Microsurgical outcomes of secondary epilepsy from hippocampal lesions: a report of 56 cases and literature review

Abstract

ABSTRACToperative methods in the treatment of secondary epilepsy from hippocampal lesions. █ MATERIAl and METhODS Selection of PatientsThere were 56 patients enrolled in this study including 31 males and 25 females. These patients were aged 16 to 74 years (mean age, 35.1±13.5 years) and had a history of epilepsy from 2 months to 10 years (mean length, 17.2±13.1 months). The inclusion criteria for patients diagnosed as having hippocampal sclerosis was that systematic anti- █ InTRODuCTIOnMesial temporal lobe epilepsy (MTLE) is the most common type of temporal lobe epilepsy in the clinic, and it tends to develop into medically intractable epilepsy. Hippocampal lesions are the most common cause of MTLE. Currently, the treatment strategy of this epilepsy type remains clinically controversial (16). In this paper, we retrospectively analyzed the clinical data and the outcomes of the microsurgical treatment of 56 patients who had secondary epilepsy from hippocampal lesions and were treated during the period from January 2005 to January 2014. The purpose of this study was to explore the significance of microsurgery and its various AIM: To explore the treatment efficacy of microsurgery for secondary epilepsy from hippocampal lesions. MATERIAl and METhODS:The clinical data, pathological findings, surgical methods and surgical outcomes of 56 patients with secondary epilepsy from hippocampal lesions were retrospectively analyzed. RESulTS:Postoperative pathological examinations confirmed that 27 patients had gliomas, 17 patients had vascular malformations and 12 patients had hippocampal sclerosis. Twenty-nine patients underwent selective resection of the lesioned tissue and the surrounding infiltrated tissue, and 26 patients underwent a more generous removal of the anterior temporal lobe, lesioned tissue, infiltrated tissue and medial structures of the temporal lobe. Fifty patients were followed up with an average follow-up duration of 25.5 months. At postoperative one year, the remission rate of epilepsy that achieved Engel grade I was 80.8% (21/26) and 83.3% (20/24) for the selective resection and more generous resection, respectively, indicating that the difference between the two methods was insignificant.COnCluSIOn: Microsurgery is the first choice for the treatment of secondary epilepsy from hippocampal lesions. Various operative routes and methods can be selected based on the lesion natures. Long-term favorable outcome of seizure control following microsurgery can be achieved in most of the patients.

Surgical treatment of epilepsy in patients with mediobasal temporal cavernous malformations

“…Оценивая результаты хирургического лечения эпилепсии при поражениях гиппокампа в группе из 56 пациентов с разнообразными по гистологической структуре поражениями МБОВД, W. Jun и соавт. [31] подчеркнули, что хороший противоэпилептический эффект может быть достигнут с одинаковым успехом (1-й класс по Engel в 80-83% случаев) как при удалении только новообразования с прилежащей мозговой тканью, так и при значительной резекции височной доли, включающей и медиальные структуры. Результаты хирургического лечения эпилепсии у пациентов с КМ МБОВД в представленной нами группе показали необходимость удаления патологического новообразования с перифокальной глиотической тканью.…”

Immunotherapy by targeting of VGKC complex for seizure control and prevention of cognitive impairment in a mouse model of epilepsy

“…Though several new antiepileptic drugs have emerged over the past years, the incidence of refractory epilepsy remains high and seizure freedom eludes many patients with epilepsy ( 3 – 5 ). Epidemiological data has indicated that more than twenty percent of newly diagnosed patients are translating into refractory epilepsy every year ( 6 , 7 ). Many factors affect the treatment of epilepsy including environmental factors and genetic factors ( 8 , 9 ).…”