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Results for “Temporal Lobe Resection”

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PubMed1999

Hippocampal cell density and subcortical metabolism in temporal lobe epilepsy.

PURPOSE: Correlations between hippocampal cell density and subcortical metabolism in patients with temporal lobe epilepsy (TLE) were studied to explore possible links between subcortical function and the regulation of hippocampal excitability. METHODS: Resected hippocampal cell densities were correlated with cortical and subcortical regional cerebral metabolic rate for glucose (CMRglu), as measured by [18F]-fluorodeoxyglucose positron emission tomography (18-FDG-PET), in 39 patients with intractable TLE who underwent anterior temporal lobectomy (ATL). CMRglu was measured ipsilateral and contralateral to the resected temporal lobe. Linear regression techniques were used for statistical analysis. RESULTS: Hilar cell densities correlated positively and significantly with CMRglu in the bilateral thalamus, putamen and globus pallidus, and the ipsilateral caudate. Dentate granule cell densities correlated positively and significantly with CMRglu in the bilateral thalamus and putamen. There was no significant correlation between cell densities and CMRglu in any cortical region, including the hippocampus. CONCLUSIONS: We postulate that hippocampal cell loss results in decreased efferent synaptic activity to the thalamus and basal ganglia, causing decreased neuronal activity in these structures with consequent hypometabolism. This synaptic activity has a significant bilateral component. Subcortical hypometabolism in patients with TLE may reinforce the epileptogenic potential of mesial temporal lobe discharges.

Amygdala↗

PubMed1995

Overexpression of the neurotrophic cytokine S100 beta in human temporal lobe epilepsy.

Neuritic sprouting and disturbances of calcium homeostasis are well described in epilepsy. S100 beta is an astrocyte-derived cytokine that promotes neurite growth and induces increases in levels of intracellular calcium in neurons. In sections of neocortex of surgically resected temporal lobe tissue from patients with intractable epilepsy, we found that the number of S100 beta-immunoreactive astrocytes was approximately threefold higher than that found in control patients (p < 0.001). These astrocytes were activated, i.e., enlarged, and had prominent processes. Temporal lobe tissue levels of S100 beta were shown by ELISA to be fivefold higher in 21 epileptics than in 12 controls (p < 0.001). The expression of the astrocyte intermediate filament protein, glial fibrillary acidic protein, was not significantly elevated in epileptics, suggesting a selective up-regulation of S100 beta expression. Our findings, together with established functions of S100 beta, suggest that this neurotrophic cytokine may be involved in the pathophysiology of epilepsy.

Adolescent↗

PubMed1994

Speech localization using repetitive transcranial magnetic stimulation.

To evaluate whether repetitive transcranial magnetic stimulation (RTMS) may be used for speech localization, we compared the results from RTMS with the intracarotid amobarbital test (IAT) in 21 patients undergoing surgical treatment (amygdalohippocampectomy or anterior temporal lobe resection) for medically intractable partial epilepsy. None of the patients had aphasia. We stimulated the temporal and frontal cortex on each side at a frequency of 30 Hz for 1 second and increased the intensity until speech was inhibited. A list of words and forward and backward counting were used to test speech function. The IAT was performed on the hemisphere of proposed surgery by unilateral injection and simultaneous regional cerebral blood flow (rCBF) recordings. In one patient, there was doubt about hemisphere dominance and a second bilateral IAT was performed. Fifteen patients had left-sided speech dominance; one, left-sided dominance and a moderate right-sided speech inhibition; two, right-sided speech dominance; and one, bilateral speech representations (bilateral injection at the IAT) with both techniques. One patient showed bilateral with right-sided speech dominance by RTMS and showed right-sided speech inhibition with right-sided injection only at the IAT procedure. One patient differed from the rest, showing bilateral representations with right-sided speech dominance with RTMS and left-sided speech inhibition by IAT with left-sided injection only. The concordance was 95%. None of the patients had seizures provoked by the procedure. We conclude that speech localization with RTMS shows a high concordance with the results from the IAT and may be useful in addition to traditional techniques in speech localization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1976

Psychomotor-psychic seizures treated with bilateral amygdalotomy and orbitotomy.

