Intractable epilepsy following radiosurgery for arteriovenous malformation

2001 ◽  
Vol 95 (5) ◽  
pp. 888-892 ◽  
Author(s):  
Aatif M. Husain ◽  
Melissa Mendez ◽  
Allan H. Friedman
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Posterior Quadrant ◽  
Original Size ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ Radiosurgery is often used to treat arteriovenous malformations (AVMs) located in deep brain locations. Most of these procedures are successful not only in obliterating the AVM but also in decreasing the frequency and severity of associated seizures. Although radiosurgery is occasionally associated with the development of easy-to-control seizures immediately postoperatively, there have been no reports of intractable epilepsy developing after radiosurgery. In this report, however, a case is presented in which a patient underwent gamma knife surgery (GKS) for an AVM, after which intractable epilepsy and mesial temporal sclerosis (MTS) gradually developed. A 37-year-old right-handed woman underwent GKS for a right mesial parietotemporooccipital AVM. One year later, the AVM had reduced in size, but the patient began to experience complex partial seizures (CPSs). These CPSs initially occurred at a frequency of one per month, but 6 months later they were occurring every other week. She also started having secondarily generalized tonic—clonic seizures (GTCSs) once per month. Over the next year the frequency of her seizures gradually increased to several CPSs per day and two to three GTCSs per week, despite treatment with various combinations of antiepileptic drugs. By this time her AVM had decreased to one half of its original size. Video-electroencephalography monitoring demonstrated that both the CPSs and GTCSs were arising from the right posterior quadrant. Magnetic resonance imaging revealed not only the presence of the right-sided AVM, but also right-sided MTS. The patient underwent surgical resection of the AVM and right temporal lobectomy. She has been free from seizure for longer than 1 year. Radiosurgery may be associated with intractable epilepsy and MTS.

scholarly journals Local distribution and toxicity of prolonged hippocampal infusion of muscimol

2005 ◽  
Vol 103 (6) ◽  
pp. 1035-1045 ◽  
Author(s):  
John D. Heiss ◽  
Stuart Walbridge ◽  
Paul Morrison ◽  
Robert R. Hampton ◽  
Susumu Sato ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Fluid Distribution ◽  
Electrode Placement ◽  
Distribution Data ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Mr Images ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Fine Print

Object. The activity of γ-aminobutyric acid (GABA), the principal inhibitory neurotransmitter, is reduced in the hippocampus in patients with complex partial seizures from mesial temporal sclerosis. To provide preliminary safety and distribution data on using convection-enhanced delivery of agents to treat complex partial seizures and to test the efficacy and safety of regional selective neuronal suppression, the authors infused muscimol, a GABA-A receptor agonist, directly into the hippocampus of nonhuman primates using an integrated catheter electrode. Methods. Ten rhesus monkeys were divided into three groups: 1) use of catheter electrode alone (four monkeys); 2) infusion of escalating concentrations of muscimol followed by vehicle (three monkeys); and 3) infusion of vehicle and subsequent muscimol mixed with muscimol tracer (three monkeys). Infusions were begun 5 days after catheter electrode placement and continued for 5.6 days before switching to the other agent. Head magnetic resonance (MR) images and electroencephalography recordings were obtained before and during the infusions. Brain histological studies and quantitative autoradiography were performed. Neurological function was normal in controls and when muscimol concentrations were 0.125 mM or less, whereas higher concentrations (0.5 and 1 mM) produced reversible apathy and somnolence. Fluid distribution was demonstrated on MR images and muscimol distribution was demonstrated on autoradiographs throughout the hippocampus and adjacent white matter. Conclusions. Targeted modulation of neuronal activity is a reasonable research strategy for the investigation and treatment of medically intractable epilepsy.

