scholarly journals Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

2014 ◽  
Vol 2014 ◽  
pp. 1-8
Author(s):  
Abdulaziz Alsemari ◽  
Faisal Al-Otaibi ◽  
Salah Baz ◽  
Ibrahim Althubaiti ◽  
Hisham Aldhalaan ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Research Centre ◽  
Mesial Temporal Sclerosis ◽  
Brain Scans ◽  
Temporal Epilepsy ◽  
Dual Pathology ◽  
Surgery Outcome ◽  
Postoperative Seizure

Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

scholarly journals Temporal Lobe Epilepsy Surgery Failures: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Adil Harroud ◽  
Alain Bouthillier ◽  
Alexander G. Weil ◽  
Dang Khoa Nguyen
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Sclerosis ◽  
Temporal Region ◽  
Incomplete Resection ◽  
Epileptogenic Zone ◽  
Temporal Epilepsy ◽  
Dual Pathology ◽  
Seizure Relapse ◽  
Temporal Structures

Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20–30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.

Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?

2009 ◽  
Vol 14 (3) ◽  
pp. 529-534 ◽  
Author(s):  
Ricardo Guarnieri ◽  
Roger Walz ◽  
Jaime E.C. Hallak ◽  
Érica Coimbra ◽  
Edna de Almeida ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Seizure Outcome ◽  
Psychiatric Comorbidities ◽  
Postoperative Seizure

scholarly journals A Review of the Epidemiology of Temporal Lobe Epilepsy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Jose F. Téllez-Zenteno ◽  
Lizbeth Hernández-Ronquillo
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Population Based ◽  
Common Type ◽  
Mesial Temporal Sclerosis ◽  
Healthy Individuals ◽  
Tertiary Referral ◽  
Future Studies ◽  
Temporal Epilepsy

Partial-onset epilepsies account for about 60% of all adult epilepsy cases, and temporal lobe epilepsy (TLE) is the most common type of partial epilepsy referred for epilepsy surgery and often refractory to antiepileptic drugs (AEDs). Little is known about the epidemiology of TLE, because it requires advanced neuroimaging, positive EEG, and appropriate clinical semiology to confirm the diagnosis. Moreover, recently recognized incidentally detected mesial temporal sclerosis in otherwise healthy individuals and benign temporal epilepsy indicate that the true epidemiology of TLE is underestimated. Our current knowledge on the epidemiology of TLE derives from data published from tertiary referral centers and/or inferred from population-based studies dealing with epilepsy. This article reviews the following aspects of the epidemiology of TLE: definitions, studies describing epidemiological rates, methodological observations, the interpretation of available studies, and recommendations for future studies.

scholarly journals Intractable Temporal Lobe Epilepsy (TLE) From Tuberculoma; Microneurosurgical Management of by Amygdalohippocampectomy with Lesionectomy Plus Standard Anterior Temporal lobectomy: A Case Report and Short Review of Literature

2019 ◽  
Vol 16 (2) ◽  
pp. 106-109
Author(s):  
Forhad Hossain Chowdhury ◽  
Mohammod Raziul Haque ◽  
AFM Momtazul Haque
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Venous Malformation ◽  
Intractable Epilepsy ◽  
Complex Partial Seizure ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Low Grade ◽  
Presenting Symptoms

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report a case of surgically treated TLE that was due to a large tuberculoma in medial temporal lobe. Intractable epilepsy caused by tuberculoma is rare. The only presenting symptoms was Complex partial seizure (Psychomotor epilepsy) for which the patient underwent scalp EEG (Electro Encephalography) and MRI (Magnetic resonance imaging) of brain. The patient was managed by amygdalohippocampectomy with lesionectomy plus standard anterior lobectomy. Postoperatively she was on anti-tubercular therapy and on carbamazepine. The case was seizure and disease free till last follow up. Journal of Surgical Sciences (2012) Vol. 16 (2) : 106-109

Transorbital endoscopic amygdalohippocampectomy: a feasibility investigation

2014 ◽  
Vol 120 (6) ◽  
pp. 1428-1436 ◽  
Author(s):  
H. Isaac Chen ◽  
Leif-Erik Bohman ◽  
Laurie A. Loevner ◽  
Timothy H. Lucas
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Hippocampal Formation ◽  
Clinical Investigation ◽  
Temporal Cortex ◽  
Intractable Epilepsy ◽  
Direct Access ◽  
Surgical Approaches ◽  
Mesial Temporal Sclerosis ◽  
Orbital Wall

