scholarly journals Temporal lobe epilepsy with unilateral hippocampal sclerosis and contralateral temporal scalp seizure onset: report of four patients with "burned-out hippocampus"

2005 ◽  
Vol 11 (2) ◽  
pp. 79-86 ◽  
Author(s):  
Luís Otávio Sales Ferreira Caboclo ◽  
Eliana Garzon ◽  
Flávia Saori Miyashira ◽  
Henrique Carrete Jr ◽  
Ricardo da Silva Centeno ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Epileptogenic Zone ◽  
Invasive Monitoring ◽  
Eeg Monitoring ◽  
Ictal Eeg ◽  
High Resolution Mri ◽  
Surgical Evaluation ◽  
Video Eeg

ABSTRACT OBJECTIVES: Patients with temporal lobe epilepsy (TLE) and unilateral severe hippocampal sclerosis (HS) may have contralateral temporal scalp ictal onset. This has recently been called "burned-out hippocampus", which is believed to be a rare entity. In this study we report four patients with unilateral hippocampal sclerosis and contralateral ictal onset registered by scalp electrodes. We discuss the importance of such cases in presurgical evaluation of patients with TLE, as well as possible strategies used for evaluation of these particular cases. PATIENTS AND METHODS: We reviewed charts from all patients with TLE submitted to pre-surgical evaluation, which included high resolution MRI and prolonged video-electroencephalogram (video-EEG) monitoring with scalp and sphenoidal electrodes, during a three-year period (2002-2004). We looked for patients who only had seizures that were clearly contralateral in location to the atrophic hippocampus. RESULTS: Four patients fulfilled the criteria above. Two of these patients had semi-invasive video-EEG monitoring with foramen ovale (FO) electrodes, which revealed seizures originating from the temporal lobe with the atrophic hippocampus, hence confirming false lateralization in the scalp-sphenoidal EEG. These patients were submitted to surgical treatment and had favorable prognosis after surgery. CONCLUSIONS: Burned-out hippocampus syndrome may not be as rare as it was previously believed. Further studies will be necessary before one can affirm that patients with unilateral HS and scalp ictal EEG showing contralateral ictal onset may be operated without confirmation of the epileptogenic zone by invasive monitoring. In these patients, semi-invasive monitoring with FO electrodes might be an interesting alternative.

scholarly journals Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy

2021 ◽  
Vol 22 (8) ◽  
pp. 3860
Author(s):  
Elisa Ren ◽  
Giulia Curia
Keyword(s):  
Animal Models ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Current Knowledge ◽  
Focal Epilepsy ◽  
Ex Vivo ◽  
Hippocampal Sclerosis ◽  
Control Group ◽  
Epileptogenic Zone ◽  
Epileptiform Discharges

Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.

scholarly journals Antiepileptic Drug Withdrawal in Patients with Temporal Lobe Epilepsy Undergoing Presurgical Video-EEG Monitoring

Epilepsia ◽  
2008 ◽  
Vol 42 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Der-Jen Yen ◽  
Chien Chen ◽  
Yang-Hsin Shih ◽  
Yuh-Cherng Guo ◽  
Li-Ting Liu ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Antiepileptic Drug ◽  
Temporal Lobe ◽  
Drug Withdrawal ◽  
Eeg Monitoring ◽  
Antiepileptic Drug Withdrawal ◽  
Video Eeg

A Quadruple Examination of Ictal EEG Patterns in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis

2013 ◽  
Vol 30 (4) ◽  
pp. 329-338 ◽  
Author(s):  
Nermin G. Sirin ◽  
Candan Gurses ◽  
Nerses Bebek ◽  
Ahmet Dirican ◽  
Betul Baykan ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Ictal Eeg ◽  
Mesial Temporal Lobe

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

Brain ◽  
2015 ◽  
Vol 139 (2) ◽  
pp. 444-451 ◽  
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.