Preserved musical abilities following right temporal lobectomy

1996 ◽  
Vol 85 (6) ◽  
pp. 1000-1004 ◽  
Author(s):  
Atsushi Koike ◽  
Hiroyuki Shimizu ◽  
Ichiro Suzuki ◽  
Buichi Ishijima ◽  
Morihiro Sugishita
Keyword(s):  
Standard Deviation ◽  
Temporal Lobe ◽  
Intractable Epilepsy ◽  
Sylvian Fissure ◽  
Temporal Lobectomy ◽  
Content Type ◽  
Before And After ◽  
The Right ◽  
Lines Of Evidence ◽  
Fine Print

✓ It has been widely accepted that the right temporal lobe plays a major role in the processing of music. One of the main lines of evidence was derived from Milner's study, published in 1962, which reported that right temporal lobectomy led to a decline in patient scores on four of the six subtests (Tonal Memory, Timbre, Loudness, and Time subtests) of the Seashore Measures of Musical Talents. That finding had led some surgeons and patients to hesitate in choosing right temporal lobectomy as a treatment for intractable epilepsy. The authors examined performance on the Seashore Measures before and after operations in 20 patients with right temporal lobectomy and nine patients with left temporal lobectomy. No disturbances in the Seashore Measures were detected after temporal lobectomy on either side. The extent of these temporal lobectomies was smaller than that of the temporal lobectomies in Milner's study, as measured along the sylvian fissure (1.5–4 cm; mean 2.7 cm, standard deviation (SD) 0.92 cm) and the base of the temporal lobe (3.5–5.5 cm; mean 4.7 cm, SD 0.63 cm). These findings indicate that the region resected on right temporal lobectomy in the present study is not essential for basic musical processing.

Significance of surgery for temporal lobe epilepsy in childhood and adolescence

1970 ◽  
Vol 33 (3) ◽  
pp. 233-252 ◽  
Author(s):  
Murray A. Falconer
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Childhood And Adolescence ◽  
Content Type ◽  
Pathological Lesion ◽  
Fine Print

✓ The problem of childhood temporal lobe epilepsy is reviewed and illustrated from three cases in which the patients were freed from fits by temporal lobectomy. The pathological lesion (mesial temporal sclerosis) is discussed and the likelihood that many adult cases have gone unrecognized in childhood is emphasized.

Pathology of temporal lobectomy for refractory seizures in children

1993 ◽  
Vol 79 (1) ◽  
pp. 53-61 ◽  
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.

Radiosurgery-induced brain tumor

2001 ◽  
Vol 95 (4) ◽  
pp. 710-713 ◽  
Author(s):  
Takanobu Kaido ◽  
Tohru Hoshida ◽  
Ryunosuke Uranishi ◽  
Nobuhisa Akita ◽  
Akihira Kotani ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Gamma Knife ◽  
Parietal Lobe ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Clonic Seizure ◽  
Content Type ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ The authors describe a case of glioblastoma multiforme (GBM) associated with previous gamma knife radiosurgery for a cerebral arteriovenous malformation (AVM). A 14-year-old boy had undergone radiosurgery for an AVM, which was performed using a 201-source 60Co gamma knife system at another institution. The maximum and margin radiation doses used in the procedure were 40 and 20 Gy, respectively. One year after radiosurgery, the patient noticed onset of mild left hemiparesis due to radiation necrosis. Six and one-half years after radiosurgery, at the age of 20 years, the patient experienced an attack of generalized tonic—clonic seizure. Magnetic resonance (MR) imaging revealed the existence of a brain tumor in the right parietal lobe. The patient underwent an operation and the histological diagnosis of the lesion was GBM. Ten months following the operation, that is, 99 months postradiosurgery, this patient died. To the best of the authors' knowledge, this is the first reported case of a neoplasm induced by radiosurgery for an AVM and the second case in which it occurred following radiosurgery for intracranial disease.

Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy

1998 ◽  
Vol 89 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Bhaskara Rao Malla ◽  
Terence J. O'Brien ◽  
Gregory D. Cascino ◽  
Elson L. So ◽  
Kurupath Radhakrishnan ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Content Type ◽  
Excellent Outcome ◽  
Prognostic Importance ◽  
Fine Print

Object. Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizures (APOS) occurring in the 1st postoperative week following anterior temporal lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance. Methods. One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a lower rate of favorable outcome with respect to seizure control at the last follow-up examination than patients without APOS (62.5% compared with 83.6%, p < 0.05). The type of APOS was of prognostic importance, with patients whose APOS were similar to their preoperative habitual seizures having a significantly worse outcome than those whose APOS were auras or were focal motor and/or generalized tonic—clonic seizures (excellent outcome: 14.3%, 77.8%, and 75%, respectively, p < 0.05). Only patients who had APOS similar to preoperative habitual seizures were less likely to have an excellent outcome than patients without APOS (14.3% compared with 75%, p < 0.05). Timing of the APOS and identification of a precipitating factor were of no prognostic importance. Conclusions. The findings of this study may be useful in counseling patients who suffer from APOS following ATL for temporal lobe epilepsy.

