Complete remission of epileptic psychosis after temporal lobectomy: case report

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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Congenital porencephaly and hippocampal sclerosis

Neurology ◽

10.1212/wnl.49.5.1382 ◽

1997 ◽

Vol 49 (5) ◽

pp. 1382-1388 ◽

Cited By ~ 20

Author(s):

S. S. Ho ◽

R. I. Kuzniecky ◽

F. Gilliam ◽

E. Faught ◽

M. Bebin ◽

...

Keyword(s):

Hippocampal Formation ◽

Hippocampal Sclerosis ◽

Vascular Occlusion ◽

Temporal Lobectomy ◽

Mesial Temporal Sclerosis ◽

Partial Seizures ◽

Perinatal Complications ◽

Complex Partial Seizures ◽

Intractable Seizures ◽

Temporal Localization

We studied clinical features and seizure localization in 14 patients with porencephaly and intractable seizures. Perinatal complications were present in nine patients, childhood febrile convulsions in two, congenital hemiparesis in 12, and intellectual impairment in seven. Ten patients had psychoparetic complex partial seizures (CPS), three had sensorimotor simple partial seizures, and one had generalized tonic-clonic seizures. Surface EEG showed temporal onset in nine patients (one bitemporal) and extratemporal onset in four. MRI showed porencephaly in the distribution of the middle cerebral artery in eight patients, posterior cerebral in three, internal carotid in one, and multiple vessels in two. MR-based volumetry revealed hippocampal formation atrophy in 13 patients (eight unilateral and five bilateral) and amygdalar atrophy in 10 patients (nine unilateral and one bilateral). Hippocampal formation atrophy was concordant with CPS semiology in 10 patients (71%) and with EEG temporal localization in nine patients. Two patients had pathologic confirmation of mesial temporal sclerosis and were seizure free after temporal lobectomy. We conclude that mesial temporal sclerosis often coexists with porencephaly and is the likely seizure focus in the presence of concordant electro-clinical data. This recognition implies that effective surgical intervention can be offered to certain patients with porencephaly-related seizure disorders. The dual pathology and association with perinatal cerebral vascular occlusion suggest a common ischemic pathogenesis.

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

Epilepsia ◽

10.1111/j.1528-1167.2006.00812.x ◽

2006 ◽

Vol 47 (11) ◽

pp. 1922-1930 ◽

Cited By ~ 26

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

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

Neurosurgery ◽

10.1227/00006123-199107000-00009 ◽

1991 ◽

Vol 29 (1) ◽

pp. 55-61 ◽

Cited By ~ 72

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)

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Epilepsy surgery without invasive EEG: early results of a new program

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1997000400004 ◽

1997 ◽

Vol 55 (3B) ◽

pp. 542-546 ◽

Cited By ~ 4

Author(s):

Paulo R. M. de Bittencourt ◽

João C. Araújo ◽

Paulo J. M. Leite ◽

Marlus S. Moro ◽

Edson R. Piana ◽

...

Keyword(s):

Hippocampal Volume ◽

Volume Measurement ◽

Temporal Lobectomy ◽

Wada Test ◽

Non Invasive ◽

Early Results ◽

Total Remission ◽

Frontal Lobectomy ◽

Video Eeg

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation.

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Complex partial seizures and mesial temporal sclerosis: evaluation with fast spin-echo MR imaging.

Radiology ◽

10.1148/radiology.189.3.8234712 ◽

1993 ◽

Vol 189 (3) ◽

pp. 835-842 ◽

Cited By ~ 37

Author(s):

R D Tien ◽

G J Felsberg ◽

C Campi de Castro ◽

A K Osumi ◽

D V Lewis ◽

...

Keyword(s):

Mr Imaging ◽

Spin Echo ◽

Fast Spin Echo ◽

Mesial Temporal Sclerosis ◽

Partial Seizures ◽

Complex Partial Seizures ◽

Fast Spin

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Temporal resolution deficits in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS)

Epilepsy & Behavior ◽

10.1016/j.yebeh.2012.03.004 ◽

2012 ◽

Vol 24 (1) ◽

pp. 126-130 ◽

Cited By ~ 9

Author(s):

Rajasekaran Aravindkumar ◽

N. Shivashankar ◽

P. Satishchandra ◽

Sanjib Sinha ◽

J. Saini ◽

...

Keyword(s):

Temporal Resolution ◽

Mesial Temporal Sclerosis ◽

Partial Seizures ◽

Complex Partial Seizures

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Complex partial seizures with speech arrest (2 case reports with video-EEG demonstrations

Electroencephalography and Clinical Neurophysiology ◽

10.1016/0013-4694(95)94087-u ◽

1995 ◽

Vol 95 (1) ◽

pp. P7

Author(s):

A. Hecker ◽

M. Engelke ◽

B. Findeis

Keyword(s):

Case Reports ◽

Partial Seizures ◽

Complex Partial Seizures ◽

Video Eeg

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Pathology of temporal lobectomy for refractory seizures in children

Journal of Neurosurgery ◽

10.3171/jns.1993.79.1.0053 ◽

1993 ◽

Vol 79 (1) ◽

pp. 53-61 ◽

Cited By ~ 79

Author(s):

Venita Jay ◽

Laurence E. Becker ◽

Hiroshi Otsubo ◽

Paul A. Hwang ◽

Harold J. Hoffman ◽

...

Keyword(s):

Temporal Lobectomy ◽

Mesial Temporal Sclerosis ◽

Pathological Study ◽

Complex Partial Seizures ◽

Content Type ◽

Neuronal Migration Disorders ◽

Transitional Forms ◽

Refractory Seizures ◽

Mixed Tumors ◽

Neuronal Heterotopia

✓ Significant pathological abnormalities were encountered in a series of 20 temporal lobectomies in children with intractable complex partial seizures. In particular, “dual pathology” (mesial temporal sclerosis with other lesions) was found rather than mesial temporal sclerosis as the only lesion. Unusual pathological findings included capillary penetration of neurons in a neuronal heterotopia in one patient, and foci of extensive cortical disorganization in some cases of mixed tumors and gangliogliomas. A high proportion of neuronal migration disorders was also seen with overlapping pathological features between cortical dysplasia and tuberous sclerosis. In this correlative clinical, radiological, electroencephalographic, and pathological study, some of the pathological lesions in children did not fit the classical categories of neoplasia and malformation and transitional forms were rarely encountered.

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

Neurosurgery ◽

10.1227/neu.0000000000000120 ◽

2013 ◽

Vol 73 (5) ◽

pp. 838-844 ◽

Cited By ~ 20

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.

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