Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy

Boling, Warren

doi:10.3390/brainsci8020035

Cited by 29 publications

(26 citation statements)

References 95 publications

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“…This is supported by the fact that animals do not present any important cognitive impairment despite complete unilateral hippocampectomy. The same results are present in humans after unilateral hippocampal removal to treat refractory TLE (Boling, 2018;Jobst & Cascino, 2015).…”

Section: Increased Adult Neurogenesis May Occur In the Contralateral supporting

confidence: 73%

“…Unilateral hippocampectomy surgery performed on human patients with refractory TLE promotes the unilateral removal of the hippocampus affected by the pathology as well as the adjacent cortical area (Boling, 2018;Jobst & Cascino, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of an experimental model of unilateral hippocampectomy allowed us to study possible neuroplastic events in the contralateral intact hippocampus. This is of clinical significance as simulates the surgery used to treat refractory TLE in humans (Boling, 2018;Jobst & Cascino, 2015). As humans do not present any considerable cognitive impairment after surgery, compensatory neuroplastic events must occur in the contralateral hippocampus.…”

Section: The Experimental Hippocampectomy Model Is An Important Achiementioning

confidence: 99%

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Compensatory hippocampal neurogenesis in the absence of cognitive impairment following experimental hippocampectomy in adult rats

Cardoso¹,

Gomes-Leal

Franco

et al. 2020

Preprint

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Temporal lobe epilepsy (TLE) is the commonest type of focal epilepsy in adult humans. In refractory TLE, patients are indicated for unilateral resection of the affected hippocampus (hippocampectomy), which generally does not cause any cognitive impairment. Once adult hippocampus is a region of endogenous neurogenesis, we have hypothesized that a compensatory increase in hippocampal neurogenesis might occur in the remaining hippocampus after unilateral hippocampectomy. To test this hypothesis, we performed unilateral hippocampectomy in adult Wistar rats (n=12). Sham animals were not hippocampectomized (n=6). Animals were deeply anesthetized and adjacent cortex and hippocampus of the left hemisphere were completely removed. They were perfused at 15 (G15, n=6) or 30 (G30, n=6) days post-surgery. Behavioral tests were performed to address possible cognitive impairments. We did not find any cognitive impairment in the hippocampectomized animals. Histopathology was performed using thionine staining and mature neurons and migratory neuroblasts were immunolabeled using anti-NeuN and anti-doublecortin (DCX) antibodies, respectively. The remaining hippocampus presented higher numbers of DCX positive cells compared to control (p<0.001) at both G15 and G30. The results suggest increased compensatory adult neurogenesis following experimental unilateral hippocampectomy in adult rats, which may contribute to absence of cognitive impairments.

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Section: Increased Adult Neurogenesis May Occur In the Contralateral supporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: The Experimental Hippocampectomy Model Is An Important Achiementioning

confidence: 99%

See 1 more Smart Citation

Compensatory hippocampal neurogenesis in the absence of cognitive impairment following experimental hippocampectomy in adult rats

Cardoso¹,

Gomes-Leal

Franco

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Typically, patients display epigastric, experiential auras, loss of awareness, staring, automatisms, and posturing. 21,22 Patients must have failed at least two ASDs for surgical consideration. Prolonged EEG recording in the epilepsy monitoring unit is employed to localize the focus.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Surgical Treatments of Epilepsy

2020

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Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment—resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation—vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.

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“…Task‐state magnetic resonance imaging (fMRI) can design language task form in different aspects to observe the activated brain functional region and localize the position of brain function region related to language processes (Kircher et al., 2011). On the one hand, minimally invasive surgery based on electroencephalography (EEG) localization is not enough to minimize the risk of brain function damage caused by surgery (Boling, 2018; Smith, 2005; Téllez‐Zenteno et al., 2005). On the other hand, language functional areas of brain are very hard to be identified in Chinese patients with epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Functional magnetic resonance imaging based on Chinese tasks to protect language function in epileptics

Wang¹,

Du²,

Li³

et al. 2020

Brain and Behavior

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Objective To evaluate the efficacy of functional magnetic resonance imaging (fMRI) based on Chinese tasks to protect the language function in epileptics. Materials and Methods A total of 34 native Chinese patients with epilepsy were enrolled and examined with BOLD‐fMRI scan based on six Chinese tasks. The epileptics were randomly divided into the control group (n = 15) and the experimental group (n = 19). The control group underwent the hollowing and multiple subpial transection operation only based on intraoperative EEG, while the experimental group was under notification of task‐state fMRI results in addition. Whereafter, the language ability of patients was evaluated by ABC assessment. Results The brain regions related to Chinese function activated by different tasks were remarkably distinct and mainly concentrated in the temporal lobe and frontal lobe. In ontoanalysis, the activation signals of the fusiform gyrus, parahippocampal gyrus, hippocampus, and precentral gyrus were generally low or even could not be detected. Unlike ontoanalysis, group analysis showed that the main effect regions of AN and PN task were in right superior temporal gyrus. The main effect regions of FF and VFC task were in right middle temporal gyrus. The main effect region of SF task was in left superior temporal gyrus. The main effect region of VFL task was in right middle frontal gyrus. The ABC assessment score of the control group 6 months after surgery was significantly lower than that 1 week before surgery (p < .05), while there was no significant difference in the experimental group, and the score of the experimental group was higher than that of the control group. Conclusion In the surgical treatment of epilepsy, a personalized surgical plan, based on task‐state fMRI and intraoperative EEG, can be developed according to the difference of activation areas to protect the language function and improve the quality of life in postoperative patients.

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Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy

Cited by 29 publications

References 95 publications

Compensatory hippocampal neurogenesis in the absence of cognitive impairment following experimental hippocampectomy in adult rats

Compensatory hippocampal neurogenesis in the absence of cognitive impairment following experimental hippocampectomy in adult rats

Surgical Treatments of Epilepsy

Functional magnetic resonance imaging based on Chinese tasks to protect language function in epileptics

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