Bitemporal Intractable Epilepsy: Could It Be Surgically Treatable?

Abstract

Citation for the original published paper (version of record):Tavakoli, M., Barekatain, M., Doust, H., Molavi, H., Kormi Nouri, R. et al. (2011) Cognitive impairments in patients with intractable temporal lobe epilepsy. Sciences, 16(11): 1466Sciences, 16(11): -1472 Access to the published version may require subscription. N.B. When citing this work, cite the original published paper. Cognitive impairment associated with temporal lobe epilepsy (TLE) has been recognized in multiple studies. We designed this study to find a specific cognitive profile in patients with TLE who were candidates for epilepsy surgery. We also sought to find if neuropsychological assessment could differentiate left TLE, right TLE and normal subjects. Journal of Research in Medical

Caveat Emptor: Bitemporal Intractable Epilepsy: Could It Be Surgically Treated?

“…As noted by Chkhenkeli et al [3], bilateral temporal lobe surgery is considered taboo : nary a neuroscience student is unaware of the late H.M. (even if they can't tell you his name: Henry Molaison), the single most tested individual in the history of mankind [5]. Following the experimental ‘radical' bilateral mesial temporal lobe suction ablation performed by William Scoville in Hartford in 1953 to treat his epilepsy, H.M. apparently never encoded another declarative memory (although procedural memory remained strikingly intact) [5].…”

“…In this issue, Chkhenkeli et al [3] report the results of bilateral stereotactic, restricted cryoablation (an ‘old' technique) of the amygdala and hippocampus in the treatment of patients with bilateral mesial temporal lobe epilepsy. This approach achieved seizure freedom in 52% and rare seizures in 29% of patients at long-term (mostly) follow-up.…”

“…Thus, Chkhenkeli et al [3] hypothesized that bilateral subtotal stereotactic ablations of the amygdala (amygdalotomy) and/or hippocampus (hippocampotomy) - sparing parahippocampal gyrus and other regions, and limited to ictogenic regions - would be effective in treating seizures and preserve anterograde memory. This is not entirely unfounded: in the monograph by Scoville and Milner [4] are reported 5 patients who underwent smaller resections as per Scoville (4-5 cm from the temporal tip) and who had moderate but not catastrophic memory decline.…”

“…Twenty-one patients were operated on, from 1980-1995, in Tbilisi, the capital of the republic of Georgia, using the classical but resurgent technique of stereoencephalography (SEEG) pioneered by Talairach and Bancaud at St. Anne Hospital in Paris. Defining interictal and ictal onset zones with depth electrodes, Chkhenkeli et al [3] then performed cryoablation of the amygdala and/or hippocampus, plus other ‘limbic' structures such as the anterior cingulate (area 24), dorsomedial thalamus, and centromedian nucleus in various combinations. The specific ablations performed are listed in their table 1, and summarized as follows: …”

Advanced nonlinear approach to quantify directed interactions within EEG activity of children with temporal lobe epilepsy in their time course

“…The zone concept of epileptic seizure generation implies that the hippocampus and other areas of the temporal cortex can act as epileptic focus for seizureonset generation (focal onset), from which the seizure spread via a preferred pathway to cortical and subcortical brain regions. This traditional concept has been falsified by many experimental and clinical results and can be seen as an overschematized simplification [1]. An important clinical point is whether or not the clinical symptomatology is stereotyped: stereotype favors focal onset.…”