Spatiotemporospectral characteristics of scalp ictal EEG in mesial temporal lobe epilepsy with hippocampal sclerosis

2009 ◽  
Vol 1287 ◽  
pp. 206-219 ◽  
Author(s):  
Ki-Young Jung ◽  
Joong-Koo Kang ◽  
Ji Hyun Kim ◽  
Chang-Hwan Im ◽  
Kyung Hwan Kim ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Ictal Eeg ◽  
Mesial Temporal Lobe

18F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1045-1053 ◽  
Author(s):  
Francine Chassoux ◽  
Eric Artiges ◽  
Franck Semah ◽  
Agathe Laurent ◽  
Elisabeth Landré ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Hippocampal Sclerosis ◽  
Statistical Parametric Mapping ◽  
Mesial Temporal Lobe Epilepsy ◽  
Epileptogenic Zone ◽  
Metabolic Pattern ◽  
Suboptimal Outcome ◽  
Mesial Temporal Lobe

Objective:To search for [18F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS).Methods:We analyzed metabolic data with [18F]-FDG-PET in 97 patients with MTLE (53 female participants; age range 15–56 years) with unilateral HS (50 left) and compared the metabolic patterns, electroclinical features, and structural atrophy on MRI in patients with the best outcome after anteromesial temporal resection (Engel class IA, completely seizure-free) to those with a non-IA outcome, including suboptimal outcome and failure. Imaging processing was performed with statistical parametric mapping (SPM5).Results:With a mean follow-up of >6 years (range 2–14 years), 85% of patients achieved a class I outcome, including 45% in class IA. Class IA outcome was associated with a focal anteromesial temporal hypometabolism, whereas non-IA outcome correlated with extratemporal metabolic changes that differed according to the lateralization: ipsilateral mesial frontal and perisylvian hypometabolism in right HS and contralateral fronto-insular hypometabolism and posterior white matter hypermetabolism in left HS. Suboptimal outcome presented a metabolic pattern similar to the best outcome but with a larger involvement of extratemporal areas, including the contralateral side in left HS. Failure was characterized by a mild temporal involvement sparing the hippocampus and relatively high extratemporal hypometabolism on both sides. These findings were concordant with electroclinical features reflecting the organization of the epileptogenic zone but were independent of the structural abnormalities detected on MRI.Conclusions:[18F]-FDG-PET patterns help refine the prognostic factors in MTLE and should be implemented in predictive models for epilepsy surgery.

scholarly journals Role of the temporal pole in temporal lobe epilepsy seizure networks: an intracranial electrode investigation

2018 ◽  
Vol 129 (1) ◽  
pp. 165-173 ◽  
Author(s):  
Taylor J. Abel ◽  
Royce W. Woodroffe ◽  
Kirill V. Nourski ◽  
Toshio Moritani ◽  
Aristides A. Capizzano ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epileptogenic Zone ◽  
Invasive Monitoring ◽  
Seizure Onset ◽  
Temporal Pole ◽  
Interictal Discharges ◽  
Temporal Lobe Seizure ◽  
Clinical Records

OBJECTIVEA convergence of clinical research suggests that the temporal pole (TP) plays an important and potentially underappreciated role in the genesis and propagation of seizures in temporal lobe epilepsy (TLE). Understanding its role is becoming increasingly important because selective resections for medically intractable TLE spare temporopolar cortex (TPC). The purpose of this study was to characterize the role of the TPC in TLE after using dense electrocorticography (ECoG) recordings in patients undergoing invasive monitoring for medically intractable TLE.METHODSChronic ECoG recordings were obtained in 10 consecutive patients by using an array customized to provide dense coverage of the TP as part of invasive monitoring to localize the epileptogenic zone. All patients would eventually undergo cortico-amygdalohippocampectomy. A retrospective review of the patient clinical records including ECoG recordings, neuroimaging studies, neuropathology reports, and clinical outcomes was performed.RESULTSIn 7 patients (70%), the TP was involved at seizure onset; in 7 patients (70%), there were interictal discharges from the TP; and in 1 case, there was early spread to the TP. Seizure onset in the TP did not necessarily correlate with preoperative neuroimaging abnormalities of the TP.CONCLUSIONSThese data demonstrate that TPC commonly plays a crucial role in temporal lobe seizure networks. Seizure onset from the TP would not have been predicted based on available neuroimaging data or interictal discharges. These findings illustrate the importance of thoroughly considering the role of the TP prior to resective surgery for TLE, particularly when selective mesial resection is being considered.

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