Seizure outcome and pathological findings following temporal lobectomy in patients with complex partial seizures and foreign tissue lesions seen only on MRI

1994 ◽  
Vol 1 (1) ◽  
pp. 38-41 ◽  
Author(s):  
M.A. Murphy ◽  
G.C.A. Fabinyi ◽  
S.F. Berkovic ◽  
R.M. Kalnins ◽  
P.F. Bladin
Keyword(s):  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Pathological Findings ◽  
Partial Seizures ◽  
Complex Partial Seizures

Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders
Keyword(s):  
Temporal Lobe ◽  
Seizure Frequency ◽  
Compartment Model ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Lateral Structures

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)

Seizure Types and Frequency in Patients Who “Fail” Temporal Lobectomy for Intractable Epilepsy

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 838-844 ◽  
Author(s):  
Dario J. Englot ◽  
Anthony T. Lee ◽  
Catherine Tsai ◽  
Cathra Halabi ◽  
Nicholas M. Barbaro ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Seizure Type ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Generalized Seizures ◽  
Number Of Patients ◽  
Before And After

Abstract BACKGROUND: Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who “fail” surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does temporal lobectomy influence seizure type and frequency? OBJECTIVE: To characterize seizure types and frequencies before and after temporal lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures. METHODS: We performed a retrospective longitudinal cohort study examining patients undergoing temporal lobectomy for epilepsy at our institution from January 1995 to August 2010. RESULTS: Among 241 TLE patients who received temporal lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P < .01), with larger reductions in consciousness-impairing seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P < .001). Simple partial seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P < .001). Favorable seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P < .5). CONCLUSION: Given important clinical and mechanistic differences between seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.

scholarly journals Memory, Emotional and Vocational Impairments before and after Anterior Temporal Lobectomy for Complex Partial Seizures

Epilepsia ◽  
2006 ◽  
Vol 47 (11) ◽  
pp. 1922-1930 ◽  
Author(s):  
Mario F. Dulay ◽  
Michele K. York ◽  
Elizabeth M. Soety ◽  
Winifred J. Hamilton ◽  
Eli M. Mizrahi ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Anterior Temporal Lobectomy ◽  
Before And After

scholarly journals Complete remission of epileptic psychosis after temporal lobectomy: case report

2001 ◽  
Vol 59 (3B) ◽  
pp. 802-805 ◽  
Author(s):  
Renato Luiz Marchetti ◽  
Alexandre Garcia Tavares ◽  
Gary Gronich ◽  
Lia Arno Fiore ◽  
Renata Barbosa Ferraz
Keyword(s):  
Refractory Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Wada Test ◽  
Comprehensive Investigation ◽  
Complex Partial Seizures ◽  
Therapeutic Measure ◽  
Intensive Monitoring ◽  
Video Eeg

We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

Anterior temporal lobectomy for complex partial seizures: Evaluation, results, and long-term follow-up in 100 cases

Neurology ◽  
1990 ◽  
Vol 40 (3, Part 1) ◽  
pp. 413-413 ◽  
Author(s):  
T. S. Walczak ◽  
R. A. Radtke ◽  
J. O. McNamara ◽  
D. V. Lewis ◽  
J. S. Luther ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Anterior Temporal Lobectomy ◽  
Long Term Follow Up

scholarly journals Surgical and seizure outcome in children with DNETs who underwent epilepsy surgery

2015 ◽  
Vol 42 (S1) ◽  
pp. S22-S22
Author(s):  
AM Bueckert ◽  
J Pugh ◽  
T Snyder ◽  
M Wheatley ◽  
F Jacob ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Partial Seizures ◽  
Complex Partial Seizures

Background: Dysembryoblastic neuroepithelial tumors (DNETs) are benign tumors of the cerebral cortex that most commonly occur in children or young adults. Seizures are a frequent presenting feature, with an incidence of 80-100%, and are often an indication for surgical resection. Methods: We performed a retrospective chart review of children with DNETs who underwent epilepsy surgery between 1998 and 2014. Results: A total of 12 subjects were identified (6 males, 6 females), all of whom had seizures prior to surgical resection. Of these patients, 1 had infantile spasms, 2 had simple partial seizures and 10 had complex partial seizures. Tumors were located in the temporal (n=7), frontal (n=3) or parietal (n=2) cortex. These patients went on to have surgery on average 15 months after seizure onset, 3 had incomplete resections. At an average follow up of 6 years 4 months, all patients were class 1 on Engel’s Classification. All but one subject with rare non-disabling seizures were seizure free, with only 6 on medication. Follow up MR imaging revealed tumor recurrence in 1 subject. Conclusions: Despite differing seizure seminology and tumor location, surgical resection of these low-grade tumors resulted in excellent seizure outcome even in the setting of incomplete tumor resection.

