Seizure Outcome After Ipsitemporal Reoperation in Pharmacoresistant Temporal Lobe Epilepsy Patients With Hippocampal Sclerosis and Nonspecific Pathology

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Jugoslav Ivanović ◽  
Kristin Åshild Alfstad ◽  
Pål Bache Marthinsen ◽  
Ketil Berg Olsen ◽  
Pål Gunnar Larsson ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Surgical Complications ◽  
Postoperative Morbidity ◽  
Hippocampal Sclerosis ◽  
Neurological Impairment ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Before And After ◽  
Repeated Surgery

ABSTRACT BACKGROUND Treatment of patients with pharmacoresistant temporal lobe epilepsy with hippocampal sclerosis and nonspecific pathology who failed initial resection is challenging, although selected patients may benefit from repeated surgery. OBJECTIVE To determine seizure outcome, postoperative morbidity, and possible predictors of seizure freedom after repeated ipsitemporal resection. METHODS We reviewed the results of comprehensive epilepsy evaluations performed before the initial and repeated resections in 10 patients with hippocampal sclerosis and 13 with nonspecific pathology. We assessed the Engel classification of seizure outcome 2 yr after repeated resection, evaluated postoperative morbidity, and examined the association of epilepsy and surgical characteristics with seizure freedom before and after reoperation. RESULTS After reoperation, in patients with hippocampal sclerosis, seizure freedom (Engel class I) was achieved in 2 (20%), 1 (10%) experienced surgical complications, and 1 (10%) experienced permanent neurological impairment. Following reoperation in patients with nonspecific pathology, seizure freedom was achieved in 1 (8%), 3 (23%) experienced surgical complications, and 4 (31%) experienced permanent neurological impairment. Epilepsy and surgical characteristics before and after reoperation were not associated with seizure freedom. CONCLUSION Patients with hippocampal sclerosis and nonspecific pathology who underwent a comprehensive initial work-up and failed original temporal lobe resection rarely become seizure-free after repeated ipsitemporal reoperation. Reoperations carry a high risk of surgical complications and neurological impairment. Predictors for seizure freedom could not be defined.

scholarly journals Temporal pole abnormalities detected by 3 T MRI in temporal lobe epilepsy due to hippocampal sclerosis: No influence on seizure outcome after surgery

Seizure ◽  
2017 ◽  
Vol 48 ◽  
pp. 74-78 ◽  
Author(s):  
Sara Casciato ◽  
Angelo Picardi ◽  
Alfredo D’Aniello ◽  
Marco De Risi ◽  
Giovanni Grillea ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Seizure Outcome ◽  
Temporal Pole

Association Between Anatomical Location of Surgically Induced Lesions and Postoperative Seizure Outcome in Temporal Lobe Epilepsy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013033
Author(s):  
Ezequiel Gleichgerrcht ◽  
Daniel L. Drane ◽  
Simon Sean Keller ◽  
Kathryn A. Davis ◽  
Robert Gross ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Anterior Commissure ◽  
Piriform Cortex ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Anatomical Location ◽  
Surgical Interventions ◽  
Postoperative Seizure ◽  
Promising Source

Objective:To determine the association between surgical lesions of distinct grey and white structures and connections with favorable post-operative seizure outcomes.Methods:Patients with drug-resistant temporal lobe epilepsy (TLE) from three epilepsy centers were included. We employed a voxel-based and connectome-based mapping approach to determine the association between favorable outcomes and surgery-induced temporal lesions. Analyses were conducted controlling for multiple confounders, including total surgical resection/ablation volume, hippocampal volumes, side of surgery, and site where the patient was treated.Results:The cohort included 113 patients with TLE [54 women; 86 right-handed; 16.5 (SD = 11.9) age at seizure onset, 54.9% left] who were 61.1% free of disabling seizures (Engel class 1) at follow-up. Postoperative seizure freedom in TLE was associated with 1) surgical lesions that targeted the hippocampus as well as the amygdala-piriform cortex complex and entorhinal cortices; 2) disconnection of temporal, frontal, and limbic regions through loss of white matter tracts within the uncinate fasciculus, anterior commissure, and fornix; and 3) functional disconnection of the frontal (superior and middle frontal gyri, orbitofrontal region) and temporal (superior and middle pole) lobes.Conclusions:Better postoperative seizure freedom are associated with surgical lesions of specific structures and connections throughout the temporal lobes. These findings shed light on the key components of epileptogenic networks in TLE and constitute a promising source of new evidence for future improvements in surgical interventions.Classification of Evidence:This study provides Class II evidence that for patients with temporal lobe epilepsy, postoperative seizure freedom is associated with surgical lesions of specific temporal lobe structures and connections.

