Seizure Types and Frequency in Patients Who “Fail” Temporal Lobectomy for Intractable Epilepsy

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 838-844 ◽  
Author(s):  
Dario J. Englot ◽  
Anthony T. Lee ◽  
Catherine Tsai ◽  
Cathra Halabi ◽  
Nicholas M. Barbaro ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Seizure Type ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Generalized Seizures ◽  
Number Of Patients ◽  
Before And After

Abstract BACKGROUND: Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who “fail” surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does temporal lobectomy influence seizure type and frequency? OBJECTIVE: To characterize seizure types and frequencies before and after temporal lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures. METHODS: We performed a retrospective longitudinal cohort study examining patients undergoing temporal lobectomy for epilepsy at our institution from January 1995 to August 2010. RESULTS: Among 241 TLE patients who received temporal lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P < .01), with larger reductions in consciousness-impairing seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P < .001). Simple partial seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P < .001). Favorable seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P < .5). CONCLUSION: Given important clinical and mechanistic differences between seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.

scholarly journals Memory, Emotional and Vocational Impairments before and after Anterior Temporal Lobectomy for Complex Partial Seizures

Epilepsia ◽  
2006 ◽  
Vol 47 (11) ◽  
pp. 1922-1930 ◽  
Author(s):  
Mario F. Dulay ◽  
Michele K. York ◽  
Elizabeth M. Soety ◽  
Winifred J. Hamilton ◽  
Eli M. Mizrahi ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Anterior Temporal Lobectomy ◽  
Before And After

Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders
Keyword(s):  
Temporal Lobe ◽  
Seizure Frequency ◽  
Compartment Model ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Lateral Structures

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)

Characteristics of auras in patients undergoing temporal lobectomy

2009 ◽  
Vol 111 (6) ◽  
pp. 1283-1289 ◽  
Author(s):  
Devin K. Binder ◽  
Paul A. Garcia ◽  
Ganesh K. Elangovan ◽  
Nicholas M. Barbaro
Keyword(s):  
Small Group ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Single Institution ◽  
Complex Partial Seizures ◽  
Large Patient Series ◽  
Large Patient ◽  
Increased Risk ◽  
Patient Series

Object Prior studies suggest that aura semiology may have localizing value. However, temporal lobe aura characteristics and response to surgery have not been studied in large patient series. Methods The authors retrospectively analyzed the case records of 182 patients undergoing temporal lobectomy for medically intractable epilepsy at a single institution. They analyzed the frequency and type of auras and seizures preoperatively, and at 3 months and 1 year after temporal lobectomy. Auras were divided into medial semiology (rising epigastric, olfactory/gustatory, experiential, and fear) and lateral semiology (auditory, somatosensory, and visual), or other. Results Of 182 patients, 150 were included in this study. The preoperative prevalence of auras was 77%. Multiple types of auras were present in 20% of patients. The most common aura was rising epigastric (26% of all auras). Postoperatively, auras were eliminated in 63% of patients at 3 months and in 64% at 1 year. Seventy-seven patients (51%) were seizure-free and aura-free, 22 (15%) were seizure-free with auras, 26 (17%) had seizures but no auras, and 25 (17%) had seizures with auras. Despite having their auras eliminated, 6.7% of patients continued to have complex partial seizures. Lateral temporal auras were more than twice as likely as medial temporal auras to persist after surgery (p < 0.002). Conclusions While the majority of patients in the authors' series became seizure- and aura-free, a significant minority still had persistent auras. Patients with lateral temporal auras appear to be at increased risk for having persistent postoperative auras. The discrepancy between aura and seizure outcomes results in a small group of patients having persistent seizures but losing their auras postoperatively.

scholarly journals Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

2021 ◽  
Author(s):  
Valeri Borger ◽  
Motaz Hamed ◽  
Inja Ilic ◽  
Anna-Laura Potthoff ◽  
Attila Racz ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Temporal Lobectomy ◽  
Secondary Outcome ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Secondary Outcome Measure ◽  
Total Resection ◽  
Class 1 ◽  
Postoperative Seizure ◽  
The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

scholarly journals Etiology of epilepsy a prospective study of 210 cases

1991 ◽  
Vol 49 (3) ◽  
pp. 251-254 ◽  
Author(s):  
Walter Oleschko Arruda
Keyword(s):  
Ct Scan ◽  
Neurological Examination ◽  
Epileptic Seizures ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Blood Tests ◽  
Generalized Seizures ◽  
A Prospective Study ◽  
Csf Examination

