Long-term seizure outcomes following amygdalohippocampectomy

Wieser, Heinz Gregor; Ortega, Marcos; Friedman, Alon; Yonekawa, Yasuhiro

doi:10.3171/jns.2003.98.4.0751

Cited by 235 publications

(174 citation statements)

References 30 publications

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“…Up to one-third of TLE patients have intractable, or drug-resistant epilepsy, and in these patients surgical treatment by anterior temporal lobectomy (ATL), which involves resection of both the neocortex and mesial structures (Engel et al, 1992), or a selective amygdalohippocampectomy (SAH), which involves resection of just the mesial structures (Wieser et al, 2003), is the standard of care. A randomized controlled trial has shown that the more commonly performed surgical treatment, ATL, significantly improves seizure-freedom and quality of life versus prolonged medical therapy with close to two thirds of patients being free of seizures at one year (Wiebe et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

et al. 2014

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We developed novel methodology for investigating the use of quantitative relaxometry (T1, T2) and diffusion tensor imaging (DTI) for lateralization in temporal lobe epilepsy. Patients with mesial temporal sclerosis confirmed by pathology (N=8) and non-MTS unilateral temporal lobe epilepsy (N=6) were compared against healthy controls (N=19) using voxel-based analysis restricted to the anterior temporal lobes, and laterality indices for each MRI metric (T1, T2, fractional anisotropy (FA), mean diffusivity, axial and radial diffusivity) were computed based on the proportion of significant voxels on each side. The diffusivity metrics were the most lateralizing MRI metrics in MTS and non-MTS subsets, with significant differences also seen with FA, T1 and T2. Patient-specific multi-modal laterality indices were also computed and were shown to clearly separate the left-onset and right-onset patients. Marked differences between leftonset and right-onset patients were also observed, with left-onset patients exhibiting stronger laterality indices. Finally, neocortical abnormalities were found to be more common in the non-MTS patients. These preliminary results on a small sample size support the further investigation of quantitative MRI and multi-modal image analysis in clinical determination of seizure onset.The presence of more neocortical abnormalities in the non-MTS group suggests a role in seizure onset or propagation and motivates the investigation of more sensitive histopathological analysis to detect and delineate potentially subtle neocortical pathology.

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Section: Introductionmentioning

confidence: 99%

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

et al. 2014

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“…Medical treatment failures are common, whereas surgery results in seizure control rates of up to 70%-90%. 26,54 Nevertheless, some patients do not have a significant improvement of their condition with surgery, even with complete resection of the suspected epileptogenic zone. Clinical factors such as seizure frequency, duration of epilepsy, sex, age of onset, and laterality of seizure focus have not been shown to Other authors have identified frequent secondarily generalized seizures, 18,20 history of encephalitis, 41 and head trauma 41,50 as poor predictive factors for good outcome.…”

Section: Discussionmentioning

confidence: 99%

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Vale¹,

Pollock²,

Benbadis

2012

FOC

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Object The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis. Methods A systematic review of the literature was performed for the years 1999–2010 to assess the cause of failure and to identify potential reoperation candidates. Results Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings. Conclusions The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.

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“…They were examined at the in-and outclinic between 1987 and 2000, and were followed-up for mean 4.5 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The schemes of diagnostic criteria (inclusion to an epileptic syndrome and criteria of exclusion from one) were worked up according to ILAE (1989) and Proposed Diagnostic Scheme for People with Epileptic Seizures and with Epilepsy (2001), and other published data.…”

Section: P782 Syndromic Classification In Childhood-onset Epilepsymentioning

confidence: 99%

Wednesday July 5, 2006 12:00-13:30 Hall 3D Platform Session Basic Science III: Pharmacology and Treatment

