Clobazam as Add-on Therapy for Temporal Lobe Epilepsy and Hippocampal Sclerosis

Background:Clobazam is a benzodiazepine with known antiepileptic action; however, it is not considered first line therapy in the treatment of epilepsy. The objective of this study was to evaluate the efficacy of clobazam as add-on therapy in adults with temporal lobe epilepsy associated with MRI evidence of hippocampal sclerosis (HS).Method:This is a retrospective study, conducted at our epilepsy clinic which evaluated clobazam as add-on therapy in patients with temporal lobe epilepsy and MRI signs of HS. Clobazam was prescribed based on the minimum effective dose up to the maximum tolerated dose.Results:Seventy-eight patients met the inclusion criteria (51 women), ages ranging from 16 to 76 years old (mean=42.2). Dosage of clobazam ranged from 5 to 60 mg/day (mean=22.6 mg/day). Clobazam was used from one month to eight years (mean=29 months). Sixteen (20.5%) patients were seizure-free, 20 (25.5%) had more than 75% improvement in seizure control, eight (10%) had more than 50% and 20 (26%) were non responders to clobazam. In 14 (18%) we could not determine seizure frequency during follow-up. The improvement in seizure control lasted for more than one year in 30 (68%) patients.Conclusion:Our data suggest that clobazam should be considered as add-on therapy in the treatment of patients with temporal lobe epilepsy associated with MRI signs of HS.

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Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140199 ◽

2015 ◽

Vol 73 (2) ◽

pp. 79-82 ◽

Cited By ~ 10

Author(s):

Ana Carolina Coan ◽

Brunno M. Campos ◽

Felipe P.G Bergo ◽

Bruno Y. Kubota ◽

Clarissa L. Yasuda ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Similar Proportion ◽

Seizure Freedom ◽

Seizure Recurrence ◽

Prolonged Seizure ◽

Mesial Temporal Lobe

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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Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis

Journal of Neurosurgery ◽

10.3171/jns.2006.104.1.70 ◽

2006 ◽

Vol 104 (1) ◽

pp. 70-78 ◽

Cited By ~ 108

Author(s):

Eliseu Paglioli ◽

André Palmini ◽

Mirna Portuguez ◽

Eduardo Paglioli ◽

Ney Azambuja ◽

...

Keyword(s):

Temporal Lobe ◽

Verbal Memory ◽

Seizure Control ◽

Hippocampal Sclerosis ◽

Surgical Techniques ◽

Mesial Temporal Lobe Epilepsy ◽

Outcome Data ◽

Temporal Lobectomy ◽

Selective Amygdalohippocampectomy

Object The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA). Methods Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05). Conclusions Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.

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PHARMACORESISTENT TEMPORAL LOBE & EXTRA TEMPORAL EPILEPSY: OUTCOMES AFTER SURGERY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1952 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Govind Mangal ◽

Uday Bhaumik ◽

Giriraj Prajapati ◽

Poojan Thakor

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Age Of Onset ◽

Hippocampal Sclerosis ◽

Temporal Lobectomy ◽

Temporal Epilepsy ◽

Post Surgery ◽

Study Population ◽

The Mean

Background: Our aim was to follow up patients postoperatively to identify seizure remission and relapse after surgery, to enable individuals considering surgery to make informed choices. Methods: Ninteen consecutive patients operated for drug resistant Temporal lobe & extra temporal lobe epilepsy between 2019 and 2020, at our centre. All the patients had at least one year post surgery follow-up. Results: The mean age of study population was 20.87 ± 10.08 years. The mean age of onset of epilepsy in study population was 14.9 ± 8 years. There were no acute post operative seizures. The most common histpathological finding was hippocampal sclerosis in 15 patients. The patients were followed up and 15 were in the class 1 of engel classification. 2 in class 2, rest had one each Conclusion: Following surgery approx half of patients were seizure free and Engel's favourable outcome was noted. The predictors of unfavourable outcome were younger age of onset and pronged duration and of epilepsy Keywords: Temporal lobe epilepsy, temporal lobectomy, amygdalohippocampectomy, outcome, extra temporal lobe epilepsy, extra temporal lobectomy

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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 randomized controlled trial