The objective of this study was to establish the etiology of epilepsy in 210 chronic epileptics (110 female, 100 male), aged 14-82 years (34.2±13.3). Patients less than 10 years-old and alcoholism were excluded. All underwent neurological examination, routine blood tests, EEG and CT-scan. Twenty patients (10.5%) were submitted to spinal tap for CSF examination. Neurological examination was abnormal in 26 (12.4%), the EEG in 68 (45.5%), and CT-scan in 93 (44.3%). According to the International Classification of Epileptic Seizures (1981), 101 (48.1%) have generalized seizures, 66 (31.4%) partial seizures secondarily generalized, 25 (11.8%) simple partial and complex partial seizures, and 14 (6.6%) generalized and partial seizures. Four patients (2.0%) could not be classified. In 125 (59.5%) patients the etiology was unknown. Neurocysticercosis accounted for 57 (27.1%) of cases, followed by cerebrovascular disease 8 (3.8%), perinatal damage 5 (2.4%), familial epilepsy 4 (1.9%), head injury 4 (1.9%), infective 1 (0.5%), and miscelanea 6 (2.8%).

Cyclic Vomiting and Recurrent Abdominal Pains as Migraine or Epileptic Equivalents*

Cephalalgia ◽  
1983 ◽  
Vol 3 (2) ◽  
pp. 115-118 ◽  
Author(s):  
G. Lanzi ◽  
U. Balottin ◽  
A. Ottolini ◽  
F. Rosano Burgio ◽  
E. Fazzi ◽  
...  
Keyword(s):  
The Other ◽  
Periodic Syndrome ◽  
Age Group ◽  
Pediatric Age ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Pediatric Age Group ◽  
Generalized Seizures ◽  
Epileptic Disorder ◽  
Cyclic Vomiting

A retrospective method was used to estimate the incidence of recurring motion-sickness, cyclic vomiting and abdominal pain considered as different manifestations of a so-called periodic syndrome in 100 migraine sufferers, 100 epileptics and 100 control subjects in the pediatric age group. Such recurrent symptoms are significantly more frequent in those suffering from migraine than in the other two groups. Examination of subgroups of patients affected by particular forms of migraine (classical and common) and of epilepsy (generalized seizures, simple partial seizures, complex partial seizures) contributed little new to our understanding of the nature of periodic syndrome. It is concluded that the above symptoms of periodic syndrome should generally be considered as manifestations of a migrainous rather than of an epileptic disorder.

scholarly journals Brain Mechanisms of Altered Consciousness in Focal Seizures

2011 ◽  
Vol 24 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Andrew P. Bagshaw ◽  
Andrea E. Cavanna
Keyword(s):  
Brain Function ◽  
Fundamental Issue ◽  
Partial Seizures ◽  
Altered Consciousness ◽  
Main Criterion ◽  
Central Concept ◽  
Complex Partial Seizures ◽  
Focal Seizures ◽  
Generalized Seizures ◽  
The Brain

Consciousness is a central concept in epileptology, relevant to the understanding of both focal and generalized seizures. Within focal seizures, impairment of consciousness has long been considered as the main criterion differentiating complex partial seizures (CPS) from simple partial seizures With the development of improved tools for investigating human brain function, new insights into the brain mechanisms of altered consciousness in CPS have become available. This paper reviews the existing literature on how the currently available methods can be used to address the fundamental issue of how CPS alter consciousness.

Seizures

2018 ◽  
Author(s):  
Dirk Bäumer
Keyword(s):  
Differential Diagnosis ◽  
Neuronal Activity ◽  
Brain Region ◽  
Diagnostic Tests ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Focal Seizures ◽  
Generalized Seizures ◽  
The Brain

Seizures are transient neurological events caused by abnormal excessive or synchronous neuronal activity in the brain. This can arise from a localized brain region, causing focal seizures, or simultaneously from both hemispheres, leading to generalized seizures. Epilepsy is the tendency to develop recurrent seizures and is usually diagnosed after two or more unprovoked seizures. This chapter covers simple partial seizures (sometimes called aura), complex partial seizures, and focal (or partial) seizures, their differential diagnosis, context, approach to diagnosis, key diagnostic tests, therapy, and prognosis, as well as dealing with uncertainty in a diagnosis.

scholarly journals Complete remission of epileptic psychosis after temporal lobectomy: case report

2001 ◽  
Vol 59 (3B) ◽  
pp. 802-805 ◽  
Author(s):  
Renato Luiz Marchetti ◽  
Alexandre Garcia Tavares ◽  
Gary Gronich ◽  
Lia Arno Fiore ◽  
Renata Barbosa Ferraz
Keyword(s):  
Refractory Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Wada Test ◽  
Comprehensive Investigation ◽  
Complex Partial Seizures ◽  
Therapeutic Measure ◽  
Intensive Monitoring ◽  
Video Eeg

We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

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