Preoperative depressive symptoms are not predictors of postoperative seizure control in patients with mesial temporal lobe epilepsy and hippocampal sclerosis

Objective Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis. Method We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50). Relapse-remitting pattern was defined as periods longer than two years of seizure-freedom intercalated with seizure recurrence. “Infrequent seizures” was considered as up to three seizures per year and “frequent seizures” as any period of seizures higher than that. Results Thirty-seven (30%) MTLE-HS and 18 (36%) MTLE-NL patients had relapse-remitting pattern (X2, p = 0.470). This was more common in those with infrequent seizures (X2, p < 0.001). Twelve MTLE-HS and one MTLE-NL patients had prolonged seizure remission between the first and second decade of life (X2, p = 0.06). Conclusion Similar proportion of MTLE-HS or MTLE-NL patients present relapse-remitting seizures and this occurs more often in those with infrequent seizures.

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Memory tests are not good predictors of surgical outcome in patients with mesial temporal Lobe epilepsy associated with hippocampal sclerosis

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492005000300003 ◽

2005 ◽

Vol 11 (3) ◽

pp. 127-130 ◽

Cited By ~ 1

Author(s):

Sara Escorsi-Rosset ◽

M Marino. Bianchin ◽

Roger Walz ◽

Vera C. Terra-Bustamante ◽

Carlos G. Carlotti Jr. ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Surgical Outcome ◽

Neuropsychological Tests ◽

Visual Memory ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Memory Tests ◽

Mesial Temporal Lobe

Introduction: One of the objectives of pre-surgical evaluation in mesial temporal epilepsy associated to hippoocampal sclerosis is the identification of patients with bad surgical prognosis for seizure control. At least theoretically, neuropsychological tests could be used in this venue. Objective: To evaluate whether verbal and visual memory tests can be used as isolate predictors of the post-surgical seizure outcome in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis refractory to pharmacological treatment. Methods: In a retrospective cohort study using the control of epileptic seizures as end-point, we evaluated 187 patients and calculated the correlation of clinical variables, cognitive evaluation, neuroimaging data, demographic data and electrophysiological findings with the result of seizure control after lobectomy in these patients. Results: An unfavorable prognosis during the postoperative period was observed only in association with low visual reproduction scores (visual memory). However, after Bonferroni correction, which was necessary to reduce the chance of type I error, this result was found to be spurious. Conclusion: We conclude that neuropsychological tests of verbal and visual memory such as those used in the routine presurgical evaluation of our patients with temporal lobe epilepsy are not good isolated predictors of surgical outcome.

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Faculty Opinions recommendation of Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736604573.793566615 ◽

2019 ◽

Author(s):

John Paul Leach

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe

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Stereotactic EEG-guided radiofrequency thermocoagulation versus anterior temporal lobectomy for mesial temporal lobe epilepsy with hippocampal sclerosis: study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05378-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yi-He Wang ◽

Si-Chang Chen ◽

Peng-Hu Wei ◽

Kun Yang ◽

Xiao-Tong Fan ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Controlled Trial ◽

Mesial Temporal Lobe Epilepsy ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe ◽

Randomised Controlled

Abstract Introduction In this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE. Methods and analysis STARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes. Discussion SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE. Trial registration ClinicalTrials.gov NCT03941613. Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

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A pioneering FreeSurfer volumetric study of a series of patients with mesial temporal lobe epilepsy and hippocampal sclerosis with comorbid depression

Psychiatry Research Neuroimaging ◽

10.1016/j.pscychresns.2021.111281 ◽

2021 ◽

pp. 111281

Author(s):

Nathália Stela Visoná de Figueiredo ◽

Larissa Botelho Gaça ◽

Idaiane Batista Assunção-Leme ◽

Lenon Mazetto ◽

Maria Teresa Fernandes Castilho Garcia ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Comorbid Depression ◽

Volumetric Study ◽

Mesial Temporal Lobe

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Mapping of the progressive metabolic changes occurring during the development of hippocampal sclerosis in a model of mesial temporal lobe epilepsy

Brain Research ◽

10.1016/s0006-8993(99)02092-2 ◽

2000 ◽

Vol 852 (2) ◽

pp. 255-262 ◽

Cited By ~ 24

Author(s):

Viviane Bouilleret ◽

Sylvette Boyet ◽

Christian Marescaux ◽

Astrid Nehlig

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Metabolic Changes ◽

Mesial Temporal Lobe

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Survival of mossy cells of the hippocampal dentate gyrus in humans with mesial temporal lobe epilepsy

Journal of Neurosurgery ◽

10.3171/2008.11.jns08779 ◽

2009 ◽

Vol 111 (6) ◽

pp. 1237-1247 ◽

Cited By ~ 17

Author(s):

László Seress ◽

Hajnalka Ábrahám ◽

Zsolt Horváth ◽

Tamás Dóczi ◽

József Janszky ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Dentate Gyrus ◽

Temporal Lobe ◽

Pyramidal Neurons ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Drug Resistant ◽

Hippocampal Dentate Gyrus ◽

Mossy Cells ◽

Mesial Temporal Lobe

Object Hippocampal sclerosis can be identified in most patients with mesial temporal lobe epilepsy (TLE). Surgical removal of the sclerotic hippocampus is widely performed to treat patients with drug-resistant mesial TLE. In general, both epilepsy-prone and epilepsy-resistant neurons are believed to be in the hippocampal formation. The hilar mossy cells of the hippocampal dentate gyrus are usually considered one of the most vulnerable types of neurons. The aim of this study was to clarify the fate of mossy cells in the hippocampus in epileptic humans. Methods Of the 19 patients included in this study, 15 underwent temporal lobe resection because of drug-resistant TLE. Four patients were used as controls because they harbored tumors that had not invaded the hippocampus and they had experienced no seizures. Histological evaluation of resected hippocampal tissues was performed using immunohistochemistry. Results Mossy cells were identified in the control as well as the epileptic hippocampi by using cocaine- and amphetamine-regulated transcript peptide immunohistochemistry. In most cases the number of mossy cells was reduced and thorny excrescences were smaller in the epileptic hippocampi than in controls; however, there was a significant loss of pyramidal cells and a partial loss of granule cells in the same epileptic hippocampi in which mossy cell loss was apparent. The loss of mossy cells could be correlated with the extent of hippocampal sclerosis, patient age at seizure onset, duration of epilepsy, and frequency of seizures. Conclusions In many cases large numbers of mossy cells were present in the hilus of the dentate gyrus when most pyramidal neurons of the CA1 and CA3 areas of the Ammon's horn were lost, suggesting that mossy cells may not be more vulnerable to epileptic seizures than the hippocampal pyramidal neurons.

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