Prognostic factors and outcome after different types of resection for temporal lobe epilepsy

Clusmann, Hans; Schramm, Johannes; Kral, Thomas; Helmstaedter, Christoph; Ostertun, B.; Fimmers, Rolf; Haun, Dorothee; Elger, Christian E.

doi:10.3171/jns.2002.97.5.1131

Cited by 317 publications

(269 citation statements)

References 51 publications

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“…In our cohort of TLE patients, 72.7% became seizure-free after surgery, which is consistent with the majority of surgical series in literature [22][23][24][25] . The best outcome was achieved by MTS type 1a and MTS type 1b groups, reproducing previous reports 6,7 .…”

Section: Discussionsupporting

confidence: 74%

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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Article temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome Epilepsia do lobo temporal com esclerose mesial temporal: o padrão da perda neuronal hipocampal como preditor do prognóstico cirúrgico Anaclara Prada Jardim¹, Rafael Scarpa da Costa Neves¹, Luís Otávio Sales Ferreira Caboclo¹, Carmen Lucia Penteado Lancellotti² , ³, Murilo Martinez Marinho¹, Ricardo Silva Centeno¹, Esper Abrão Cavalheiro 4 , Carla Alessandra Scorza 4 , Elza Márcia Targas Yacubian¹Mesial temporal sclerosis (MTS) is the most common pathological finding in drug refractory, chronic temporal lobe epilepsy (TLE) 1 . Mesial temporal lobe structures with a sclerotic hippocampus have been considered the site of seizure onset for most TLE patients, and hippocampal sclerosis (HS) has been considered essential for MTS diagnosis. Surgery has become the treatment of choice in the management of patients with this epilepsy syndrome 2,3 . Tailored resections of temporal neocortex and mesial temporal structures, including hippocampus and amygdala, are an established epilepsy treatment modality and offer a favorable outcome in approximately two-thirds of patients 4,5 .The reason why around one-third of individuals with this epilepsy syndrome still present seizures after surgical treatment ABStrActObjective: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. Method: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. Results: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). Conclusion: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.Key words: epilepsy, temporal lobe, mesial temporal sclerosis, hippocampal sclerosis, pathology, surgical prognosis. reSUMO Objetivo: Analisar retrospectivamente uma série de pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT), bem como correlacionar os padrões de esclerose hipocampal com os dados clínicos e o prognóstico cirúrgico. Métodos: Foram incluídos neste estudo 66 pacientes com ELT refratária a tratamento medicamentoso e com EMT unilateral submetidos à lobectomia temporal anterior. A análise neuropatológica quantitativa foi realizada em seções hipocampais imunomarcadas com NeuN. Dados clínicos e resultados do acompanhamento pós-cirúrgico foram revisados. Resultados: Ocorrência de evento precipitante inicial e melhor controle de crises após a cirurgia (i.e. classe 1 de Engel) foram associados aos pad...

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Section: Discussionsupporting

confidence: 74%

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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“…The resection may disturb or damage cortex eloquent for memory and language functioning. Despite extensive non-invasive and invasive pre-operative hemispheric language and memory testing, subtle problems may arise in post-operative language functioning after left ATL (Hermann et al, 1994;Davies et al, 1998;Langfitt and Rausch, 1996;Clusmann et al, 2002). More frequently difficulties in verbal memory are found post-operatively (Rausch et al, 2003;Lee et al, 2002;Bell and Davies, 1998).…”

Section: Introductionmentioning

confidence: 99%

Language activation distributions revealed by fMRI in post-operative epilepsy patients: Differences between left- and right-sided resections

