Mood Disorder, ‘Pre-ictal’ Psychosis and Temporal Lobe Damage

1990 ◽  
Vol 157 (3) ◽  
pp. 441-444 ◽  
Author(s):  
Bankole A. Johnson ◽  
Lachlan B. Campbell

A patient with an abnormality in the right temporal lobe presented with episodes of mania many years before the clinical manifestation of both a simple partial seizure and complex partial seizures.

Author(s):  
Ajith J. Thomas ◽  
Kost Elisevich ◽  
Brien Smith

Objective and importance:The occurrence of a unilateral sensory loss in the second trigeminal distribution and the inability to tear following an ipsilateral temporal lobectomy has not been noted despite a number of reports of cranial nerve compromise under similar situations.Clinical presentation:A 48-year-old woman experienced complex partial seizures over three years attributable to the presence of cavernous malformations of the right temporal lobe.Intervention:An anterior temporal extrahippocampal resection was performed. The surgery was marked by the need for electrocoagulation of the dural base of the temporal lobe where numerous bleeding points were encountered. Postoperatively, the patient experienced an ipsilateral maxillary division sensory loss, absence of tearing, and diminished nasal congestion for an eight-month period until resolution.Conclusion:Injury of the fibers of the maxillary division of the trigeminal nerve and the adjacent greater superficial petrosal nerve appears to be the cause. No prior account of such an occurrence has been published.


Author(s):  
Richard Wennberg ◽  
Sukriti Nag ◽  
Mary-Pat McAndrews ◽  
Andres M. Lozano ◽  
Richard Farb ◽  
...  

A 24-year-old woman was referred because of incompletely-controlled complex partial seizures. Her seizures had started at age 21, after a mild head injury with brief loss of consciousness incurred in a biking accident, and were characterized by a sensation of bright flashing lights in the right visual field, followed by numbness and tingling in the right foot, spreading up the leg and to the arm, ultimately involving the entire right side, including the face. Occasionally they spread further to involve right facial twitching with jerking of the right arm and leg, loss of awareness and, at the onset of her epilepsy, rare secondarily generalized convulsions. Seizure frequency averaged three to four per month. She was initially treated with phenytoin and clobazam and subsequently changed to carbamazepine 800 milligrams per day. She also complained that her right side was no longer as strong as her left and that it was also numb, especially the leg, but felt that this weakness had stabilized or improved slightly over the past two years.


Neurology ◽  
2003 ◽  
Vol 60 (4) ◽  
pp. 538-547 ◽  
Author(s):  
J. Engel ◽  
S. Wiebe ◽  
J. French ◽  
M. Sperling ◽  
P. Williamson ◽  
...  

Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures by systematic review and analysis of the literature since 1990.Results: One intention-to-treat Class I randomized, controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available.Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.


Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)


2000 ◽  
Vol 38 (2-3) ◽  
pp. 133-138 ◽  
Author(s):  
Yushi Inoue ◽  
Tadahiro Mihara ◽  
Kazumi Matsuda ◽  
Takayasu Tottori ◽  
Toshiaki Otsubo ◽  
...  

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Eduard Bercovici ◽  
Balagobal Santosh Kumar ◽  
Seyed M. Mirsattari

Complex partial seizures (CPSs) can present with various semiologies, while mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of CPS, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. This paper provides a comprehensive review of the diagnostic workup, particularly the application of recent advances in electroencephalography and functional brain imaging, in neocortical temporal lobe epilepsy.


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