Temporal pole epilepsy surgery—Sparing the hippocampus

Herlin, Bastien; Adam, Claude; Habert, Marie Odile; Mathon, Bertrand; Clemenceau, Stéphane; Navarro, Vincent

doi:10.1111/epi.16693

Cited by 16 publications

(6 citation statements)

References 13 publications

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“…It is our experience and others [2][3][4][5][6] that temporal lobe epilepsy (TLE), and specifically TPE, could be caused by small encephaloceles that are frequently located at the temporal tip. Contrary to these findings, this pathology was not found by Herlin et al 1 Recent studies have shown that temporal lobe encephaloceles could account for 5% of patients with TLE 4 and up to 2%-12% of patients with drug-resistant epilepsy. 3,7 In our epilepsy program, TP encephaloceles were detected in 23% of patients with refractory TLE in whom the initial magnetic resonance imaging (MRI) assessment was considered normal.…”

Section: To the Editorscontrasting

confidence: 64%

“…We read with great interest the study by Herlin et al, 1 describing 19 patients with drug-resistant temporal pole epilepsy (TPE). In this article, the authors evaluated the main features of this epilepsy syndrome as well as the surgical outcome.…”

Section: To the Editorsmentioning

confidence: 99%

“…Based on connectivity, it might be assumed that the semiology of seizures arising from the TP is always similar to that of medial TLE. 1,8 On the other hand, the proximity of the TP to the basal temporal language area could explain why some patients with TPE have an alteration of language as a major feature of their seizures. 9,10 Aphasic seizures have been reported in previous studies of patients with TPE from the dominant hemisphere 2,6,10 ; up to 80% of patients with left TP encephaloceles had aphasic seizures along with other seizures types during the course of their epilepsy.…”

Section: To the Editorsmentioning

confidence: 99%

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Temporal pole epilepsy: Do not forget to look for occult encephaloceles

2020

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Section: To the Editorscontrasting

confidence: 64%

Section: To the Editorsmentioning

confidence: 99%

Section: To the Editorsmentioning

confidence: 99%

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Temporal pole epilepsy: Do not forget to look for occult encephaloceles

2020

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“…In a study (20), oroalimentary automatisms occurred in 20 of 23 patients with early temporal pole involvement in seizures. And in another study (30), oroalimentary automatisms occurred in 15 of the 19 patients with temporal pole epilepsy. Compared with MTLE, the first clinical sign and loss of awareness occurred sooner in the temporal pole epilepsy (20).…”

Section: The Anatomic-electroclinical Correlation Of Groupmentioning

confidence: 87%

“…In addition, temporal pole plays a vital role in TLE (19). The temporal pole activity can mimic the semiologic features of medial temporal and frontal epilepsy (30). When temporal pole discharge spreads preferentially to the frontal lobe, it may produce hyperkinetic.…”

Section: The Anatomic-electroclinical Correlation Of Groupmentioning

confidence: 99%

Correlation Between Ictal Signs and Anatomical Subgroups in Temporal Lobe Seizures: A Stereoelectroencephalography Study

Zhang

Wang

et al. 2022

Front. Neurol.

