Predictors of outcome after anterior temporal lobectomy

Sperling, Michael R.; Saykin, Andrew J.; Glosser, Guila; Moran, Mark; French, Jacqueline; Brooks, Michael; O’Connor, Michael J.

doi:10.1212/wnl.44.12.2325

Cited by 113 publications

(78 citation statements)

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“…However, convergence of MRI together with interictal and ictal scalp EEG is usually sufficient to reliably diagnose unilateral MTS. In patients with concordance of interictal EEG findings and MRI abnormality, seizure-free outcomes of 77% (70) and 78.9%, respectively (40), have been described in the literature.…”

Section: Fig 1 T and Flair Mr Images Of A 30mentioning

confidence: 98%

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Temporal Lobe Epilepsy: When Are Invasive Recordings Needed?

2000

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Summary:Temporal lobe epilepsy (TLE) is the most common type of medically intractable partial epilepsy amenable to surgery. In the majority of cases, the underlying pathology in temporal lobe epilepsy is mesial temporal sclerosis (MTS). Whereas historically invasive recordings were required for most epilepsy surgeries, indications have dramatically changed since the introduction of high-resolution MRI, which uncovers structural lesions in a high percentage of cases. No invasive recordings are required to perform a temporal lobectomy in patients with intractable epilepsy who have structural imaging suggesting unilateral MTS and concordant interictal and ictal surface EEG recordings, functional imaging, and clinical findings. Invasive testing is needed if there is evidence of bitemporal MTS on structural imaging and/or electrophysiologically, and additional information from functional imaging, neuropsychology, and the intracarotid amobarbital (Wada) test also does not help to lateralize the epileptogenic zone. Depth electrodes can be particularly helpful in this setting. However, no surgery is indicated, even without invasive recordings, if bitemporalindependent seizures are recorded by surface EEG and all additional testing is inconclusive. Other etiologies of TLE such as a tumor, vascular malformation, encephalomalacia, or congenital developmental abnormality account for about 30% of all patients who undergo epilepsy surgery. Epilepsy surgery is indicated after limited electrophysiologic investigations if neuroimaging and electrophysiology converge. However, approaches for resection in lesional temporal lobe epilepsy vary among centers. Completeness of resection is crucial and invasive recordings may be needed to guide the resection by mapping eloquent cortex and/or to determine the extent of the non-MRI-visible epileptogenic area. Specific approaches for the different pathologies are discussed because there is evidence that the relationship between the lesions visible on MRI and the epileptogenic zone varies among lesions of different pathologies, and therefore variable surgical strategies must be applied. Key Words: Temporal lobe-Epilepsy-Electrodes, implanted-Magnetic resonance imaging-Brain neoplasms. HISTORICAL PERSPECTIVES: INVASIVE RECORDINGS FOR EPILEPSY SURGERYThe pioneers of epilepsy surgery utilized clinical findings and seizure semiology to localize the epilepsy and to guide the neurosurgical intervention. This is illustrated by Victor Horsley's first neurosurgical intervention at Queens Square in 1886. The patient was a 22-year-old Scotsman who had a posttraumatic epilepsy. He had very frequent focal motor seizures characterized by a clear march. The diagnosis of "scar involving the hinder end of the superior frontal sulcus" was made according to the ictal semiology and the seizures stopped after surgical removal of the scar. Apart from semiologic analysis of the seizures, additional information was obtained by intraoperative cortical stimulations to reproduce the patient's seizure semiology and to ...

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Section: Fig 1 T and Flair Mr Images Of A 30mentioning

confidence: 98%

“…formance after injection of the contralateral hemisphere is associated with good surgical results (68,70).…”

Section: Fig 1 T and Flair Mr Images Of A 30mentioning

confidence: 99%

Temporal Lobe Epilepsy: When Are Invasive Recordings Needed?

