New Horizons in Temporal Lobe Seizure Control

A patient with classic temporal lobe seizure semiology may present with aura, automatisms, and dystonic posturing. Video-electroencephalography (EEG) may identify the ictal onset and magnetoencephalography may further elucidate the anatomy of a temporal lobe abnormality, EEG dipoles, epileptogenic spike sources, and eloquent areas of language or motor function. Structural imaging of the temporal lobe with magnet resonance imaging (MRI) should also be obtained, as well as functional and metabolic imaging such as a subtraction single-photon emission computed tomography (SPECT) and interictal positron emission tomography (PET). Early surgery should be considered in pediatric patients for seizure control, to minimize the adverse effects of anti-epileptic drugs, maximize the child’s developmental potential, and reduce behavioral, cognitive and psychosocial problems. Intraoperative stereotactic navigation and electrocorticography (ECoG) can guide resection. Careful pre-operative planning for correct extent of surgery is key to the best possible seizure outcome.

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Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy

Journal of Neurosurgery ◽

10.3171/2018.4.jns184 ◽

2019 ◽

Vol 131 (3) ◽

pp. 781-789 ◽

Cited By ~ 1

Author(s):

Ching-Yi Lee ◽

Han-Tao Li ◽

Tony Wu ◽

Mei-Yun Cheng ◽

Siew-Na Lim ◽

...

Keyword(s):

Adverse Effects ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Seizure Frequency ◽

Seizure Control ◽

Mesial Temporal Lobe Epilepsy ◽

Temporary Increase ◽

Drug Resistant ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe

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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Seizure Control of Current Shunt on Rats with Temporal Lobe Epilepsy and Neocortical Epilepsy

PLoS ONE ◽

10.1371/journal.pone.0086477 ◽

2014 ◽

Vol 9 (1) ◽

pp. e86477 ◽

Cited By ~ 1

Author(s):

Limin Zhang ◽

Shuli Liang ◽

Guojun Zhang ◽

Zhizhong Liu ◽

Hong Lv ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Seizure Control ◽

Neocortical Epilepsy ◽

Current Shunt

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Electroclinical Analysis of Postictal Noserubbing

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

10.1017/s0317167100052239 ◽

2000 ◽

Vol 27 (2) ◽

pp. 131-136 ◽

Cited By ~ 14

Author(s):

Richard Wennberg

Keyword(s):

Temporal Lobe ◽

Seizure Onset ◽

Scalp Eeg ◽

Autonomic Activation ◽

Ictal Activity ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Temporal Lobe Seizure ◽

Intracranial Electrodes ◽

Video Eeg

ABSTRACT:Background:Postictal noserubbing (PIN) has been identified as a good, albeit imperfect, lateralizing and localizing sign in human partial epilepsy, possibly related to ictal autonomic activation.Methods:PIN was studied prospectively in a group of consecutive patients admitted for video-EEG monitoring, with the laterality of noserubbing correlated with electrographic sites of seizure onset, intra- and interhemispheric spread, and sites of seizure termination.Results:PIN was significantly more frequent in temporal than extratemporal epilepsy (p<0.001; 23/41 (56%) patients and 41/197 (21%) seizures in temporal lobe epilepsy compared with 4/34 (12%) patients and 12/167 (7%) seizures in extratemporal epilepsy). The hand used to rub the nose was ipsilateral to the side of seizure onset in 83% of both temporal and extratemporal seizures. Seizures with contralateral PIN correlated with spread to the contralateral temporal lobe on scalp EEG (p<0.04). All extratemporal seizures with PIN showed spread to temporal lobe structures. One patient investigated with intracranial electrodes showed PIN only when ictal activity spread to involve the amygdala: seizures confined to the hippocampus were not associated with PIN. PIN was not observed in 63 nonepileptic events in 17 patients. Unexpectedly, one patient with primary generalized epilepsy showed typical PIN after 1/3 recorded absence seizures.Conclusions:This study confirms PIN as a good indicator of ipsilateral temporal lobe seizure onset. Instances of false lateralization and localization appear to reflect seizure spread to contralateral or ipsilateral temporal lobe structures, respectively. Involvement of the amygdala appears to be of prime importance for induction of PIN.

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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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Three-dimensional hippocampal atrophy maps distinguish two common temporal lobe seizure-onset patterns

Epilepsia ◽

10.1111/j.1528-1167.2008.01881.x ◽

2009 ◽

Vol 50 (6) ◽

pp. 1361-1370 ◽

Cited By ~ 52

Author(s):

Jennifer A. Ogren ◽

Anatol Bragin ◽

Charles L. Wilson ◽

Gil D. Hoftman ◽

Jack J. Lin ◽

...

Keyword(s):

Temporal Lobe ◽

Three Dimensional ◽

Hippocampal Atrophy ◽

Seizure Onset ◽

Temporal Lobe Seizure

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Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Neurosurgical FOCUS ◽

10.3171/2011.12.focus11318 ◽

2012 ◽

Vol 32 (3) ◽

pp. E9 ◽

Cited By ~ 18

Author(s):

Fernando L. Vale ◽

Glen Pollock ◽

Selim R. Benbadis

Keyword(s):

Systematic Review ◽

Failure Rate ◽

Temporal Lobe ◽

Seizure Control ◽

Mesial Temporal Sclerosis ◽

Detailed Knowledge ◽

Review Of The Literature ◽

Temporal Lobe Seizures ◽

Cause Of Failure ◽

Mesial Temporal Lobe

Object The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis. Methods A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates. Results Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings. Conclusions The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.

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