Characteristics of auras in patients undergoing temporal lobectomy

2009 ◽  
Vol 111 (6) ◽  
pp. 1283-1289 ◽  
Author(s):  
Devin K. Binder ◽  
Paul A. Garcia ◽  
Ganesh K. Elangovan ◽  
Nicholas M. Barbaro
Keyword(s):  
Small Group ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Single Institution ◽  
Complex Partial Seizures ◽  
Large Patient Series ◽  
Large Patient ◽  
Increased Risk ◽  
Patient Series

Object Prior studies suggest that aura semiology may have localizing value. However, temporal lobe aura characteristics and response to surgery have not been studied in large patient series. Methods The authors retrospectively analyzed the case records of 182 patients undergoing temporal lobectomy for medically intractable epilepsy at a single institution. They analyzed the frequency and type of auras and seizures preoperatively, and at 3 months and 1 year after temporal lobectomy. Auras were divided into medial semiology (rising epigastric, olfactory/gustatory, experiential, and fear) and lateral semiology (auditory, somatosensory, and visual), or other. Results Of 182 patients, 150 were included in this study. The preoperative prevalence of auras was 77%. Multiple types of auras were present in 20% of patients. The most common aura was rising epigastric (26% of all auras). Postoperatively, auras were eliminated in 63% of patients at 3 months and in 64% at 1 year. Seventy-seven patients (51%) were seizure-free and aura-free, 22 (15%) were seizure-free with auras, 26 (17%) had seizures but no auras, and 25 (17%) had seizures with auras. Despite having their auras eliminated, 6.7% of patients continued to have complex partial seizures. Lateral temporal auras were more than twice as likely as medial temporal auras to persist after surgery (p < 0.002). Conclusions While the majority of patients in the authors' series became seizure- and aura-free, a significant minority still had persistent auras. Patients with lateral temporal auras appear to be at increased risk for having persistent postoperative auras. The discrepancy between aura and seizure outcomes results in a small group of patients having persistent seizures but losing their auras postoperatively.

scholarly journals Transient Hemifacial Sensory Loss with Xerophthalmia following Temporal Lobectomy

2000 ◽  
Vol 27 (3) ◽  
pp. 251-253 ◽  
Author(s):  
Ajith J. Thomas ◽  
Kost Elisevich ◽  
Brien Smith
Keyword(s):  
Temporal Lobe ◽  
Clinical Presentation ◽  
Nasal Congestion ◽  
Temporal Lobectomy ◽  
Sensory Loss ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Cavernous Malformations ◽  
Greater Superficial Petrosal Nerve ◽  
The Right

Objective and importance:The occurrence of a unilateral sensory loss in the second trigeminal distribution and the inability to tear following an ipsilateral temporal lobectomy has not been noted despite a number of reports of cranial nerve compromise under similar situations.Clinical presentation:A 48-year-old woman experienced complex partial seizures over three years attributable to the presence of cavernous malformations of the right temporal lobe.Intervention:An anterior temporal extrahippocampal resection was performed. The surgery was marked by the need for electrocoagulation of the dural base of the temporal lobe where numerous bleeding points were encountered. Postoperatively, the patient experienced an ipsilateral maxillary division sensory loss, absence of tearing, and diminished nasal congestion for an eight-month period until resolution.Conclusion:Injury of the fibers of the maxillary division of the trigeminal nerve and the adjacent greater superficial petrosal nerve appears to be the cause. No prior account of such an occurrence has been published.

scholarly journals Congenital porencephaly and hippocampal sclerosis

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1382-1388 ◽  
Author(s):  
S. S. Ho ◽  
R. I. Kuzniecky ◽  
F. Gilliam ◽  
E. Faught ◽  
M. Bebin ◽  
...  
Keyword(s):  
Hippocampal Formation ◽  
Hippocampal Sclerosis ◽  
Vascular Occlusion ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Perinatal Complications ◽  
Complex Partial Seizures ◽  
Intractable Seizures ◽  
Temporal Localization

We studied clinical features and seizure localization in 14 patients with porencephaly and intractable seizures. Perinatal complications were present in nine patients, childhood febrile convulsions in two, congenital hemiparesis in 12, and intellectual impairment in seven. Ten patients had psychoparetic complex partial seizures (CPS), three had sensorimotor simple partial seizures, and one had generalized tonic-clonic seizures. Surface EEG showed temporal onset in nine patients (one bitemporal) and extratemporal onset in four. MRI showed porencephaly in the distribution of the middle cerebral artery in eight patients, posterior cerebral in three, internal carotid in one, and multiple vessels in two. MR-based volumetry revealed hippocampal formation atrophy in 13 patients (eight unilateral and five bilateral) and amygdalar atrophy in 10 patients (nine unilateral and one bilateral). Hippocampal formation atrophy was concordant with CPS semiology in 10 patients (71%) and with EEG temporal localization in nine patients. Two patients had pathologic confirmation of mesial temporal sclerosis and were seizure free after temporal lobectomy. We conclude that mesial temporal sclerosis often coexists with porencephaly and is the likely seizure focus in the presence of concordant electro-clinical data. This recognition implies that effective surgical intervention can be offered to certain patients with porencephaly-related seizure disorders. The dual pathology and association with perinatal cerebral vascular occlusion suggest a common ischemic pathogenesis.

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