rasmussen (43) noted that after surgery for epilepsy, patients may experience some seizures in the first few months or years, but the seizures later remit.…”

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confidence: 99%

Improvement and Deterioration of Seizure Control During the Postsurgical Course of Epilepsy Surgery Patients

Ficker

Mosewich

et al. 1999

Epilepsia

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Summary:Purpose: To determine the factors associated with changes in seizure control during the postsurgical course of epilepsy surgery patients.Methods: Evaluation of patients after consecutive temporal and frontal resection whose seizure frequency was scored for each year of postsurgical follow-up. In each cohort, patients with a change in their seizure control after the first postsurgical year were compared with control subjects to determine factors that may be responsible for the change.Results: Thirty-three (15%) of 214 temporal lobectomy versus 12 (20%) of 59 frontal resection patients experienced a change in seizure control (p > 0.05). Ten (5%) of 214 temporal lobectomy versus nine (15%) of 59 frontal resection patients experienced an improvement in seizure control (p = 0.009), but 23 ( I 1%) of 214 temporal lobectomy versus three (5%) of 59 frontal resection patients had a worsening in seizure control (p > 0.05). In temporal lobectomy patients, preoperative unilateral temporal epileptiform discharges were associated with improvement (p = 0.03), whereas older age at surgery was associated with worsening of seizure control (p = 0.007). In frontal resection patients, presence of a congenital central nervous system (CNS) anomaly was associated with late improvement in seizure control (p = 0.006).Conclusion: During the postsurgical course, an improvement in seizure control is more common after frontal resection than after temporal lobectomy. Factors associated with improvement are the presence of a congenital CNS abnormality in frontal resection patients, and the occurrence of preoperative unilateral epileptiform discharges in temporal lobectomy patients. Older age at temporal lobectomy may be associated with greater risk of worsening seizure control.

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confidence: 99%

Improvement and Deterioration of Seizure Control During the Postsurgical Course of Epilepsy Surgery Patients

Ficker

Mosewich

et al. 1999

Epilepsia

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“…Temporal lobe resection leads to improvement in seizure control or abolition of seizures in 60-80% of selected cases (1)(2)(3)(4). In the minority who do not benefit, the reasons are often unclear.…”

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confidence: 99%

Analysis of Temporal Lobe Resections in MR Images

Moran¹,

Lemieux²,

Maudgil³

et al. 1999

Epilepsia

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Summary: Purpose:The nature of the resection in surgery for intractable medial temporal lobe epilepsy is likely to be a principal factor determining seizure and neuropsychological outcome. However, there is no universally accepted system for describing the characteristics of individual resections to allow comparison between patients and patient groups treated at different institutions. We therefore developed a technique of volumetric analysis of temporal lobe resections.Methods: With comparison of coregistered pre-and postoperative, volumetric magnetic resonance imaging (MRI) scans in 10 subjects, the volumes of six temporal lobe substructures were determined by manual delineation in the pre-and postoperative images for each case, allowing the extent of resection to be determined.Results: The substructures and their extent of resection were measured with acceptable repeatability in each case.Conclusions: We developed a reliable method for the quantitative description of temporal lobe resections. This will be of application in determining the relation between the anatomic nature of the resection in intractable epilepsy and the seizure and neuropsychological outcome.

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“…First, IEDs may be completely absent despite definite focal epilepsy as captured by ictal recordings in nearly 20% of known persons with epilepsy [11,12]. If the epileptogenic region is either too small (b6 cm 3 ), too deep (depth of sulcus), or located in an "invisible" region such as orbitofrontal cortex or the interhemispheric fissure, discharges may not be seen on the surface EEG.…”

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confidence: 99%

“…It has shown the best outcome [35,36] in the only randomized prospective controlled study for assessing temporal lobectomy [37]. Studies have found that 74 and 92% of patients with interictal unilateral anterior temporal spikes became seizure free or significantly improved after anteromedial temporal resection [11,38]. In another study, a positive outcome was noted in patients with more than 90% of IEDs ipsilaterally [39].…”

Section: Mesial Temporal Sclerosismentioning

confidence: 99%