scholarly journals Temporal Lobe Epilepsy Surgery Failures: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Adil Harroud ◽  
Alain Bouthillier ◽  
Alexander G. Weil ◽  
Dang Khoa Nguyen
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Sclerosis ◽  
Temporal Region ◽  
Incomplete Resection ◽  
Epileptogenic Zone ◽  
Temporal Epilepsy ◽  
Dual Pathology ◽  
Seizure Relapse ◽  
Temporal Structures

Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20–30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.

scholarly journals A Review of the Epidemiology of Temporal Lobe Epilepsy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Jose F. Téllez-Zenteno ◽  
Lizbeth Hernández-Ronquillo
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Population Based ◽  
Common Type ◽  
Mesial Temporal Sclerosis ◽  
Healthy Individuals ◽  
Tertiary Referral ◽  
Future Studies ◽  
Temporal Epilepsy

Partial-onset epilepsies account for about 60% of all adult epilepsy cases, and temporal lobe epilepsy (TLE) is the most common type of partial epilepsy referred for epilepsy surgery and often refractory to antiepileptic drugs (AEDs). Little is known about the epidemiology of TLE, because it requires advanced neuroimaging, positive EEG, and appropriate clinical semiology to confirm the diagnosis. Moreover, recently recognized incidentally detected mesial temporal sclerosis in otherwise healthy individuals and benign temporal epilepsy indicate that the true epidemiology of TLE is underestimated. Our current knowledge on the epidemiology of TLE derives from data published from tertiary referral centers and/or inferred from population-based studies dealing with epilepsy. This article reviews the following aspects of the epidemiology of TLE: definitions, studies describing epidemiological rates, methodological observations, the interpretation of available studies, and recommendations for future studies.

scholarly journals Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

2014 ◽  
Vol 2014 ◽  
pp. 1-8
Author(s):  
Abdulaziz Alsemari ◽  
Faisal Al-Otaibi ◽  
Salah Baz ◽  
Ibrahim Althubaiti ◽  
Hisham Aldhalaan ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Research Centre ◽  
Mesial Temporal Sclerosis ◽  
Brain Scans ◽  
Temporal Epilepsy ◽  
Dual Pathology ◽  
Surgery Outcome ◽  
Postoperative Seizure

Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

scholarly journals Occult focal cortical dysplasia may predict poor outcome of surgery for drug-resistant mesial temporal lobe epilepsy

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257678
Author(s):  
Arkadiusz Nowak ◽  
Aleksandra Bala
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Focal Cortical Dysplasia ◽  
Mesial Temporal Lobe Epilepsy ◽  
Cortical Dysplasia ◽  
Class I ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Dual Pathology ◽  
Mesial Temporal Lobe

Purpose The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. Methods We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005–2016, and correlated factors associated with seizure relapse. Results At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. Conclusions The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.

scholarly journals Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report

2001 ◽  
Vol 59 (2A) ◽  
pp. 255-258 ◽  
Author(s):  
Eliane Kobayashi ◽  
Carlos A.M. Guerreiro ◽  
Fernando Cendes
Keyword(s):  
Case Report ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Late Onset ◽  
Mesial Temporal Sclerosis ◽  
Temporal Region ◽  
Partial Seizures ◽  
Mri Scan ◽  
Multiple Cysts ◽  
New Onset

The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. CONCLUSIONS: This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.

scholarly journals COMPARISION OF QUANTITATIVE AND QUALITITATIVE ASSESSMENT OF MRI IN DIAGNOSING HIPOCAMPAL ATROPHY AMONG CASES OF TEMPORAL EPILEPSY.

