Parahippocampectomy as a New Surgical Approach to Mesial Temporal Lobe Epilepsy Caused By Hippocampal Sclerosis: A Pilot Randomized Comparative Clinical Trial

Alonso-Vanegas, Mario; Carlier, Iván D. Freire; San-Juan, Daniel; Martínez, Alma Rosa; Trenado, Carlos

doi:10.1016/j.wneu.2017.11.170

Cited by 13 publications

(16 citation statements)

References 34 publications

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“…As previously described, the lower values in the mesial temporal lobe are likely due to the presence of mesial temporal sclerosis in the pathological hemisphere 18 . The presence of mesial temporal sclerosis also explains the lower values seen in the parahippocampus as well as it is the region of the brain surrounding the hippocampus, also involved in the limbic system, and has been shown to be affected by this sclerotic process in temporal lobe epilepsy 22 . The increase in ipsilateral RD values for the hippocampus and parahippocampus is related to the meaning of the RD value as it measures increases in white matter with demyelination which occurs with MTS.…”

Section: Discussionmentioning

confidence: 98%

“…The significant decreases exhibited in tractography on the ipsilateral hemisphere as the pathological process are likely attributed to direct effects of the sclerotic disease such as the ipsilateral temporal pole in TLE patients 18 . These findings may also be attributed to extensions of the disease process/disruptions in connections to adjacent structures, for instance, the ipsilateral lingual gyrus which joins the parahippocampal gyrus and is a continuation of the tentorial surface of the temporal lobe 22 .…”

Section: Discussionmentioning

confidence: 99%

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Hemispheric Regional Based Analysis of Diffusion Tensor Imaging and Diffusion Tensor Tractography in Patients with Temporal Lobe Epilepsy and Correlation with Patient outcomes

Alizadeh

Kozlowski

Muller

et al. 2019

Sci Rep

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Imaging in the field of epilepsy surgery remains an essential tool in terms of its ability to identify regions where the seizure focus might present as a resectable area. However, in many instances, an obvious structural abnormality is not visualized. This has created the opportunity for new approaches and imaging innovation in the field of epilepsy, such as with Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT). In this study, we aim to evaluate the use of DTI and DTT as a predictive model in the field of epilepsy, specifically Temporal Lobe Epilepsy (TLE), and correlate their clinical significance with respect to postsurgical outcomes. A hemispheric based analysis was used to compare the tract density, as well as DTI indices of the specific regions of interest from the pathologic hemisphere to the healthy hemisphere in TLE patients. A total of 22 patients with TLE (12 males, 10 females, 22–57 age range) underwent either a craniotomy, Anterior Temporal Lobectomy (ATL), or a less invasive method of Selective Laser Amygdalohippocampectomy (SLAH) and were imaged using 3.0 T Philips Achieva MR scanner. Of the participants, 12 underwent SLAH while 10 underwent ATL. The study was approved by the institutional review board of Thomas Jefferson University Hospital. Informed consent was obtained from all patients. All patients had a diagnosis of TLE according to standard clinical criteria. DTI images were acquired axially in the same anatomical location prescribed for the T1-weighted images. The raw data set consisting of diffusion volumes were first corrected for eddy current distortions and motion artifacts. Various DTI indices such as Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD) and Axial Diffusivity (AD) were estimated and co-registered to the brain parcellation map obtained by freesurfer. 16 consolidated cortical and subcortical regions were selected as regions of interest (ROIs) by a functional neurosurgeon and DTI values for each ROI were calculated and compared with the corresponding ROI in the opposite hemisphere. Also, track density imaging (TDI) of 68 white matter parcels were generated using fiber orientation distribution (FOD) based deterministic fiber tracking and compared with contralateral side of the brain in each epileptic group: left mesial temporal sclerosis (LMTS) and right MTS (RMTS)). In patients with LMTS, MD and RD values of the left hippocampus decreased significantly using two-tailed t-test (p = 0.03 and p = 0.01 respectively) compared to the right hippocampus. Also, RD showed a marginally significant decrease in left amygdala (p = 0.05). DTT analysis in LMTS shows a marginally significant decrease in the left white matter supramarginal parcel (p = 0.05). In patients with RMTS, FA showed a significant decrease in the ipsilateral mesial temporal lobe (p = 0.02), parahippocampal area (p = 0.03) and thalamus (p = 0.006). RD showed a marginally significant increase in the ipsilateral hippocampus (p = 0.05) and a significant increase in the ipsilatera...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Hemispheric Regional Based Analysis of Diffusion Tensor Imaging and Diffusion Tensor Tractography in Patients with Temporal Lobe Epilepsy and Correlation with Patient outcomes