Fentanyl-induced electrocorticographic seizures in patients with complex partial epilepsy

1992 ◽  
Vol 77 (2) ◽  
pp. 201-208 ◽  
Author(s):  
René Tempelhoff ◽  
Paul A. Modica ◽  
Kerry L. Bernardo ◽  
Isaac Edwards
Keyword(s):  
Temporal Lobe ◽  
Seizure Activity ◽  
Epileptiform Activity ◽  
Temporal Lobectomy ◽  
Electrode Arrays ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings ◽  
The Right

✓ Although electrical seizure activity in response to opioids such as fentanyl has been well described in animals, scalp electroencephalographic (EEG) recordings have failed to demonstrate epileptiform activity following narcotic administration in humans. The purpose of this study was to determine whether fentanyl is capable of evoking electrical seizure activity in patients with complex partial (temporal lobe) seizures. Nine patients were studied in whom recording electrode arrays had been placed in the bitemporal epidural space several days earlier to determine which temporal lobe gave rise to their seizures. The symptomatic temporal lobe was localized by correlating clinical and electrical seizure activity obtained during continuous simultaneous videotape and epidural EEG monitoring. In each patient, clinical seizures and electrical seizure activity were consistently demonstrated to arise unilaterally from one temporal lobe (four on the right, five on the left). During fentanyl induction of anesthesia in preparation for secondary craniotomy for anterior temporal lobectomy, eight of the nine patients exhibited electrical seizure activity at fentanyl doses ranging from 17.7 to 35.71 µg · kg−1 (mean 25.75 µg · kg−1). More importantly, four of these eight seizures occurred initially in the “healthy” temporal lobe contralateral to the surgically resected lobe from which the clinical seizures had been shown to arise. These findings indicate that, in patients with complex partial seizures, moderate doses of fentanyl can evoke electrical seizure activity. The results of this study could have important implications for neurosurgical centers where electrocorticography is used during surgery for the purpose of determining the extent of the resection.

Resective surgery for medically intractable epilepsy associated with schizencephaly

1994 ◽  
Vol 80 (5) ◽  
pp. 820-825 ◽  
Author(s):  
Daniel L. Silbergeld ◽  
John W. Miller
Keyword(s):  
Temporal Lobe ◽  
Intractable Epilepsy ◽  
The Other ◽  
Temporal Lobectomy ◽  
Eeg Monitoring ◽  
Resonance Imaging ◽  
Ipsilateral Hemisphere ◽  
Content Type ◽  
Intracranial Electrodes ◽  
Fine Print

✓ Four adults with unilateral (three cases) or bilateral (one case) closed schizencephaly, medically intractable epilepsy, and otherwise normal neurological examinations are presented. Three were examined preoperatively with magnetic resonance imaging and one with computerized tomography. Scalp electroencephalographic (EEG) studies in all four patients and electrocorticography via intracranial electrodes in two showed seizure origin in the cleft regions in two patients and in the ipsilateral temporal lobe in the other two. Temporal lobectomy was performed in the two patients with temporal lobe foci. Resection of superficial pachygyria around the cleft was performed in one patient. The authors conclude that the abnormal cortical mantle lining schizencephalic clefts may be epileptogenic. Alternatively, temporal allocortex may become the source of seizures. Therefore, these patients require careful EEG monitoring of the entire ipsilateral hemisphere as well as the cleft region.