10.21203/rs.3.rs-56665/v1 ◽

2021 ◽

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

Abstract Introduction: In this report, we aim to describe the design for the randomized 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 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. Disscussion: SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual filed 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 a higher levels of clinical evidence for the treatment for mTLE. Trial registration: The STARTS protocol has been registered on the US National Institutes of Health (ClinicalTrials.gov): NCT03941613. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

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Electrical Stimulation of Subiculum for the Treatment of Refractory Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis: A 2-Year Follow-Up Study

Stereotactic and Functional Neurosurgery ◽

10.1159/000510295 ◽

2020 ◽

pp. 1-8

Author(s):

Daruni Vázquez-Barrón ◽

Manola Cuéllar-Herrera ◽

Francisco Velasco ◽

Ana Luisa Velasco

Keyword(s):

Electrical Stimulation ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Open Label ◽

Anticonvulsive Effect ◽

Mesial Temporal Lobe ◽

Stimulation Of

Introduction: Evidence has been provided that the subiculum may play an important role in the generation of seizures. Electrical stimulation at this target has been reported to have anticonvulsive effects in kindling and pilocarpine rat models, while in a clinical study of hippocampal deep brain stimulation (DBS), contacts closest to the subiculum were associated with a better anticonvulsive effect. Objectives: To evaluate the effect of electrical stimulation of the subiculum in patients with refractory mesial temporal lobe epilepsy (MTLE) who have hippocampal sclerosis (HS). Methods: Six patients with refractory MTLE and HS, who had focal impaired awareness seizures (FIAS) and focal to bilateral tonic-clonic seizures (FBTCS), had DBS electrodes implanted in the subiculum. During the first month after implantation, all patients were OFF stimulation, then they all completed an open-label follow-up of 24 months ON stimulation. DBS parameters were set at 3 V, 450 µs, 130 Hz, cycling stimulation 1 min ON, 4 min OFF. Results: There was a mean reduction of 49.16% (±SD 41.65) in total seizure number (FIAS + FBTCS) and a mean reduction of 67.93% (±SD 33.33) in FBTCS at 24 months. FBTCS decreased significantly with respect to baseline, starting from month 2 ON stimulation. Conclusions: Subiculum stimulation is effective for FBTCS reduction in patients with MTLE and HS, suggesting that the subiculum mediates the generalization rather than the genesis of mesial temporal lobe seizures. Better results are observed at longer follow-up times.

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Longer epilepsy duration and multiple lobe involvement predict worse seizure outcomes for patients with refractory temporal lobe epilepsy associated with neurocysticercosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150175 ◽

2015 ◽

Vol 73 (12) ◽

pp. 1014-1018 ◽

Cited By ~ 3

Author(s):

Lucas Crociati Meguins ◽

Rodrigo Antônio Rocha da Cruz Adry ◽

Sebastião Carlos da Silva Júnior ◽

Carlos Umberto Pereira ◽

Jean Gonçalves de Oliveira ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Surgical Outcomes ◽

Hippocampal Sclerosis ◽

Class I ◽

Tertiary Center ◽

One Year ◽

Patients With Epilepsy ◽

Retrospective Investigation

ABSTRACT Objective To investigate the surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) and neurocysticercosis (NCC). Methods A retrospective investigation of patients with TLE-HS was conducted in a tertiary center. Results Seventy-nine (62.2%), 37 (29.1%), 6 (4.7%), and 5 (3.9%) patients were Engel class I, II, III, and IV, respectively. Fifty-two (71.2%) patients with epilepsy durations ≤ 10 years prior to surgery were seizure-free 1 year after the operation compared to 27 (50.0%) patients with epilepsy durations > 10 years (p = 0.0121). Forty-three (72.9%) patients with three or fewer lobes affected by NCC were seizure-free one year after the operation, and 36 (52.9%) patients with more than three involved lobes were seizure-free after surgery (p = 0.0163). Conclusions Longer epilepsy durations and multiple lobe involvement predicted worse seizure outcomes in TLE-HS plus NCC patients.

