Temporal lobe epilepsy: neuropathological and clinical correlations in 243 surgically treated patients (original) (raw)
Related papers
Epilepsia, 2015
Hippocampal sclerosis (HS) is the most frequent neuropathologic finding in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). The International League Against Epilepsy (ILAE) has recently proposed a new classification of HS based on specific patterns of cell loss. The aim of this study was to investigate the relationships between HS types, their etiologic factors, and the short- and long-term postsurgical outcomes of patients undergoing surgery because of drug-resistant TLE with HS. Two hundred thirteen patients with a neuropathologic diagnosis of HS and a minimum follow-up of 2 years were divided on the basis of their ILAE HS type and further classified into: (1) isolated HS, (2) HS associated with focal cortical dysplasia (FCD IIIa), or (3) HS associated with other lesions. Their clinical and neuropathologic data were correlated with their Engel class postsurgical outcomes. The main findings were the following: (1) HS type 1 was associated with a longer dura...
Journal of Neurology, Neurosurgery & Psychiatry, 2001
Objectives-To evaluate the influence of clinical, investigative, and pathological factors on seizure remission after temporal lobectomy for medically intractable epilepsy associated with focal lesions other than hippocampal sclerosis. Methods-From a series of 234 consecutive "en bloc" temporal resections for medically intractable epilepsy performed between 1976 and 1995, neuropathological examination disclosed a focal lesion in 80. The preoperative clinical, neuropsychological, interictal EEG, and neuroimaging characteristics of these patients were assembled in a computerised database. The original neuropathological material was re-examined for lesion classification and completeness of removal. The presence of additional cortical dysplasia and mesial temporal sclerosis was also noted. Survival analysis was performed using Kaplein-Meier curves and actuarial statistics. Logistic regression analysis was used to establish the independent significance of the clinical variables. Results-The probability of achieving a 1 year seizure remission was 71% by 5 years of follow up. Factors predicting a poor outcome on multivariate analysis included the need for special schooling and a long duration of epilepsy. Generalised tonic-clonic seizures, interictal EEG discharges confined to the resected lobe, demonstration of the lesion preoperatively on CT, and complete histological resection of the lesion were not predictive of outcome. Neuropsychological tests correctly predicted outcome in left sided cases but apparently congruent findings in right sided resections were associated with a poor outcome. Pathological reclassification established the dysembryoplastic neuroepithelial tumour as the commonest neoplasm (87%) in this series, with a significantly better seizure outcome than for developmental lesions, such as focal cortical dysplasia. Conclusions-The findings highlight the importance of dysembryoplastic neuroepithelial tumour in the pathogenesis of medically refractory lesional temporal lobe epilepsy and the prognostic significance of preoperative duration of epilepsy emphasises the need for early recognition and surgical treatment. Cognitive and behavioural dysfunction, however, is associated with a lower seizure remission rate, independent of duration of epilepsy. (J Neurol Neurosurg Psychiatry 2001;70:450-458)
Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome
Brain, 2004
Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the type of epilepsy most frequently operated on. The predictors for long-term seizure freedom after surgery of TLE-HS are unknown. In this study, we aimed to identify prognostic factors which predict the outcome 6 months and 2, 3 and 5 years after epilepsy surgery of TLE-HS. Our working hypothesis was that the prognostic value of potential predictors depended on the post-operative time interval for which the assessment was made. We included 171 patients (100 females and 71 males, aged 16-59 years) who had undergone presurgical evaluation, including video-EEG, who had had MRIdefined HS, and who had undergone temporal lobectomy. We found that secondarily generalized seizures (SGTCS) and ictal dystonia were associated with a worse 2-year outcome. Both these variables together with older age and longer epilepsy duration were also related to a worse 3-year outcome. Ictal limb dystonia, older age and longer epilepsy duration were associated with longterm surgical failure evaluated 5 years post-operatively. In order to determine the independent predictors of outcomes, we calculated multivariate analyses. The presence of SGTCS and ictal dystonia independently predicted the 2-year outcome. Longer epilepsy duration and ictal dystonia predicted the 3-year outcome. Longer epilepsy duration (P = 0.003) predicted a poor 5-year outcome. Conclusively, predictors for the long-term surgical results of TLE with HS are different from those variables that predict the short-term outcome. Epilepsy duration is the most important predictor for long-term surgical outcome. Our results strongly suggest that surgery for TLE-HS should be performed as early as possible.
Seizure-european Journal of Epilepsy, 2006
Objective: To compare the efficacy of medical and surgical treatment for refractory mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE). Methods: A prospective controlled non-randomized study of 26 patients with MTLE who underwent surgical treatment and 75 patients with MTLE who underwent medical treatment between August 2002 and October 2004. All patients failed to achieve seizure control with at least two first line antiepileptic drugs (AED) for partial seizures before entering the study. We used Kaplan-Meier survival analyses as a function of time of seizure recurrence to obtain estimates of 95% confident interval of seizure freedom and log-rank test to compare the status of seizure control between the two groups. Results: The cumulative proportion of patients free of all seizures (Engel's class IA) was higher in the surgical group (73%) compared to the clinical group (12%) ( p < 0.0001). In the surgical group, 2 of 26 patients (7.7%) had transient adverse effects and 2 of 26 patients (7.7%) had a permanent deficit related to the surgical procedure. In the clinical group 7 patients (9.3%) major adverse events during follow-up, including burns and status epilepticus. Conclusions: Surgical treatment for patients with MTLE who failed to achieve seizure control with two previous AED regimens was more efficient than medical treatment with further trials of AED.