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

2015 ◽  
Vol 73 (2) ◽  
pp. 79-82 ◽  
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.

scholarly journals Hippocampal internal architecture and postoperative seizure outcome in temporal lobe epilepsy due to hippocampal sclerosis

Seizure ◽  
2016 ◽  
Vol 35 ◽  
pp. 65-71 ◽  
Author(s):  
Samia Elkommos ◽  
Bernd Weber ◽  
Pitt Niehusmann ◽  
Elisa Volmering ◽  
Mark P. Richardson ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Seizure Outcome ◽  
Postoperative Seizure ◽  
Internal Architecture

Resection of Temporal Neocortex During Multiple Hippocampal Transections for Mesial Temporal Lobe Epilepsy Does not Affect Seizure or Memory Outcome

2017 ◽  
Vol 13 (6) ◽  
pp. 711-717 ◽  
Author(s):  
Fady Girgis ◽  
Madeline E Greil ◽  
Philip S Fastenau ◽  
Jennifer Sweet ◽  
Hans Lüders ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Visual Memory ◽  
Mesial Temporal Lobe Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Visual Spatial ◽  
Mesial Temporal Lobe ◽  
Postoperative Seizure ◽  
Temporal Neocortex

Abstract BACKGROUND Multiple hippocampal transection (MHT) is a surgical treatment for mesial temporal lobe epilepsy associated with improved postoperative neuropsychological outcomes compared with lobectomy. OBJECTIVE To determine whether resection of the amygdala and anterior temporal neocortex during MHT affects postoperative seizure/memory outcome. METHODS Seventeen patients with normal magnetic resonance imaging and stereo-electroencephalogram-proven drug-resistant dominant mesial temporal lobe epilepsy were treated with MHT. Nine patients underwent MHT alone (MHT–) and 8 patients underwent MHT plus removal of the amygdala and anterior 4.5 cm of temporal neocortex lateral to the fusiform gyrus (MHT+). Verbal and visual-spatial memory were assessed in all patients preoperatively and in 14 patients postoperatively using the Wechsler Memory Scale. Postoperative seizure control was assessed at 12 months for all patients. RESULTS Overall, 11 of 17 patients (64.7%) were Engel class 1 at 1 year (6/9 MHT–, 5/8 MHT+, P = .38), and 10 of 14 patients (71.4%) had no significant postoperative decline in either verbal or visual memory (6/8 MHT–, 4/6 MHT+, P = .42). Verbal memory declined in 2 of 8 MHT– and 1 of 6 MHT+ patients, and visual memory declined in 1 of 8 MHT– and 2 of 6 MHT+ patients. Two patients had improved visual memory postoperatively, both in the MHT+ group. CONCLUSION MHT on the dominant side is associated with high rates of seizure freedom and favorable memory preservation outcomes regardless of the extent of neocortical resection. Preservation of the temporal neocortex and amygdala during MHT does not appear to decrease the risk of postoperative memory decline, nor does it alter seizure outcome.

scholarly journals Temporal pole abnormalities in temporal lobe epilepsy with hippocampal sclerosis: Clinical significance and seizure outcome after surgery

Seizure ◽  
2015 ◽  
Vol 32 ◽  
pp. 84-91 ◽  
Author(s):  
Giancarlo Di Gennaro ◽  
Alfredo D’Aniello ◽  
Marco De Risi ◽  
Giovanni Grillea ◽  
Pier Paolo Quarato ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Clinical Significance ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Seizure Outcome ◽  
Temporal Pole

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

2013 ◽  
Vol 84 (7) ◽  
pp. 800-805 ◽  
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

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

Brain ◽  
2015 ◽  
Vol 139 (2) ◽  
pp. 444-451 ◽  
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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