2019 ◽  
Vol 26 (07) ◽  
pp. 1009-1013
Author(s):  
Abdul Raouf ◽  
Saba Jehangir ◽  
Asma Shoukat ◽  
Muhammad Ahsan
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Visual Assessment ◽  
The Body ◽  
Temporal Lobectomy ◽  
Radiology Department ◽  
Mesial Temporal Sclerosis ◽  
Hippocampal Atrophy ◽  
Temporal Epilepsy ◽  
Coronal Section

Mesial temporal sclerosis (MTS) is the most common pathology in patients undergoing anterior temporal lobectomy. Magnetic resonance imaging (MRI) is valuable in detecting MTS. Reduced hippocampal volume and elevated T2 signal are associated with MTS, and both quantitative T2 and volumetric measurementshave been associated with hippocampal cellular loss that characterizes this condition. Objectives: To determine the accuracy of hippocampal quantitative (T2 relaxometric) assessment in diagnosing hippocampal atrophy in patients with temporal lobe epilepsy by comparing it with qualitative (visual) assessment on MRI. Study Design: Cross sectional study. Setting: Radiology department of Allied Hospital Faisalabad. Period: 12 months from theapproval from Sep, 2016 to Dec, 2017. Subjects & Methods: After taking permission from hospital ethical committee, and written informed consent, patients with history of temporal lobe epilepsy and EEG findings consistent with temporal lobe epilepsy were examined on 1.5 Tesla Achieva philips scanner, visual assessment and T2 relaxometry. Section of the hippocampus head was defined as the first in which it was possible to see the temporal horn of the lateral ventricle and therefore to appropriately separate the hippocampal formation from the amygdala. The body of the hippocampus defined in the fourth coronal section after the region of interest of the hippocampus head, and the tail was defined in the third coronal section after the hippocampus body, in which it is also possible to visualize the quadrigeminal plate (section of 5mm).Visually the images were assessed and MRI examination was done. All the data was collected on a performa. Results: We concluded that the frequency of accuracy of hippocampal quantitative (t2 relaxometric) assessment in diagnosing hippocampal atrophy in patients with temporal lobe epilepsy by comparing it with qualitative (visual) assessment on MRIis high but needs validation through some-other studies. Conclusion: We concluded that the frequency of accuracy of hippocampal quantitative (t2 relaxometric) assessment in diagnosing hippocampal atrophy in patients with temporal lobe epilepsy by comparing it with qualitative (visual) assessment on MRI is high but needs validation through some-other studies. 

scholarly journals Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy

2012 ◽  
Vol 70 (12) ◽  
pp. 945-952 ◽  
Author(s):  
Luís Otávio Sales Ferreira Caboclo ◽  
Rafael Scarpa Neves ◽  
Anaclara Prada Jardim ◽  
Ana Paula Andrade Hamad ◽  
Ricardo Silva Centeno ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Response To Treatment ◽  
Mesial Temporal Sclerosis ◽  
Epileptogenic Zone ◽  
Postmortem Studies ◽  
Extensive Information ◽  
Long Term Prognosis ◽  
The Brain

Pathology studies in epilepsy patients bring useful information for comprehending the physiopathology of various forms of epilepsy, as well as aspects related to response to treatment and long-term prognosis. These studies are usually restricted to surgical specimens obtained from patients with refractory focal epilepsies. Therefore, most of them pertain to temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and malformations of cortical development (MCD), thus providing information of a selected group of patients and restricted regions of the brain. Postmortem whole brain studies are rarely performed in epilepsy patients, however they may provide extensive information on brain pathology, allowing the analysis of areas beyond the putative epileptogenic zone. In this article, we reviewed pathology studies performed in epilepsy patients with emphasis on neuropathological findings in TLE with MTS and MCD. Furthermore, we reviewed data from postmortem studies and discussed the importance of performing these studies in epilepsy populations.

scholarly journals Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

2021 ◽  
Vol 22 (8) ◽  
pp. 3860
Author(s):  
Elisa Ren ◽  
Giulia Curia
Keyword(s):  
Animal Models ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Focal Epilepsy ◽  
Ex Vivo ◽  
Hippocampal Sclerosis ◽  
Control Group ◽  
Epileptogenic Zone ◽  
Epileptiform Discharges

Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.

scholarly journals Extrahippocampal temporal lobe atrophy in temporal lobe epilepsy and mesial temporal sclerosis

Brain ◽  
2001 ◽  
Vol 124 (1) ◽  
pp. 167-175 ◽  
Author(s):  
N. F. Moran ◽  
L. Lemieux ◽  
N. D. Kitchen ◽  
D. R. Fish ◽  
S. D. Shorvon
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Sclerosis ◽  
Lobe Atrophy
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