2006

Epilepsia

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Purpose: This study was designed to compare monotherapy with sodium valproate (VPA) and lamotrigine (LTG) in patients with newly diagnosed epilepsy.Method: A total of 226 untreated patients (116 male) with a recent diagnosis of epilepsy (60 idiopathic generalised epilepsy, 149 localisationrelated epilepsy, 17 unclassified) were randomised to receive either VPA or LTG as monotherapy. Median age was 35 years (range 13-80 years). Patients were followed-up at six-weekly intervals and remained in the study until reaching a predetermined end point (12 month seizurefreedom; intolerable side-effects including idiosyncratic reaction; lack of efficacy despite adequate dosing).Results: Twenty-nine patients were excluded from the analysis (24 lost to follow-up, 3 withdrawn consent, 1 protocol violator, 1 nonepileptic attack). A total of 197 patients reached an end point, with 126 (63%) becoming seizure-free for a minimum period of 12 months on initial monotherapy. Of these, 64 took VPA (67% of VPA completers; median dose = 1000 mg, range 600-3000 mg) and 62 took LTG (60% of LTG completers; median dose = 200 mg, range 100-700 mg). Thirty-eight patients (24 VPA, 14 LTG) experienced intolerable side effects, while a further 33 (18 VPA, 15 LTG) failed to report acceptable efficacy despite adequate dosing. There were no significant changes in mean (±SEM) serum concentrations of testosterone (p = 0.225), SHBG (p = 0.201), or androstenedione (p = 0.394) in either patient group at 6 months after initiation of therapy.Conclusion: These findings suggest that there is little (if any) difference in the efficacy, tolerability, or hormonal effects of VPA or LTG monotherapy in the treatment of newly diagnosed epilepsy. Purpose: There is a paucity of randomised controlled trials (RCTs) that inform a choice among antiepileptic drugs, and existing trials have largely failed to examine longer term effectiveness. SANAD assesses these longer term outcomes. MULTICENTRE RANDOMISED CONTROLLED TRIAL COM-PARING STANDARD AND NEW ANTIEPILEPTIC DRUGS (SANAD)Method: SANAD is a multicentre, UK based, unblinded RCT recruiting patients over the age of 5 years, requiring antiepileptic drug monotherapy. SANAD has 2 arms. Patients for whom carbamazepine was the standard drug (arm A) were randomised to carbamazepine, gabapentin, lamotrigine, oxcarbazepine or topiramate. Patients for whom valproate was the standard drug (arm B) were randomised to valproate, lamotrigine or topiramate. Recruitment commenced in 1999, ended 2005, and follow up ended in 2005. Outcomes included time to the following events: withdrawal of allocated treatment, 12 month remission from seizures, first seizure, as well as adverse events, quality of life and cost effectiveness.Results: 2443 patients were recruited, for whom we have 7799 patient years follow up, 95% of the maximum possible. 1721 patients entered arm A, 378 were allocated carbamazepine, 377 gabapentin, 378 lamotrigine, 210 oxcarbazepine and 378 topiramate. The mean age was 38.3 yrs, 55% were male and 89% were classified as h...

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Long-term seizure outcomes following amygdalohippocampectomy

Abstract: The authors conclude that SelAH is a safe and effective surgical procedure for MTLE.

Cited by 235 publications

References 30 publications

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Wednesday July 5, 2006 12:00-13:30 Hall 3D Platform Session Basic Science III: Pharmacology and Treatment

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Long-term seizure outcomes following amygdalohippocampectomy

Abstract: The authors conclude that SelAH is a safe and effective surgical procedure for MTLE.

Cited by 235 publications

References 30 publications

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

Quantitative relaxometry and diffusion MRI for lateralization in MTS and non-MTS temporal lobe epilepsy

Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Wednesday July 5, 2006 12:00-13:30 Hall 3D Platform Session Basic Science III: Pharmacology and Treatment

Contact Info

Product

Resources

About

Wednesday July 5, 2006 12:00-13:30 Hall 3D Platform Session Basic Science III: Pharmacology and Treatment