Clinical and Neuroimaging Features of Good and Poor Seizure Control Patients with Mesial Temporal Lobe Epilepsy and Hippocampal Atrophy

OBJECTIVERadiofrequency thermocoagulation (RFTC), which has been developed for drug-resistant epilepsy patients, involves less brain tissue loss due to surgery, fewer surgical adverse effects, and generally good seizure control. This study demonstrates the effectiveness of RFTC performed at limited hippocampal locations.METHODSDaily seizure diaries were prospectively maintained for at least 6 months by 9 patients (ages 30–59 years) with drug-resistant mesial temporal lobe epilepsy (MTLE) before treatment with RFTC. The limited target for stereotactic RFTC was chosen based on intraoperative electroencephalography (EEG) recording and was initially tested with a Radionics electrode at a low temperature, 45°C, for 60 seconds. The therapeutic RFTC heating parameters were 78°C–80°C for 90 seconds. All patients who received the RFTC treatment underwent both MRI and EEG recording immediately postoperatively and at the 3-month follow-up. Monthly outpatient clinic visits were arranged over 6 months to document seizure frequency and severity to clarify the changes noted in imaging studies and EEG patterns.RESULTSTwo patients were excluded from our analysis because one had undergone multiple seizure surgeries and the other had a poor recording of seizure frequency, before the RFTC surgery. Five and two patients underwent left-sided and right-sided RFTC, respectively. None of the patients had generalized tonic-clonic attacks postoperatively, and no adverse effects or complications occurred. According to MRI data, the effect of coagulation was limited to less than 1.0 cm in diameter and perifocal edema was also in limited range. The seizure frequency within 6 months decreased postoperatively with a mean reduction in seizures of 78% (range 36%–100%). Only two patients had a temporary increase in seizure frequency within 2 weeks of the surgery, and over 50% of all patients showed a decrease in average seizure frequency.CONCLUSIONSThe study results confirm that limited RFTC provides a more effective surgery with similar seizure control but fewer complications than resective surgery for drug-resistant MTLE patients.

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Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes

Journal of Neurosurgery ◽

10.3171/2013.6.jns13244 ◽

2013 ◽

Vol 119 (5) ◽

pp. 1098-1104 ◽

Cited By ~ 18

Author(s):

Takehiro Uda ◽

Michiharu Morino ◽

Hirotaka Ito ◽

Noriaki Minami ◽

Atsushi Hosono ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Verbal Memory ◽

Memory Function ◽

Mesial Temporal Lobe Epilepsy ◽

Hippocampal Atrophy ◽

Delayed Recall ◽

Nonverbal Memory ◽

Mesial Temporal Lobe ◽

The Right

Object Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed; rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure. Methods Thirty-seven patients with MTLE (18 men and 19 women; age range 9–63 years; 19 with surgery on the right side and 18 with surgery on the left side; seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale–Revised. Patients underwent evaluation of the memory function before and after surgery (6 months–1 year). Results Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively). Conclusions Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis.

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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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Hippocampal atrophy and T2-weighted signal changes in familial mesial temporal lobe epilepsy

Neurology ◽

10.1212/wnl.60.3.405 ◽

2003 ◽

Vol 60 (3) ◽

pp. 405-409 ◽

Cited By ~ 69

Author(s):

E. Kobayashi ◽

M.D. D'Agostino ◽

I. Lopes-Cendes ◽

S.F. Berkovic ◽

M.L. Li ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Hippocampal Atrophy ◽

Mesial Temporal Lobe ◽

Signal Changes

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Voxel-Based Morphometry—from Hype to Hope. A Study on Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy

American Journal of Neuroradiology ◽

10.3174/ajnr.a6545 ◽

2020 ◽

Vol 41 (6) ◽

pp. 987-993

Author(s):

F. Riederer ◽

R. Seiger ◽

R. Lanzenberger ◽

E. Pataraia ◽

G. Kasprian ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Mesial Temporal Lobe Epilepsy ◽

Hippocampal Atrophy ◽

Voxel Based Morphometry ◽

Mesial Temporal Lobe

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Segregation analysis in mesial temporal lobe epilepsy with hippocampal atrophy

Epilepsia ◽

10.1111/j.1528-1167.2009.02445.x ◽

2010 ◽

Vol 51 ◽

pp. 47-50 ◽

Cited By ~ 3

Author(s):

Rodrigo Secolin ◽

Claudia Maurer-Morelli ◽

Fernando Cendes ◽

Iscia Lopes-Cendes

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Segregation Analysis ◽

Mesial Temporal Lobe Epilepsy ◽

Hippocampal Atrophy ◽

Mesial Temporal Lobe

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Structural Abnormalities are Similar in Familial and Nonfamilial Mesial Temporal Lobe Epilepsy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100003462 ◽

2004 ◽

Vol 31 (3) ◽

pp. 368-372 ◽

Cited By ~ 7

Author(s):

Fabio Thadeu Ferreira ◽

Eliane Kobayashi ◽

Iscia Lopes-Cendes ◽

Fernando Cendes

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Visual Analysis ◽

Mesial Temporal Lobe Epilepsy ◽

Control Group ◽

Hippocampal Atrophy ◽

Anterior Temporal Lobe ◽

Temporal Lobes ◽

Mesial Temporal Lobe ◽

Lobe Atrophy

Background/Objective:Diffuse temporal lobe abnormalities can be observed on MRI of patients with mesial temporal lobe epilepsy (MTLE). Our objective was to perform qualitative and quantitative analyses of temporal lobe structures in patients with familial MTLE (FMTLE) and nonfamilial MTLE.Methods:Two groups of patients were ascertained: 67 FMTLE patients (14 with refractory seizures) and 30 patients with nonfamilial refractory MTLE. We performed qualitative analyses of MRI (with multiplanar reconstruction) and volumes of hippocampi and anterior temporal lobes in all patients, and in a normal control group of 23 individuals. We used the Chi-square test and ANOVA for statistical analyses.Results:We identified anterior temporal lobe abnormalities by visual analysis in only 4% of FMTLE patients and atrophy of the anterior temporal lobe by volumetric analysis in 19%. In the group of nonfamilial MTLE patients we found anterior temporal lobe abnormalities by visual analysis in 17% of patients and anterior temporal lobe atrophy in 13%. Hippocampal atrophy was present in 90% of FMTLE and in 83% of nonfamilial MTLE. No signs of cortical dysplasia were observed.Conclusion:Anterior temporal lobe atrophy and other abnormalities outside the mesial portion of temporal lobes were infrequent in both familial and nonfamilial MTLE patients. Despite the genetic basis, hippocampal atrophy in FMTLE is not associated with other abnormalities outside the mesial temporal regions.

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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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