Surgical outcome of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis
Epilepsia, 2008
Seizure outcome in mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) that was evaluated according to a noninvasive protocol was assessed in 165 patients and reported using both Engel's and ILAE classifications. The mean postoperative follow-up was 5.0 ± 2.7 years. At the end of first year, 77.1% of patients were in Engel-I, and 52.7% were in ILAE-I. Antiepileptic drugs (AEDs) were discontinued in 41 patients (42.7%), all remained seizure-free for >2 years that could be accepted as "cure." Thirty-six patients had recur-rences, 19 had running-down phenomena. Anterior temporal lobectomy (ATL) was performed in 27 patients with a better outcome when compared to patients operated by selective anterior hippocampectomy. Clinical risk factors for better and worse outcome, which show some similarity in different reports, seem to veil the main reason, which is the accurate delineation of epileptogenic zone considering the presence of different subgroups and underlying developmental pathologies.
Arquivos de Neuro-Psiquiatria, 2012
Epilepsia do lobo temporal com esclerose mesial temporal: o padrão da perda neuronal hipocampal como preditor do prognóstico cirúrgico Mesial 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 .
Journal of Neurosurgery, 2006
HE syndrome of MTLE/HS is the most common medically refractory epilepsy syndrome in adolescents and adults seen in epilepsy surgery programs. 14,16 Excellent surgical results in terms of seizure control and psychosocial rehabilitation have proven that MTLE/HS is a surgically remediable disorder. 14,44 Note, however, that the increasing ability to visualize the sclerotic hippocampus on MR imaging 2,12,20,21 and the evolving knowledge about the pathogenetic bases of MTLE/HS have raised questions about the best surgical approach to treat patients with refractory seizures. Particularly, it has been questioned whether the epileptogenic zone comprises both neocortical and mesial temporal structures or whether the latter are sufficient to generate the recurrent seizures in this disorder.
Temporal plus epilepsy is a major determinant of temporal lobe surgery failures
Brain : a journal of neurology, 2015
Reasons for failed temporal lobe epilepsy surgery remain unclear. Temporal plus epilepsy, characterized by a primary temporal lobe epileptogenic zone extending to neighboured regions, might account for a yet unknown proportion of these failures. In this study all patients from two epilepsy surgery programmes who fulfilled the following criteria were included: (i) operated from an anterior temporal lobectomy or disconnection between January 1990 and December 2001; (ii) magnetic resonance imaging normal or showing signs of hippocampal sclerosis; and (iii) postoperative follow-up ≥ 24 months for seizure-free patients. Patients were classified as suffering from unilateral temporal lobe epilepsy, bitemporal epilepsy or temporal plus epilepsy based on available presurgical data. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom over time. Predictors of seizure recurrence were investigated using Cox proportional hazards model. Of 168 patients included,...
Albanian journal of trauma and emergency surgery, 2023
Introduction; epilepsy is one of the most common neurological chronic disorders, with an estimated prevalence of 0. 5-1%. Partial focal epilepsy (Pe) is one of the most common types of epilepsies that originates from a relatively limited number of neurons, whose malfunction generates epileptic attacks. Partial focal epilepsies make up 60% of the whole spectrum of epilepsies. recent studies show that 25% of patient who suffer from Pe show a resistance against medication. the duration of symptoms on the one hand and aeD treatment on the other hand cause the cognitive dysfunctions in the patients suffering from epileptic seizures, especially children, to suffer progressive damage. Patients suffering from epilepsy have a cost that at the moment is difficult to calculate accurately, but it is still very high. Mesial temporal lobe seizures are the most common form of partial epileptic seizures originating in the temporal lobe, and they are frequently resistant to anti-epileptic drug treatment. Materials and Methods, at Neurosurgical Department, University Hospital "Mother theresa", since 2013 there is a team consisting of different medical specialists, for the study and selection of candidates, who can benefit from surgery. At the same time, since many years now in neurological department there is already a successful tradition in the medicament treatment of epilepsy. the team of medical doctors in our Department, which makes the treatment of these diseases by means of surgery, is made up of: neuro-epileptologist, radiologists, neurologists, psychologists and neurosurgeons. During the period, from 2013 until the year 2021, 35 patients have undergone an operation. all the patients were considered, based on protocols, as pharmacoresistant. Conclusions; the post-surgical results were 80% of the patient's seizure free and without need to use any antiepileptic treatment, meaning engel 1. 15% of the patients were seizure free but with the need of antiepileptic treatment and meaning engel 2 and 5% of patients were not able to be cured by achieving only a modification of the semiology of the crisis and frequency, meaning Engel 3. anterior temporal lobectomy in majority of the cases is the best surgical treatment of drug-resistant Hs-tLe and long-term seizure free patients in this group have been reported about 70% (62-83%).