Systematic Testing of Medical Intractability for Carbamazepine, Phenytoin, and Phenobarbital or Primidone in Monotherapy for Patients Considered for Epilepsy Surgery

Hermanns, Guido; Noachtar, Soheyl; Tuxhorn, Ingrid; Holthausen, Hans; Ebner, Alois; Wolf, Peter

doi:10.1111/j.1528-1157.1996.tb00632.x

Cited by 36 publications

(12 citation statements)

References 15 publications

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“…The rates of seizure freedom achieved in our study and other reported series18 20 – 23 of surgery for bitemporal epilepsy far exceed the rates of seizure freedom in pharmacoresistant epilepsy treated with medication alone 34 35. Medically intractable epilepsy is a dangerous disease that has morbidity and mortality several times greater than the general population 36.…”

Section: Discussioncontrasting

confidence: 45%

Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings

Boling

Aghakhani

Andermann

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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Section: Discussioncontrasting

confidence: 45%

Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings

Boling

Aghakhani

Andermann

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…Seventy eight patients had antiepileptic drugs in polytherapy and 131 patients had monotherapy. Pharmacoresistance of epilepsy was confirmed in all patients 4. Of the 209 patients altogether employed, 127 have undergone anterior temporal lobectomy at present and were neuropsychologically assessed 6 months postoperatively.…”

Section: Methodsmentioning

confidence: 86%

Long term effects of refractory temporal lobe epilepsy on cognitive abilities: a cross sectional study

Jokeit

Ebner

1999

Journal of Neurology, Neurosurgery & Psychiatry

286

161

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Objective-Intractable epilepsy is related to various transient and chronic brain electric and neurochemical disturbances. There is increasing evidence that chronic epilepsy induces secondary neuronal metabolic and structural decline. However, there is no convincing evidence that the cognitive abilities of patients deteriorate with increasing duration of intractable epilepsy. A second ANOVA including education as factor showed that in patients with higher educational attainment, the mean FSIQ was stable for a longer duration of TLE than in less educated patients. Retesting 6 months after anterior temporal lobectomy seizure free patients (n=85 of 127) had an higher FSIQ but showed a similar duration eVect before and after anterior temporal lobectomy. The variables age at epilepsy onset, education, frequency of interictal epileptiform discharges, frequency of habitual and generalised seizures, serum concentration of antiepileptic drugs, and polypharmacy were statistically controlled. Conclusions-Psychometric intelligence of patients with a longer duration of refractory TLE were most severely impaired. Consequently, refractory TLE seems to be associated with slow but ongoing cognitive deterioration. It is assumed that epilepsy related noxious events and agents exhaust the compensatory capacity of brain functions. However, as in dementia and Alzheimer's disease, higher educational attainment as an indicator of higher brain reserve might delay the cognitive decline. (J Neurol Neurosurg Psychiatry 1999;67:44-50) Methods-To

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“…A long duration of intractable TLE is related to a considerable number of focal or secondarily generalized seizures, pathological interictal electric brain activity, chronic and transient metabolic disturbances [2,50,59], and chronic antiepileptic medication with usually high serum levels [21]. The presence of reactive microglia [5], reduced dendritic spine density, dendritic swellings [39], and senile plaques [32] in temporal lobectomy specimens suggests that neuronal injury within and beyond the temporal lobes continues to occur with ongoing seizure activity in TLE patients.…”

Section: Discussionmentioning

confidence: 99%

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

Jokeit¹,

Ebner²,

Arnold³

et al. 1999

Journal of Neurology

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In refractory temporal lobe epilepsy (TLE) temporal lobe structures and functions are continuously or intermittently affected by abnormal brain electrical events, noxious neurochemical agents, and metabolic disturbances. There is conflicting evidence regarding the relationship between the duration of refractory mesial TLE and quantitative measures of temporal lobe functions and volumes of the hippocampi. Twenty patients (aged 28 +/- 7 years, 14 males) with an initial precipitating injury before the age of 5 years were subjected to high-resolution magnetic resonance imaging, fluoro-2-deoxy-d-glucose positron-emission tomography (PET), and the Wada test. We investigated whether the duration of unilateral refractory TLE (12 left, 8 right) affects hippocampal volume, glucose metabolism, or Wada hemispheric memory performance. Ipsilateral to the epileptogenic zone the hippocampal volume, metabolism, and Wada hemispheric memory performance were reduced compared to the corresponding contralateral measures. The duration of epilepsy controlled for age at investigation, side of seizure origin, underlying cause, and sex were negatively correlated with ipsi- and contralateral hippocampal volume, hippocampal metabolism, and Wada hemispheric memory performance. Moreover, ipsilateral Wada hemispheric memory performance and contralateral hippocampal glucose metabolism were correlated with the frequency of habitual seizures. Refractory TLE seems to be associated with a slow but ongoing bilateral temporal lobe damage. These cross-sectional results require verification by longitudinal studies carried out over a period of more than two decades.

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Systematic Testing of Medical Intractability for Carbamazepine, Phenytoin, and Phenobarbital or Primidone in Monotherapy for Patients Considered for Epilepsy Surgery

Cited by 36 publications

References 15 publications

Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings

Surgical treatment of independent bitemporal lobe epilepsy defined by invasive recordings

Long term effects of refractory temporal lobe epilepsy on cognitive abilities: a cross sectional study

Bilateral reductions of hippocampal volume, glucose metabolism, and Wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy

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