Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy

Luo, Huimin; Zhao, Qian; Tian, Zhen; Wu, Zhaohui; Wang, Fuli; Lin, Hong; Yin, Feng; Zhao, Hulin; Xiang-sheng, Xiao; Xue, Yongji; Wang, Haiying; Zhao, Hongxi; Cai, Cheng

doi:10.1111/epi.12387

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…On the basis of the data relating to our few patients who underwent surgery, patients with BTLE are not good candidates for resection, and probably account for a large proportion of poor TLE surgery outcomes. Other investigators have described the usefulness of invasive recordings [8,10,40], but we believe that a careful presurgical non-invasive work-up can adequately identify patients with BTLE and that therapeutic strategies other than resective surgery should be further investigated for those who are drug resistant [42,43].…”

Section: Discussionmentioning

confidence: 89%

Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum

Didato

Chiesa

Villani

et al. 2015

Seizure

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Section: Discussionmentioning

confidence: 89%

Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum

Didato

Chiesa

Villani

et al. 2015

Seizure

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“…The use of icEEG allowed establishment of bilateral TLE as those with truly independent bitemporal ictal origins. Despite electrographic features supporting bilateral independent temporal epileptogenicity, there have been efforts by several groups to assess predominance of one side over the other, leading to considerations of surgical candidacy ( Boling et al, 2009 , Chung et al, 1991 , Hirsch et al, 1991 , Holmes et al, 2003 , Luo et al, 2013 , Malmgren et al, 2014 , Sirven et al, 1997 ). In a review of bitemporal epileptogenicity, Aghakhani et al (2014) evaluated group data of those cases declared to express genuine bitemporal epileptogenicity by extraoperative icEEG.…”

Section: Discussionmentioning

confidence: 99%

DTI-based response-driven modeling of mTLE laterality

Nazem-Zadeh

Elisevich

Air

et al. 2016

NeuroImage: Clinical

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PurposeTo develop lateralization models for distinguishing between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) and determining laterality in cases of unilateral mTLE.BackgroundmTLE is the most common form of medically refractory focal epilepsy. Many mTLE patients fail to demonstrate an unambiguous unilateral ictal onset. Intracranial EEG (icEEG) monitoring can be performed to establish whether the ictal origin is unilateral or truly bilateral with independent bitemporal ictal origin. However, because of the expense and risk of intracranial electrode placement, much research has been done to determine if the need for icEEG can be obviated with noninvasive neuroimaging methods, such as diffusion tensor imaging (DTI).MethodsFractional anisotropy (FA) was used to quantify microstructural changes reflected in the diffusivity properties of the corpus callosum, cingulum, and fornix, in a retrospective cohort of 31 patients confirmed to have unilateral (n = 24) or bilateral (n = 7) mTLE. All unilateral mTLE patients underwent resection with an Engel class I outcome. Eleven were reported to have hippocampal sclerosis on pathological analysis; nine had undergone prior icEEG. The bilateral mTLE patients had undergone icEEG demonstrating independent epileptiform activity in both right and left hemispheres. Twenty-three nonepileptic subjects were included as controls.ResultsIn cases of right mTLE, FA showed significant differences from control in all callosal subregions, in both left and right superior cingulate subregions, and in forniceal crura. Comparison of right and left mTLE cases showed significant differences in FA of callosal genu, rostral body, and splenium and the right posteroinferior and superior cingulate subregions. In cases of left mTLE, FA showed significant differences from control only in the callosal isthmus. Significant differences in FA were identified when cases of right mTLE were compared with bilateral mTLE cases in the rostral and midbody callosal subregions and isthmus. Based on 11 FA measurements in the cingulate, callosal and forniceal subregions, a response-driven lateralization model successfully differentiated all cases (n = 54) into groups of unilateral right (n = 12), unilateral left (n = 12), and bilateral mTLE (n = 7), and nonepileptic control (23).ConclusionThe proposed response-driven DTI biomarker is intended to lessen diagnostic ambiguity of laterality in cases of mTLE and help optimize selection of surgical candidates. Application of this model shows promise in reducing the need for invasive icEEG in prospective cases.

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“…The prognostic significance of unilateral temporal spikes in the scalp electroencephalogram (EEG) as a predictor of outcome after temporal lobe surgery has been reinforced by several studies [6,7]. However, interictal spikes or sharp waves over the bilateral temporal region are not rare [8,9,10], and autopsies of chronically institutionalized patients with clinical diagnoses of TLE have provided a spectrum of bilateral temporal pathology, with evidence of some type of bilateral temporal pathology in as many as 80% of patients and bilateral hippocampal sclerosis in 50% [11]. Furthermore, not all patients with bilateral temporal spikes experience poor seizure control, and approximately 54% become seizure free after surgery [3].…”

Section: Introductionmentioning

confidence: 99%

Contralateral Hippocampal Stimulation for Failed Unilateral Anterior Temporal Lobectomy in Patients with Bilateral Temporal Lobe Epilepsy

Ding¹,

Zhang²,

Zhang

et al. 2016

Stereotact Funct Neurosurg

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Aims: To prospectively study the surgical outcomes of unilateral anterior temporal lobectomy (ATL) in patients with intractable bilateral temporal lobe epilepsy (TLE) as well as two-staged contralateral hippocampal stimulation in patients after failed unilateral ATL. Methods: Eighteen carefully selected patients with bilateral TLE underwent unilateral ATL. Five cases with failed ATL underwent two-staged contralateral hippocampal stimulation. Seizure control and changes in intelligence quotient (IQ), memory quotient, and quality of life (QOL) were analyzed 2-5 years after treatment. Results: In the patients with unilateral ATL, the percentages seizure free were 55.6% (10/18), 50.0% (9/18), and 44.4% (4/9) at the 1-, 2-, and 5-year follow-up visits, respectively. There were significant difference in seizure control between the patients with unilateral ATL and the 12 cases in the medication group. Significant differences were also found in changes in the patients' QOL and full-scale IQ at the 2-year follow-up between the surgical and medication groups. Five patients who underwent contralateral hippocampal stimulation after failed unilateral ATL experienced 80-100% seizure reductions, and 80% were seizure free 1 year after hippocampal stimulation. Conclusion: Unilateral ATL provides good seizure control and does not cause serious memory or IQ injury in carefully selected patients with true bilateral TLE. Contralateral hippocampal stimulation is a useful approach for patients who experience unilateral ATL failure.

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Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy

Cited by 14 publications

References 13 publications

Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum

Bitemporal epilepsy: A specific anatomo-electro-clinical phenotype in the temporal lobe epilepsy spectrum

DTI-based response-driven modeling of mTLE laterality

Contralateral Hippocampal Stimulation for Failed Unilateral Anterior Temporal Lobectomy in Patients with Bilateral Temporal Lobe Epilepsy

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