et al. 2005

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Objective: To reveal differences of cerebral activation related to language functions in post-operative temporal lobe epilepsy (TLE) patients. Methods: Right (RTL) and left temporal lobe (LTL) resected patients, and healthy controls were studied using functional magnetic resonance imaging (fMRI). Only patients with complete left-hemispheric language dominance according to the intracarotid amytal procedure (IAP) were included. Language-related activations were evoked by performing word generation and text reading language tasks. Activation lateralization and temporo-frontal distribution effects were analysed. Results: For word generation, only LTL patients showed reduced left lateralized activation compared to controls, due to a decrease in activation in the left prefrontal cortex and an increase in the right prefrontal cortex. For reading, the left-hemispheric lateralization in RTL patients increased because of enhanced activity in the left prefrontal cortex, whereas for LTL patients the activation became bilaterally distributed over the temporal lobes. Lateralization results between pre-operative IAP and postoperative fMRI were highly discordant. Significant temporo-frontal distribution changes manifested from the reading but not from the word generation task. * Corresponding author. Backes et al. / Epilepsy Research 66 (2005) [1][2][3][4][5][6][7][8][9][10][11][12] Conclusion: The cerebral language representation in post-operative LTL epilepsy patients is more bi-hemispherically lateralized than in controls and RTL patients. Post-operative temporo-frontal and interhemispheric redistribution effects, involving contralateral homologuous brain areas, are suggested to contribute to the cerebral reorganisation of language function.

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“…Because of the involvement of the hippocampus in the generation and maintenance of seizures in TLE, the conventional treatment of patients with medically intractable TLE has been neurosurgical excision of the hippocampus or both hippocampus and amygdala. This procedure, though greatly reduces seizure frequency (Clusmann et al, 2002;Engel, 2003), may lead to impairments in learning and memory functions (Nunn et al, 1998;Martin et al, 2002;Richardson et al, 2004). Therefore, alternative therapeutic options that not only suppress seizures but also preserve hippocampal-dependent learning and memory functions are critical.…”

Section: Introductionmentioning

confidence: 99%

Restoration of calbindin after fetal hippocampal CA3 cell grafting into the injured hippocampus in a rat model of temporal lobe epilepsy

Shetty

Hattiangady

2007

Hippocampus

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Degeneration of the CA3 pyramidal and dentate hilar neurons in the adult rat hippocampus after an intracerebroventricular kainic acid (KA) administration, a model of temporal lobe epilepsy, leads to permanent loss of the calcium binding protein calbindin in major fractions of dentate granule cells and CA1 pyramidal neurons. We hypothesize that the enduring loss of calbindin in the dentate gyrus and the CA1 subfield after CA3-lesion is due to disruption of the hippocampal circuitry leading to hyperexcitability in these regions; therefore, specific cell grafts that are capable of both reconstructing the disrupted circuitry and suppressing hyper-excitability in the injured hippocampus can restore calbindin. We compared the effects of fetal CA3 or CA1 cell grafting into the injured CA3 region of adult rats at 45 days after KA-induced injury on the hippocampal calbindin. The calbindin immunoreactivity in the dentate granule cells and the CA1 pyramidal neurons of grafted animals was evaluated at 6 months after injury (i.e. at 4.5 months post-grafting). Compared with the intact hippocampus, the calbindin in "lesion-only" hippocampus was dramatically reduced at 6 months post-lesion. However, calbindin expression was restored in the lesioned hippocampus receiving CA3 cell grafts. In contrast, in the lesioned hippocampus receiving CA1 cell grafts, calbindin expression remained less than the intact hippocampus. Thus, specific cell grafting restores the injury-induced loss of calbindin in the adult hippocampus, likely via restitution of the disrupted circuitry. Since loss of calbindin after hippocampal injury is linked to hyperexcitability, re-expression of calbindin in both dentate gyrus and CA1 subfield following CA3 cell grafting may suggest that specific cell grafting is efficacious for ameliorating injury-induced hyperexcitability in the adult hippocampus. However, electrophysiological studies of KA-lesioned hippocampus receiving CA3 cell grafts are required in future to validate this possibility.

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Prognostic factors and outcome after different types of resection for temporal lobe epilepsy

Abstract: Different strategies for surgical approaches in TLE result in equally good outcomes. Seizure outcome is mainly dependent on the diagnosis and clinical factors, whereas the neuropsychological results are more beneficial after resections limited to an epileptogenic lesion and focus.

Cited by 317 publications

References 51 publications

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Language activation distributions revealed by fMRI in post-operative epilepsy patients: Differences between left- and right-sided resections

Restoration of calbindin after fetal hippocampal CA3 cell grafting into the injured hippocampus in a rat model of temporal lobe epilepsy

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