Alizadeh

Kozlowski

Muller

et al. 2019

Sci Rep

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“…61 Neuropsychological data at an individual level were found in six of the open surgery studies and were summarized. 4,37,38,40,44,45 Postoperative visual memory decline was reported in 24.8% (35/141) and 25.7% (45/175) after ATL and sAHE, respectively, whereas an improvement in visual memory function was found in 31.2% (44/141) after ATL and in 33.1% (58/175) after sAHE. A deterioration of verbal memory was reported in 24.7% (55/223) after ATL and in 24.0% (52/217) after sAHE, whereas an improvement of verbal memory performance was found in 11.7% (26/223) and 15.2% (33/217) after ATL and sAHE, respectively.…”

Section: Neuropsychological Outcomementioning

confidence: 99%

Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes

et al. 2021

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Magnetic resonance‐guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug‐refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta‐analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty‐three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel‐I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%–67.4%), RFA in 44% (54/123, range = 0%–67.2%), ATL in 69% (1032/1504, range = 40%–92.9%), and sAHE in 66% (887/1326, range = 21.4%–93.3%). Meta‐analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow‐up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel‐I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left‐sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel‐I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel‐I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.

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“…Surgery of epilepsy is a highly effective treatment to stop seizures for the majority of PWE [ 69 , 70 ]. The “low hanging fruit” of surgical treatment is surgery of temporal lobe epilepsy (TLE) due to the fact that TLE is common, frequently does not respond to medication, and has excellent opportunity to achieve seizure freedom from surgery.…”

Section: Literature Reviewmentioning

confidence: 99%

Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa

2018

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Epilepsy is an important and common worldwide public health problem that affects people of all ages. A significant number of individuals with epilepsy will be intractable to medication. These individuals experience an elevated mortality rate and negative psychosocial consequences of recurrent seizures. Surgery of epilepsy is highly effective to stop seizures in well-selected individuals, and seizure freedom is the most desirable result of epilepsy treatment due to the positive improvements in psychosocial function and the elimination of excess mortality associated with intractable epilepsy. Globally, there is inadequate data to fully assess epilepsy-related quality of life and stigma, although the preponderance of information we have points to a significant negative impact on people with epilepsy (PWE) and families of PWE. This review of the psychosocial impact of epilepsy focuses on regions of Asia and Sub-Saharan Africa that have been analyzed with population study approaches to determine the prevalence of epilepsy, treatment gaps, as well as factors impacting psychosocial function of PWE and their families. This review additionally identifies models of care for medically intractable epilepsy that have potential to significantly improve psychosocial function.

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Parahippocampectomy as a New Surgical Approach to Mesial Temporal Lobe Epilepsy Caused By Hippocampal Sclerosis: A Pilot Randomized Comparative Clinical Trial

Cited by 13 publications

References 34 publications

Hemispheric Regional Based Analysis of Diffusion Tensor Imaging and Diffusion Tensor Tractography in Patients with Temporal Lobe Epilepsy and Correlation with Patient outcomes

Hemispheric Regional Based Analysis of Diffusion Tensor Imaging and Diffusion Tensor Tractography in Patients with Temporal Lobe Epilepsy and Correlation with Patient outcomes

Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes

Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa

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