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ObjectiveIctal semiology is a fundamental part of the presurgical evaluation of patients with temporal lobe epilepsy. We aimed to identify different anatomical and semiologic subgroups in temporal lobe seizures, and investigate the correlation between them.MethodsWe enrolled 93 patients for whom stereoelectroencephalography exploration indicated that the seizure-onset zone was within the temporal lobe. Ictal signs and concomitant stereoelectroencephalography changes were carefully reviewed and quantified, and then cluster analysis and the Kendall correlation test were used to associate ictal signs with the temporal structures of patients.ResultsClustering analysis identified two main groups of temporal structures. Group 1 consisted of the medial temporal lobe structures and the temporal pole, which were divided into two subgroups. Group 1A included the hippocampal head, hippocampal body, and amygdala, and this subgroup correlated significantly with oroalimentary automatisms, feeling of fear, and epigastric auras. Group 1B included the hippocampal tail, temporal pole, and parahippocampal gyrus, and this subgroup correlated significantly with manual and oroalimentary automatisms. Group 2 consisted of the cortical structures of the temporal lobe and was also divided into two subgroups. Group 2A included the superior and middle temporal gyrus, correlated significantly with bilateral rictus/facial contraction, generalized tonic–clonic seizure, and manual automatisms. Group 2B included Heschl's gyrus, the inferior temporal gyrus, and the fusiform gyrus, and this subgroup correlated significantly with auditory auras, focal hypokinetics, unilateral upper and lower limbs tonic posture/clonic signs, head/eye deviation, unilateral versive signs, and generalized tonic–clonic seizure.SignificanceThe temporal structures can be categorized according to the level at which each structure participates in seizures, and different anatomical subgroups can be correlated with different ictal signs. Identifying specific semiologic features can help us localize the epileptogenic zone and thus develop stereoelectroencephalography electrode implantation and surgical resection protocols for patients with temporal lobe epilepsy.

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Exploration of epileptic networks in temporal lobe encephaloceles with stereotactic EEG: Electroclinical characteristics and surgical outcomes

Zillgitt,

Mong,

Manasseh

et al. 2024

Epilepsia Open

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ObjectiveTemporal lobe encephaloceles (TLEN) have been implicated as a cause of temporal lobe epilepsy (TLE), the treatment which is primarily surgical; however, there is no clear consensus on the optimal surgical approach, because it is unclear whether TLE related to TLEN can be addressed by a restricted encephalocele resection or if a more extensive resection is required. The aim of the current article is to report the clinical and electrophysiological profile of patients with TLE secondary to TLEN who underwent stereotactic electroencephalography (SEEG) implantation to identify the epileptogenic network.MethodsA retrospective review was performed of patients with TLE related to TLEN who underwent SEEG implantation. Medical charts were reviewed for demographic data, the results of noninvasive and invasive investigations, and operative details. Surgical outcomes were based on Engel classification with at least 6 months follow‐up.ResultsNine patients were identified. The mean age at epilepsy onset was 28 years (range, 15–41 years), and 7/9 patients were female. Scalp EEG revealed interictal epileptiform activity most often maximum in the frontotemporal and/or temporal regions. A discrete TLEN was often not identified on initial imaging, but was identified during re‐review or at the time of surgery. Seizure onset zones during SEEG were localized to the mesial temporal structures, the temporal pole, or both. One patient became seizure‐free following SEEG and another refused further surgery. Of the 7 patients who underwent epilepsy surgery, 5/7 underwent an anterior temporal lobectomy—surgical outcomes were favorable, with 5/7 achieving Engel I outcomes.SignificanceInvasive SEEG monitoring demonstrated ictal onsets may not be restricted to the TLEN, and often the temporal pole and mesial structures are involved at seizure onset. Ictal propagation patterns vary significantly, which may be related to the underlying pathology and explain the variability in semiology. These findings may inform surgical treatment options.Plain language summaryTemporal lobe encephaloceles can cause intractable epilepsy, although their presence may be missed on routine imaging. The management of encephaloceles is primarily surgical; however, the optimal surgical approach can be unclear. Invasive monitoring with SEEG may help characterize the epileptogenic network and result in more optimal surgical outcomes.

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Temporal pole epilepsy surgery—Sparing the hippocampus

Cited by 16 publications

References 13 publications

Temporal pole epilepsy: Do not forget to look for occult encephaloceles

Temporal pole epilepsy: Do not forget to look for occult encephaloceles

Correlation Between Ictal Signs and Anatomical Subgroups in Temporal Lobe Seizures: A Stereoelectroencephalography Study

Exploration of epileptic networks in temporal lobe encephaloceles with stereotactic EEG: Electroclinical characteristics and surgical outcomes

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