Object Resection of the hippocampus is the standard of care for medically intractable epilepsy in patients with mesial temporal sclerosis. Although temporal craniotomy in this setting is highly successful, the procedure carries certain immutable risks and may be associated with cognitive deficits related to cortical and white matter disruption. Alternative surgical approaches may reduce some of these risks by preserving the lateral temporal lobe. This study examined the feasibility of transorbital endoscopic amygdalohippocampectomy (TEA) as an alternative to open craniotomy in cadaveric specimens. Methods TEA dissections were performed in 4 hemispheres from 2 injected cadaveric specimens fixed in alcohol. Quantitative predictions of the limits of exposure based on predissection imaging were compared with intradissection measurements. The extent of resection and angles of exposure during the dissection and on postdissection imaging were recorded. These measurements were validated with MRI studies from 10 epilepsy patients undergoing standard surgical evaluations. Results The transorbital approach permitted direct access to the mesial temporal structures through the lateral orbital wall. Up to 97% of the hippocampal formation was resected with no brain retraction and minimal (mean 6.0 ± 1.4 mm) globe displacement. Lateral temporal lobe white matter tracts were preserved. Conclusions TEA permits hippocampectomy comparable to standard surgical approaches without disrupting the lateral temporal cortex or white matter. This novel approach is feasible in cadaveric specimens and warrants clinical investigation in carefully selected cases.

Principles of Invasive EEG

2018 ◽  
pp. 19-25
Author(s):  
Samden D. Lhatoo ◽  
Nuria Lacuey ◽  
Philippe Ryvlin
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Focal Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Cortical Dysplasia ◽  
Palliative Surgery ◽  
Mesial Temporal Sclerosis ◽  
Choice Of Technique ◽  
Inappropriate Choice

The growing requirement for invasive EEG in presurgical evaluation of intractable focal epilepsy has been driven largely by the increasing complexity of epilepsy surgery cases. Extratemporal surgeries now exceed anterior temporal lobe resections for mesial temporal sclerosis, and the proportion of patients undergoing invasive EEGs has significantly increased. Half of all patients undergoing stereotactic EEG (SEEG) evaluations are MRI-negative (usually with focal cortical dysplasia type 1 or 2) and a third are reoperations for failed resective or palliative surgery. Certain principles guide the decision to use invasive EEG and the choice of invasive EEG technique. SEEG has distinct advantages, as do subdural grid evaluations and intraoperative corticography. The consequences of loose hypotheses in the decision to invasively evaluate a patient, and of inappropriate choice of technique, include poor seizure outcomes after surgery, morbidity, and mortality. This chapter discusses the guiding principles for invasive studies of the human epileptic brain.

Long-term Seizure Outcome in Reoperation after Failure of Epilepsy Surgery

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 873-880 ◽  
Author(s):  
Jorge A. González-Martínez ◽  
Teeradej Srikijvilaikul ◽  
Dileep Nair ◽  
William E. Bingaman
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Cortical Dysplasia ◽  
Categorical Variables ◽  
Seizure Outcome ◽  
Mesial Temporal Sclerosis ◽  
Long Term Outcome ◽  
The Relationship

Abstract OBJECTIVE Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. METHODS We performed a retrospective consecutive analysis of patients who underwent reoperative procedures because of medically intractable epilepsy at our institution from 1990 to 2001. Seventy patients underwent reoperative epilepsy surgery, with 57 patients having a minimum follow-up period of 2 years. We assessed the relationship between seizure outcome and categorical variables using χ2 and Fisher's exact tests, and the relationship between outcome and continuous variables using a Wilcoxon rank-sum test. Statistical significance was set at a P value of 0.05. RESULTS Of the 57 patients (29 male and 28 female patients), the age of seizure onset ranged from 3 months to 39 years (mean, 10.7 ± 10.3 yr; median, 7 yr). The mean age at reoperation was 24.7 ± 12 years (range, 4–50 yr). The interval between first and second resection was 7 days to 16 years. The follow-up period ranged from 24 to 228 months (mean, 128 mo; mode, 132 mo). Seizure outcome was classified according to Engel's classification. Fifty-two percent of the patients had a favorable outcome (38.6% were Class I and 14.0% were Class II). Patients with tumors as their initial pathology had better outcome compared with patients with focal cortical dysplasia and mesial temporal sclerosis (P < 0.05). CONCLUSION Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.

scholarly journals Preoperative prediction of temporal lobe epilepsy surgery outcome

2016 ◽  
Vol 127 ◽  
pp. 331-338 ◽  
Author(s):  
Daniel M. Goldenholz ◽  
Alexander Jow ◽  
Omar I. Khan ◽  
Anto Bagić ◽  
Susumu Sato ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Surgery Outcome ◽  
Preoperative Prediction
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