Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery

ABSTRACT OBJECTIVE Meyer's loop, the most vulnerable part of the optic radiations during approaches to the temporomedial region, extends to the tip of the temporal horn and is often encountered in epilepsy surgery. The risk of damaging Meyer's loop during transsylvian selective amygdalohippocampectomy peaks while accessing the temporal horn through its roof by opening the inferior limiting sulcus of the insula. In this prospective study, we sought to evaluate and identify the incidence of visual field deficits in a homogeneous group of patients who had temporal lobe epilepsy with hippocampal sclerosis and who underwent transsylvian selective amygdalohippocampectomy. METHODS We studied 30 patients who were referred for epilepsy surgery for intractable complex partial and/or secondary generalized seizures and evaluated according to a noninvasive protocol. All patients underwent selective amygdalohippocampectomy for temporal lobe epilepsy with hippocampal sclerosis using the standard transsylvian approach. Visual field deficits were examined preoperatively in 30 patients, by either a confrontation method (n = 18) or standard Goldmann perimetry (n = 12) and postoperatively in all patients using standard Humphrey digital perimetry. RESULTS Visual field examination was normal in all patients before surgery. Humphrey perimetric measurement revealed visual field deficits in 11 patients (36.6%) after surgery. CONCLUSION We have shown that there is a considerable risk of having visual field deficits after standard transsylvian selective amygdalohippocampectomy owing to the interruption of the anterior bundle of the optic radiation fibers, which most likely occurs while opening the temporal horn through the inferior limiting sulcus of the insula.

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TEMPORAL GAP BETWEEN THE DIAGNOSIS OF DRUG RESISTANT TEMPORAL LOBE EPILEPSY ASSOCIATED WITH HIPPOCAMPAL SCLEROSIS AND INDICATION OF EPILEPSY SURGERY

Frente Diagnóstica e Terapêutica na Neurologia ◽

10.22533/at.ed.57820280128 ◽

2020 ◽

pp. 174-175

Author(s):

Bárbara Pina Aiello ◽

Brenno Tavares de Vasconcelos Brandão ◽

Claudia Cecília da Silva Rêgo ◽

Valeria Coelho Santa Rita Pereira ◽

Tiago Silva Aguiar ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Drug Resistant

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

Brain ◽

10.1093/brain/awv372 ◽

2015 ◽

Vol 139 (2) ◽

pp. 444-451 ◽

Cited By ~ 86

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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Determination of the Initial Abnormal Discharge Site in Temporal Lobe Epilepsy Through Combined EEG and Neuroimaging. What Is Next?

Frontiers in Neurology ◽

10.3389/fneur.2021.798228 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ana A. Rentería-Palomo ◽

Jose L. Montes-Ochoa ◽

Adriana Martinez-Mayorga ◽

Jorge Guillermo Reyes-Vaca ◽

Ildefonso Rodríguez-Leyva

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Latin American ◽

Epilepsy Surgery ◽

Comprehensive Evaluation ◽

Hippocampal Sclerosis ◽

Hippocampal Atrophy ◽

Significant Difference ◽

The Relationship

Objective: The objective of this study was to determine the relationship between atrophy of the hippocampus and severity of epilepsy in patients with temporal lobe epilepsy (TLE) as the first step to evaluate the possibility of surgery for epilepsy and analyze why patients cannot undergo epilepsy surgery.Methods: Volumetric MRI of the hippocampus was performed in 51 consecutive patients (29 men; mean age 40) with TLE. TLE diagnosis, lateralization, and severity (mild, moderate, severe) of seizures were based on a comprehensive evaluation that included neurologic examination and EEG in all patients. Patients with evidence of a lesion other than hippocampal sclerosis were not included in the study. We assessed the relationship between hippocampal volumes and electrophysiological evidence of seizure severity.Results: According to the affected side based on the EEG, a statistically significant difference (p < 0.001) in volume and a positive correlation between epilepsy and hippocampal atrophy were found.Conclusion: Our results confirm that volume loss to the hippocampus in patients with TLE correlates with the severity of epilepsy based on the EEG. Therefore, surgical treatment is considered early when hippocampal atrophy is evident in patients with refractory TLE. However, in Latin American countries, it is a challenge to get a patient to undergo epilepsy surgery. Therefore, we try to analyze the sad situation in our hospital.

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Advanced [18F]FDG and [11C]flumazenil PET analysis for individual outcome prediction after temporal lobe epilepsy surgery for hippocampal sclerosis

NeuroImage Clinical ◽

10.1016/j.nicl.2014.11.013 ◽

2015 ◽

Vol 7 ◽

pp. 122-131 ◽

Cited By ~ 11

Author(s):

J. Yankam Njiwa ◽

K.R. Gray ◽

N. Costes ◽

F. Mauguiere ◽

P. Ryvlin ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Outcome Prediction ◽

Hippocampal Sclerosis ◽

Individual Outcome ◽

18F Fdg

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Hippocampal Sclerosis Associated Temporal Lobe Epilepsy Surgery in the Setting of Neurofibromatosis

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqw159.081 ◽

2016 ◽

Vol 146 (suppl_1) ◽

Author(s):

Jordan Gales ◽

Richard Prayson

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis

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Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery

Epilepsy Research ◽

10.1016/j.eplepsyres.2015.02.013 ◽

2015 ◽

Vol 112 ◽

pp. 76-83 ◽

Cited By ~ 11

Author(s):

Pedro V.F. Naves ◽

Luís Otávio S.F. Caboclo ◽

Henrique Carrete ◽

Bruno V. Kelmann ◽

Larissa B. Gaça ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Long Term Prognosis

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Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment?

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492009000200008 ◽

2009 ◽

Vol 15 (2) ◽

pp. 89-93 ◽

Cited By ~ 4

Author(s):

Neide Barreira Alonso ◽

Auro Mauro Azevedo ◽

Ricardo Silva Centeno ◽

Laura M. F. Ferreira Guilhoto ◽

Luis Otávio Sales Ferreira Caboclo ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Before And After ◽

Mesial Temporal Lobe

PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9%) it remained unchanged, in six (10.3%) it improved, and one patient (1.7%), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5%) were seizure-free, seven (31.8%) had only rare auras, and five (22.7%) had seizures. In the group of improvement, 12 patients (70.5%) had no-formal employment and five (29.5%) had a formal job before surgery. After three years, 14 (63.6%) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of life measured by ESI-55, before and after surgical evaluation. CONCLUSION: Our study demonstrated in a homogeneous group of MTLE with HS, a modest, but positive relationship between surgical outcome and work gain, and that QOL had strong correlation with the fact of being employed.

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