Comparison of Autonomic Function before and after Surgical Intervention in Patients with Temporal Lobe Epilepsy

OBJECTIVEEpilepsy surgery is the recommended treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). This method offers a good chance of seizure freedom but carries a considerable risk of postoperative language impairment. The extremely variable neurocognitive profiles in surgical epilepsy patients cannot be fully explained by extent of resection, fiber integrity, or current task-based functional MRI (fMRI). In this study, the authors aimed to investigate pathology- and surgery-triggered language organization in TLE by using fMRI activation and network analysis as well as considering structural and neuropsychological measures.METHODSTwenty-eight patients with unilateral TLE (16 right, 12 left) underwent T1-weighted imaging, diffusion tensor imaging, and task-based language fMRI pre- and postoperatively (n = 15 anterior temporal lobectomy, n = 11 selective amygdalohippocampectomy, n = 2 focal resection). Twenty-two healthy subjects served as the control cohort. Functional connectivity, activation maps, and laterality indices for language dominance were analyzed from fMRI data. Postoperative fractional anisotropy values of 7 major tracts were calculated. Naming, semantic, and phonematic verbal fluency scores before and after surgery were correlated with imaging parameters.RESULTSfMRI network analysis revealed widespread, bihemispheric alterations in language architecture that were not captured by activation analysis. These network changes were found preoperatively and proceeded after surgery with characteristic patterns in the left and right TLEs. Ipsilesional fronto-temporal connectivity decreased in both left and right TLE. In left TLE specifically, preoperative atypical language dominance predicted better postoperative verbal fluency and naming function. In right TLE, left frontal language dominance correlated with good semantic verbal fluency before and after surgery, and left fronto-temporal language laterality predicted good naming outcome. Ongoing seizures after surgery (Engel classes ID–IV) were associated with naming deterioration irrespective of seizure side. Functional findings were not explained by the extent of resection or integrity of major white matter tracts.CONCLUSIONSFunctional connectivity analysis contributes unique insight into bihemispheric remodeling processes of language networks after epilepsy surgery, with characteristic findings in left and right TLE. Presurgical contralateral language recruitment is associated with better postsurgical language outcome in left and right TLE.

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Alterations of Brain Networks Before and After Surgery in Temporal Lobe Epilepsy Patients with Hippocampal Sclerosis

10.1007/978-981-16-0317-4_22 ◽

2021 ◽

pp. 211-218

Author(s):

Chuanzuo Yang ◽

Guoming Luan ◽

Qingyun Wang

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Hippocampal Sclerosis ◽

Brain Networks ◽

Before And After

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Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

Epilepsy Research and Treatment ◽

10.1155/2016/7417540 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Rokia Ghchime ◽

Halima Benjelloun ◽

Hajar Kiai ◽

Halima Belaidi ◽

Fatiha Lahjouji ◽

...

Keyword(s):

Heart Rate ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Cerebral Hemisphere ◽

Autonomic Function ◽

Hippocampal Sclerosis ◽

Hemispheric Lateralization ◽

Unexpected Death ◽

Complex Partial Seizures ◽

The Right

It is well established that the temporal lobe epilepsy (TLE) is linked to the autonomic nervous system dysfunctions. Seizures alter the function of different systems such as the respiratory, cardiovascular, gastrointestinal, and urogenital systems. The aim of this work was to evaluate the possible factors which may be involved in interictal cardiovascular autonomic function in temporal lobe epilepsy with complex partial seizures, and with particular attention to hippocampal sclerosis. The study was conducted in 30 patients with intractable temporal lobe epilepsy (19 with left hippocampal sclerosis, 11 with right hippocampal sclerosis). All subjects underwent four tests of cardiac autonomic function: heart rate changes in response to deep breathing, heart rate, and blood pressure variations throughout resting activity and during hand grip, mental stress, and orthostatic tests. Our results show that the right cerebral hemisphere predominantly modulates sympathetic activity, while the left cerebral hemisphere mainly modulates parasympathetic activity, which mediated tachycardia and excessive bradycardia counterregulation, both of which might be involved as a mechanism of sudden unexpected death in epilepsy patients (SUDEP).

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P4.020 Psychiatric morbidity, quality of life anddisability in mesial temporal lobe epilepsy patients before and after epilepsy surgery

European Neuropsychopharmacology ◽

10.1016/s0924-977x(04)80444-9 ◽

2004 ◽

Vol 14 ◽

pp. S330-S331

Author(s):

E.S. Cankurtaran ◽

B. Ulug ◽

S. Saygý

Keyword(s):

Quality Of Life ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Psychiatric Morbidity ◽

Mesial Temporal Lobe Epilepsy ◽

Before And After ◽

Mesial Temporal Lobe

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Sleep before and after temporal lobe epilepsy surgery

Seizure ◽

10.1016/j.seizure.2012.01.007 ◽

2012 ◽

Vol 21 (4) ◽

pp. 260-265 ◽

Cited By ~ 16

Author(s):

Anna Serafini ◽

Callixte Kuate ◽

Philippe Gelisse ◽

Reana Velizarova ◽

Gian Luigi Gigli ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Before And After

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Seizure Outcome After Ipsitemporal Reoperation in Pharmacoresistant Temporal Lobe Epilepsy Patients With Hippocampal Sclerosis and Nonspecific Pathology

Neurosurgery Open ◽

10.1093/neuopn/okab001 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Jugoslav Ivanović ◽

Kristin Åshild Alfstad ◽

Pål Bache Marthinsen ◽

Ketil Berg Olsen ◽

Pål Gunnar Larsson ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Surgical Complications ◽

Postoperative Morbidity ◽

Hippocampal Sclerosis ◽

Neurological Impairment ◽

Seizure Outcome ◽

Seizure Freedom ◽

Before And After ◽

Repeated Surgery

ABSTRACT BACKGROUND Treatment of patients with pharmacoresistant temporal lobe epilepsy with hippocampal sclerosis and nonspecific pathology who failed initial resection is challenging, although selected patients may benefit from repeated surgery. OBJECTIVE To determine seizure outcome, postoperative morbidity, and possible predictors of seizure freedom after repeated ipsitemporal resection. METHODS We reviewed the results of comprehensive epilepsy evaluations performed before the initial and repeated resections in 10 patients with hippocampal sclerosis and 13 with nonspecific pathology. We assessed the Engel classification of seizure outcome 2 yr after repeated resection, evaluated postoperative morbidity, and examined the association of epilepsy and surgical characteristics with seizure freedom before and after reoperation. RESULTS After reoperation, in patients with hippocampal sclerosis, seizure freedom (Engel class I) was achieved in 2 (20%), 1 (10%) experienced surgical complications, and 1 (10%) experienced permanent neurological impairment. Following reoperation in patients with nonspecific pathology, seizure freedom was achieved in 1 (8%), 3 (23%) experienced surgical complications, and 4 (31%) experienced permanent neurological impairment. Epilepsy and surgical characteristics before and after reoperation were not associated with seizure freedom. CONCLUSION Patients with hippocampal sclerosis and nonspecific pathology who underwent a comprehensive initial work-up and failed original temporal lobe resection rarely become seizure-free after repeated ipsitemporal reoperation. Reoperations carry a high risk of surgical complications and neurological impairment. Predictors for seizure freedom could not be defined.

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