Relationship of hippocampal sclerosis to duration and age of onset of epilepsy, and childhood febrile seizures in temporal lobectomy patients

Davies, Keith G.; Hermann, Bruce P.; Dohan, F. C.; Foley, Kevin T.; Bush, Andrew; Wyler, Allen R.

doi:10.1016/0920-1211(96)00008-3

Cited by 150 publications

(93 citation statements)

References 24 publications

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“…Our data are consistent with previous studies with regard to seizure frequency and age at surgery, suggesting no correlation between them and the pattern of HS 7,20,21 . Also, duration of epilepsy in our series is suggested to be shorter for patients with normal hippocampus 6,7 .…”

Section: Discussionsupporting

confidence: 83%

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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Article temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome Epilepsia do lobo temporal com esclerose mesial temporal: o padrão da perda neuronal hipocampal como preditor do prognóstico cirúrgico Anaclara Prada Jardim¹, Rafael Scarpa da Costa Neves¹, Luís Otávio Sales Ferreira Caboclo¹, Carmen Lucia Penteado Lancellotti² , ³, Murilo Martinez Marinho¹, Ricardo Silva Centeno¹, Esper Abrão Cavalheiro 4 , Carla Alessandra Scorza 4 , Elza Márcia Targas Yacubian¹Mesial temporal sclerosis (MTS) is the most common pathological finding in drug refractory, chronic temporal lobe epilepsy (TLE) 1 . Mesial temporal lobe structures with a sclerotic hippocampus have been considered the site of seizure onset for most TLE patients, and hippocampal sclerosis (HS) has been considered essential for MTS diagnosis. Surgery has become the treatment of choice in the management of patients with this epilepsy syndrome 2,3 . Tailored resections of temporal neocortex and mesial temporal structures, including hippocampus and amygdala, are an established epilepsy treatment modality and offer a favorable outcome in approximately two-thirds of patients 4,5 .The reason why around one-third of individuals with this epilepsy syndrome still present seizures after surgical treatment ABStrActObjective: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. Method: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. Results: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). Conclusion: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.Key words: epilepsy, temporal lobe, mesial temporal sclerosis, hippocampal sclerosis, pathology, surgical prognosis. reSUMO Objetivo: Analisar retrospectivamente uma série de pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT), bem como correlacionar os padrões de esclerose hipocampal com os dados clínicos e o prognóstico cirúrgico. Métodos: Foram incluídos neste estudo 66 pacientes com ELT refratária a tratamento medicamentoso e com EMT unilateral submetidos à lobectomia temporal anterior. A análise neuropatológica quantitativa foi realizada em seções hipocampais imunomarcadas com NeuN. Dados clínicos e resultados do acompanhamento pós-cirúrgico foram revisados. Resultados: Ocorrência de evento precipitante inicial e melhor controle de crises após a cirurgia (i.e. classe 1 de Engel) foram associados aos pad...

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Section: Discussionsupporting

confidence: 83%

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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“…This dichotomous grouping has been used in previous investigations that have demonstrated meaningful relationships with regard to memory status and clinical features in patients with TLE (24,26,27). Because grade 1 HS represents 4 0 % neuronal dropout, HS-essentially denotes absence of HS.…”

Section: Discussionmentioning

confidence: 99%

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

et al. 1998

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Summary: Purpose:To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming.Methods: In a group of 99 patients undergoing lobectomy of the left, language-dominant anterior temporal lobe, we examined naming ability using two measures: the 60 item Boston Naming Test (BNT), and the Visual Naming (VN) subtest of the Multilingual Aphasia Examination (MAE). ATL entailed resection of lateral temporal lobe followed by microsurgical complete removal of hippocampus. Language mapping was not performed. The status of the resected hippocampus was graded on a scale 0-4 of hippocampal sclerosis (HS). A dichotomous grouping HS-(grades 0 and 1, n = 34) and HS+ (grades 3 and 4, n = 61) was effected. Age at surgery, age of epilepsy onset, sex, extent of lateral temporal resection, Full-Scale IQ (FSIQ), and preoperative naming scores were also examined as potential predictors of pre-versus postoperative naming change.Results: Preoperative BNT and VN scores were significantly worse for HS+ than for HS-(BNT, p c 0.05; VN, p = 0.001).Postoperatively, BNT and VN scores significantly declined for HS-as compared with HS+ patients (p c 0.001). For individual risk, the 90th centile of reliable change index (RCI) was used. By this criterion, of the total sample, 39% evidenced decline on the BNT and 17% evidenced decline on the VN. Logistic regression analysis with backward elimination showed HS to be the only predictor of decline in BNT and HS and sex to be the only predictors of VN decline. Males were more at risk than females. Age, age at onset, extent of lateral resection, preoperative scores, and FSIQ were not predictors. Using age at onset as a proxy for HS+/HS-we calculated probabilities for naming decline for given onset age. Conclusions: Both preoperative and postoperative change in naming ability are associated with the pathological status of the hippocampus. The potential interpretations and implications of these findings are discussed.

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“…Furthermore, the presence of HS is known to be associated with an earlier age at onset of epilepsy (14,20,29,42,43), and which probably explains the predictive effect of earlier age at onset on pre-to postoperative memory stability. Preoperatively, the precise pathological status of the hippocampus is unknown, although it can sometimes be inferred from imaging studies (1,44), and from a low ipsilateral memory score or a memory asymmetry during the intracarotid amobarbital test (45)(46)(47).…”

Section: Discussionmentioning

confidence: 99%

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

et al. 1998

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Summary:Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre-to postoperative memory decline using only information available preoperatively.Methods: We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined.Results: The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (290th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures. Conclusions:The derived regression equations can accurately predict verbal memory decline on a list-learning task in -50% of individual patients undergoing ATL, and falsepositive prediction errors are very rare. Key Words: Epilepsy-Memory-Surgery-Temporal lobectomy.Decreased memory function represents the greatest potential neuropsychological morbidity after performance of anterior temporal lobectomy (ATL), particularly for verbal memory measures in patients undergoing left-sided resection (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Right-sided resections pose less consistent risk of memory impairment, possibly reflecting the absence of currently available adequate measures of nonverbal memory. Verbal memory deficit in association with right temporal lobe epilepsy (RTLE) is relatively rare and may be due to the presence of concomitant left mesial temporal abnormality, as demonstrated by magnetic resonance imaging (MRI) spectroscopy (21). Identified risk factors for postoperative memory decline after left ATL are older age at time of surgery, later age at onset of unprovoked seizures, and better preoperative memory performance (1)(2)(3)11,22 Males have been shown to be at greater risk than females in some series (23,24). Better preoperative memory performance is also a risk factor for post-ATL decline for right-sided resections ( I 1). For left-sided resections, the principal risk factor is the absence of hippocampal sclerosis (HS...

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Relationship of hippocampal sclerosis to duration and age of onset of epilepsy, and childhood febrile seizures in temporal lobectomy patients

Cited by 150 publications

References 24 publications

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

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