2000

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“…Sperling et al (6) reported that seizure outcome was closely linked to intracarotid amytal scores in temporal lobectomy patients. They reported better outcome when ipsilateral injection score minus contralateral injection score was >O.…”

Section: Rk Then Underwent Neuropsychological Testing Andmentioning

confidence: 99%

Abnormal Wada and Neuropsychological Testing Results Due to Topiramate Therapy

McCabe

Eslinger

2000

Epilepsia

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Summary:A 46-year-old man experienced intractable seizures since childhood. Due to lack of response to antiepilepsy drugs (AEDs), he underwent a surgical evaluation that was consistent with seizure onset in the left medial temporal lobe. While on topiramate and carbamazepine, his preoperative neuropsychological scores and sodium amytal (Wada) scores were low and may have excluded him from surgery. Repeat testing on lamotrigine and carbamazepine showed improvement in his scores, allowing him to undergo surgery. Physicians must therefore be cautious in evaluating such test scores while a patient is on topiramate. Key Words: Topiramate-WddaNeuropsychological-Surgery-Temporal.Although topiramate (TPM) is a potent antiepilepsy drug, cognitive side effects must be considered when choosing this new antiepilepsy drug. One particular concern would be if the drug interfered with the accuracy of neuropsychological testing, particularly in the case of surgical evaluation. We present a case where topiramate therapy caused significantly altered memory scores during standardized neuropsychological testing and in memory assessment during intracarotid sodium amytal (Wada) procedure. CASE REPORTR.K. is a 46-year-old right-handed male with a history of epilepsy since childhood, including febrile seizures. He is a college graduate with a degree in architectural engineering and serves as the manager of design/ construction at a major hospital. His seizures consist of staring, loss of awareness, and mild oral automatisms. They last from 30 to 45 s. He averaged 10-15 seizures per month. On at least one occasion, he was admitted Accepted March 10, 2000. Address correspondence and reprint requests to Dr. P. McCabe at Section of Neurology, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, U.S.A. E-mail: pmccabe@psghs.edu with nonconvulsive status. Past medical management consisted of phenobarbital, mephobarbital, primidone, valproic acid, phenytoin, lamotrigine, and carbamazepine. Due to the intractability of his seizures, he underwent surgical evaluation. At the time, he was on carbamazepine (1,800 mg of extended releaselday) and topiramate (500 nig/day). While on this combination, his performance at work decreased, and he required a temporary leave of absence. He complained of decreased memory and concentration. Magnetic resonance imaging revealed left mesial temporal sclerosis and interictal electroencephalogram (EEG) showed frequent left-sided spikes with phase reversal at F7-T3 (ictal EEG was not obtained). R.K. then underwent neuropsychological testing andWada testing to complete his surgical evaluation. WMS-R general memory index was 66 (1st percentile), with verbal memory being 61 (

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“…Correlates of epilepsy cure after temporal lobe resection include unilateral hippocampal atrophy on MRI; unilateral temporal lobe hypometabolism on PET; CAI cell loss histologically; asymmetric memory competence on the Wada test; presence of an early risk factor such as prolonged febrile seizure; and the combination of few or no generalized tonic-clonic seizures, mesial temporal sclerosis, and a known cause (34,(40)(41)(42)(74)(75)(76)(77)(78)(79). These observations support almost all of the localizing studies I have mentioned in terms of their ability to identify the syndrome.…”

Section: Developmental Acquired Medial Temporal Lobe Epilepsy Localmentioning

confidence: 99%

Substrates of Localization‐Related Epilepsies: Biologic Implications of Localizing Findings in Humans

Spencer

1998

Epilepsia

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Predictors of outcome after anterior temporal lobectomy

Cited by 113 publications

References 0 publications

Temporal Lobe Epilepsy: When Are Invasive Recordings Needed?

Temporal Lobe Epilepsy: When Are Invasive Recordings Needed?

Abnormal Wada and Neuropsychological Testing Results Due to Topiramate Therapy

Substrates of Localization‐Related Epilepsies: Biologic Implications of Localizing Findings in Humans

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