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An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2012-304038 ◽

2013 ◽

Vol 84 (7) ◽

pp. 800-805 ◽

Cited By ~ 44

Author(s):

M. Hemb ◽

A. Palmini ◽

E. Paglioli ◽

E. B. Paglioli ◽

J. Costa da Costa ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Seizure Outcome

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Temporal plus epilepsy is a major determinant of temporal lobe surgery failures

Brain ◽

10.1093/brain/awv372 ◽

2015 ◽

Vol 139 (2) ◽

pp. 444-451 ◽

Cited By ~ 86

Author(s):

Carmen Barba ◽

Sylvain Rheims ◽

Lorella Minotti ◽

Marc Guénot ◽

Dominique Hoffmann ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Cox Proportional Hazards Model ◽

Temporal Lobectomy ◽

Seizure Freedom ◽

Epileptogenic Zone ◽

Anterior Temporal Lobectomy

Abstract See Engel (doi:10.1093/awv374) for a scientific commentary on this article. 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, 108 (63.7%) underwent stereoelectroencephalography, 131 (78%) had hippocampal sclerosis, 149 suffered from unilateral temporal lobe epilepsy (88.7%), one from bitemporal epilepsy (0.6%) and 18 (10.7%) from temporal plus epilepsy. The probability of Engel class I outcome at 10 years of follow-up was 67.3% (95% CI: 63.4–71.2) for the entire cohort, 74.5% (95% CI: 70.6–78.4) for unilateral temporal lobe epilepsy, and 14.8% (95% CI: 5.9–23.7) for temporal plus epilepsy. Multivariate analyses demonstrated four predictors of seizure relapse: temporal plus epilepsy (P < 0.001), postoperative hippocampal remnant (P = 0.001), past history of traumatic or infectious brain insult (P = 0.022), and secondary generalized tonic-clonic seizures (P = 0.023). Risk of temporal lobe surgery failure was 5.06 (95% CI: 2.36–10.382) greater in patients with temporal plus epilepsy than in those with unilateral temporal lobe epilepsy. Temporal plus epilepsy represents a hitherto unrecognized prominent cause of temporal lobe surgery failures. In patients with temporal plus epilepsy, anterior temporal lobectomy appears very unlikely to control seizures and should not be advised. Whether larger resection of temporal plus epileptogenic zones offers greater chance of seizure freedom remains to be investigated.

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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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Analysis of Reoperation in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis

Neurosurgery ◽

10.1227/neu.0b013e3181fdf8f8 ◽

2011 ◽

Vol 68 (1) ◽

pp. 89-97 ◽

Cited By ~ 14

Author(s):

Reinhard. Schulz ◽

Matthias. Hoppe ◽

Frank. Boesebeck ◽

Csilla. Gyimesi ◽

Heinz W. Pannek ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Incomplete Resection ◽

T2 Relaxometry ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Mesial Temporal Lobe

Abstract BACKGROUND: Most patients do well after epilepsy surgery for mesial temporal lobe sclerosis, and in only 8 to 12% of all operations, the outcome is classified as not improved. OBJECTIVE: To analyze the outcome of reoperation in cases of incomplete resection of mesial temporal lobe structures in patients with mesial temporal lobe sclerosis in temporal lobe epilepsy. METHODS: We analyzed 22 consecutive patients who underwent reoperation for mesial temporal lobe sclerosis (follow-up, 23-112 months; mean, 43.18 months) by evaluating noninvasive electroencephalographic/video monitoring before the first and second surgeries (semiology, interictal epileptiform discharges, ictal electroencephalography with special attention to the secondary contralateral evolution of the electroencephalographic seizure pattern after the initial regionalization), and magnetic resonance imaging (resection indices after the first and second surgeries on the amygdala, hippocampus, lateral temporal lobe). In 18 of 22 patients T2 relaxometry of the contralateral hippocampus was performed. RESULTS: Nine of 22 patients became seizure free; another 4 patients had a decrease in seizures and eventually became seizure free (range, 16-51 months; mean, 30.3). Recurrence of seizures is associated with (1) ictal electroencephalography with later evolution of an independent pattern over the contralateral temporal lobe (0 of 5 patients seizure free vs 5 of 7 patients non–seizure free; P = .046) and (2) a smaller amount of lateral temporal lobe resection in the second surgery (1.06 ± 0.59 cm vs 2.18 ± 1.37 cm; P = .019). No significant correlation with outcome was found for lateralization of interictal epileptiform discharges, change in semiology, other resection indices, T2 relaxometry, onset and duration of epilepsy, duration of follow-up, and side of surgery. CONCLUSION: Patients have a less favorable outcome with a reoperation if they show ictal scalp electroencephalography with secondary contralateral propagation and if only a small second resection of the lateral temporal lobe is performed.

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