Temporal lobectomy in children: cognitive outcome

2000 ◽  
Vol 92 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Michael Westerveld ◽  
Kimberlee J. Sass ◽  
Gordon J. Chelune ◽  
Bruce P. Hermann ◽  
William B. Barr ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Intellectual Functioning ◽  
Significant Loss ◽  
Significant Decline ◽  
Cognitive Outcome ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. The authors sought to determine the impact of early temporal lobectomy (in patients younger than age 17 years) on intellectual functioning. The efficacy of temporal lobectomy for treating seizures is well established and the procedure is becoming more acceptable as a treatment for children whose seizures are intractable. However, cognitive outcomes of temporal lobectomy in children and adolescents are largely unreported. The present study takes advantage of a unique multicenter collaboration to examine retrospectively intellectual functioning in a large sample of children who underwent temporal lobectomy.Methods. Intellectual functioning was assessed before and after temporal lobectomy for treatment of medication-resistant seizures in 82 patients at eight centers of epilepsy surgery. All children underwent standard presurgical examinations, including electroencephalography—video monitoring, magnetic resonance (MR) imaging, and neuropsychological testing, at their respective centers.Forty-three children underwent left temporal lobectomy and 39 underwent right temporal lobectomy. For the entire sample, there were no significant declines in intelligence quotient (IQ) following surgery. Children who underwent left temporal lobectomy demonstrated no significant loss in verbal intellectual functioning and improved significantly in nonverbal intellectual functioning. Children who underwent right temporal lobectomy did not demonstrate significant changes in intellectual functioning. Although group scores showed no change in overall IQ values, an analysis of individual changes revealed that approximately 10% of the sample experienced a significant decline and 9% experienced significant improvement in verbal functioning. Significant improvement in nonverbal cognitive function was observed in 16% of the sample and only 2% of the sample showed significant declines. Risk factors for significant decline included older patient age at the time of surgery and the presence of a structural lesion other than mesial temporal sclerosis on MR imaging.Conclusions. The present study provides preliminary data for establishing the risk of cognitive morbidity posed by temporal lobectomy performed during childhood. With respect to global intellectual functioning, a slight improvement was significantly more likely to occur than a decline. However, there were several patients in whom significant declines did occur. It will be necessary to study further the factors associated with such declines. In addition, further study of more specific cognitive functions, particularly memory, is needed.

Intractable epilepsy after a functional hemispherectomy: important lessons from an unusual case

2001 ◽  
Vol 94 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Sandeep Mittal ◽  
Jean-Pierre Farmer ◽  
Bernard Rosenblatt ◽  
Frederick Andermann ◽  
José L. Montes ◽  
...  
Keyword(s):  
Single Photon ◽  
Anterior Commissure ◽  
Photon Emission ◽  
Intractable Epilepsy ◽  
Insular Cortex ◽  
Cortical Dysplasia ◽  
Content Type ◽  
Functional Hemispherectomy ◽  
The Right ◽  
Fine Print

✓ Residual seizures after functional hemispherectomy occur in approximately 20% of patients with catastrophic epilepsy. These episodes are traditionally attributed to incomplete disconnection, persistent epileptogenic activity in the ipsilateral insular cortex, or bilateral independent epileptogenic activity. The authors report on the case of an 8-year-old boy with an intractable seizure disorder who had classic frontal adversive seizures related to extensive unilateral left hemispheric cortical dysplasia. The initial intervention consisted of extensive removal of the epileptic frontal and precentral dysplastic tissue and multiple subpial transections of the dysplastic motor strip, guided by intraoperative electrocorticography. Subsequently, functional hemispherectomy including insular cortex resection was performed for persistent attacks. After a seizure-free period of 6 months, a new pattern ensued, consisting of an aura of fear, dystonic posturing of the right arm, and unusual postictal hyperphagia coupled with an interictal diencephalic-like syndrome. Electroencephalography and ictal/interictal single-photon emission computerized tomography were used to localize the residual epileptic discharges to deep ipsilateral structures. Results of magnetic resonance imaging indicated a complete disconnection except for a strip of residual frontobasal tissue. Therefore, a volumetric resection of the epileptogenic frontal basal tissue up to the anterior commissure was completed. The child has remained free of seizures during 21 months of follow-up review. Standard hemispherectomy methods provide extensive disconnection, despite the presence of residual frontal basal cortex. However, rarely, and especially if it is dysplastic, this tissue can represent a focus for refractory seizures. This is an important consideration in determining the source of ongoing seizures posthemispherectomy in patients with extensive cortical dysplasia. It remains important to assess them fully before considering their disease refractory to surgical treatment.

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