Seizure-related outcome after corticoamygdalohippo-campectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis evaluated by magnetic resonance imaging alone

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors conducted a study to assess the efficacy of surgery in patients who underwent magnetic resonance (MR) imaging alone for localization of foci in temporal lobe epilepsy (TLE).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>One hundred patients (43 men, 57 women) with a clinical diagnosis of TLE were prospectively studied (mean age 28 ± 9 years [± standard deviation {SD}]). All patients underwent high-resolution MR imaging, and in all unilateral mesial temporal sclerosis (MTS) was diagnosed by visual inspection. All patients underwent interictal pre-operative electroencephalography (EEG) and in 87 patients pre- and 1-year postoperative neuropsychological testing was performed. Both EEG and neuropsychological examinations were conducted in a blinded fashion, and these data were not taken into account during the surgery-related decision-making process. All patients underwent a corti-coamygdalohippocampectomy at the side of the MTS. Surgery-related outcome was rated as Class I (seizure free or simple partial seizures only) or Class II (⩾ 90% improvement). The follow-up period ranged from 18 to 48 months (mean 24 ± 5 months [±SD]). No patient underwent prolonged video-EEG monitoring, Wada testing, positron emission tomography, or single-photon emission computerized tomography.</jats:p> <jats:p>In eighty-nine patients Class I results were achieved, and 11 Class II results were achieved postoperatively. There was no mortality in this series. Except for in two patients who underwent surgery in the dominant temporal lobe, there was no postoperatively cognitive decline. In these two patients verbal memory decline occurred, which was associated with posterior temporal cortical damage, demonstrated postoperatively on MR imaging. Twenty-five percent of the patients experienced improved memory function related to the nonoperated side, and 54% experienced a 10% gain in general intelligence quotient status.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In patients with clinically suspected TLE, MR imaging alone is able to localize temporal lobe foci correctly. Ruling out pseudoseizures remains the only indication for prolonged video-EEG recordings in this group of patients.</jats:p></jats:sec>

Outcome after corticoamygdalohippocampectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis without preoperative ictal recording

“…In our series, patients with bilateral interictal EEG findings did not have a worst postoperative prognosis. This finding suggests that the presence of MTS on MRI would be the most important positive postoperative prognostic factor after CAH (Cukiert et al., 2002). We found that all patients with MTS on MRI had favorable postoperative outcome (Engel class I or II).…”

“…The need for video electroencephalography (EEG) seizure recording in all patients has been extensively studied (Engel, 1999; Cendes et al., 2000), and many authors emphasized the value of magnetic resonance imaging (MRI) and interictal EEG findings in patients with TLE who were considered candidates for surgery (Chee et al., 1993; Cascino, 1995; Bronem et al., 1997). Better surgical outcome regarding seizures was found in patients with concordant MRI and interictal EEG findings, especially when MRI disclosed unilateral mesial temporal sclerosis (MTS) (Gilliam et al., 1997; Cukiert et al., 2002).…”

Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control

“…[1][2][3]5,7,[10][11][12]14,15,19,28,29,31,32,37,[46][47][48]50,52,56,57,63,64,66,73,74 Studies varied with inclusion of imaging-defined and/or pathologically diagnosed MTS, the type and timing of the seizure outcome analyses, and the definitions used for seizure freedom. Rates of seizure freedom decrease with longer follow-up.…”

Surgical outcome in patients with refractory epilepsy associated to MRI-defined unilateral mesial temporal sclerosis

“…Many authors emphasized the value of MRI and interictal EEG findings in patients with TLE who were considered candidates for s u rg e ry 1 3 -1 5 . Better surgical outcome related to seizures was found in patients with concordant MRI and interictal EEG findings, especially when MRI disclosed unilateral mesial temporal sclerosis (MTS) 12,16,17 . We studied the surgical outcome of patients with TLE and MTS selected based on the anatomical findings provided by MRI and that were submitted to c o rtico-amygdalo-hippocampectomy (CAH) at the side shown by imaging.…”