A 26-year-old woman developed seizures and psychiatric disorders after having been in coma with encephalitis for a protracted period at age 11. Seizures were psychomotor, minor motor, and major motor with auras of fear, panic, and olfaction. The patient hallucinated, had paranoid ideas, was depressed, and attempted suicide. Medical and psychiatric treatment with anticonvulsants and tranquilizers was ineffective. Depth and surface EEG recordings revealed bilateral discharge abnormality in temporal, frontal, and thalamic areas. Lesions were placed in the temporal and orbitofrontal area bilaterally for the psycho-motor-psychic seizures and in the left thalamus for the minor motor seizure. The seizures were relieved without the incapacitating complications that occur with standard lobotomy and temporal lobe resection. Improvement of the psychic component of the seizures is believed due to interrupting seizure discharging circuitry in the temporal and frontal areas. The term temporofrontal seizures is proposed for the anatomic designation of psychomotor-psychic seizures.

Adult↗

PubMed1993

Lateralizing signs in intractable partial epilepsy: blinded multiple-observer analysis.

We evaluated the accuracy and interobserver variability of selected ictal and postictal behavioral changes. Three observers, blinded to clinical history, EEG, and side of surgical resection, analyzed videotapes of 166 seizures in 38 patients, looking for lateralizing signs. Twenty-seven patients with temporal lobe resections were seizure-free for > or = 1 year postoperatively, and 11 with extratemporal resections had at least 90% reduction in seizures > or = 1 year postsurgery. The epileptogenic region (ER) was lateralized by analyzing lateralizing signs in 78% of patients; positive predictive value (PPV) was 94% (90% CI = 87% to 100%). Overall kappa was 0.68. Signs were considered present if seen by two or more observers. Forty-five percent had version, ie, forced and sustained head deviation (kappa = 0.76, PPV = 94%); 37% had dystonic posturing of the upper extremity (kappa = 0.47, PPV = 93%); and 34% had unilateral mouth deviation (kappa = 0.83, PPV = 92%). These signs indicated a contralateral ER. Twenty-one percent had unilateral upper extremity automatisms, all ipsilateral to the ER (kappa = 0.65, PPV = 100%); 21% had postictal dysnomia, indicating a dominant-hemisphere ER (kappa = 0.89, PPV = 100%); and 16% had ictal speech, usually indicating a nondominant-hemisphere ER (kappa = 0.75, PPV = 83%). Dystonic posturing, postictal dysnomia, ictal speech, and unilateral upper extremity automatisms may indicate a higher probability of temporal lobe epilepsy. Analysis of lateralizing signs shows good interobserver agreement and provides useful clinical information.

Arm↗

PubMed1988

Wisconsin Card Sorting Test performance in patients with complex partial seizures of temporal-lobe origin.

Wisconsin Card Sorting Test (WCST) performance was investigated in patients with complex partial seizures (CPS) of dominant (n = 16) or nondominant (n = 19) temporal-lobe origin as well as in an epilepsy control group (n = 6) which consisted largely of patients with primary generalized epilepsies. Fifty seven percent of the CPS group (39% of dominant and 74% of nondominant temporal-lobe patients) performed in a manner suggestive of frontal-lobe pathology compared to 17% of the epilepsy controls. There were no differences among the groups in the number of categories achieved, but there were substantial qualitative differences in problem-solving efficiency. Nondominant temporal patients manifested more total errors and perseverative errors relative to both dominant temporal and epilepsy controls, and more perseverative responses relative to epilepsy controls. Dominant temporal-lobe patients showed more perseverative errors than epilepsy controls. Finally, a consecutive series of patients who underwent partial temporal-lobe resection were examined 6 months post-surgically and they were found to manifest significantly fewer perseverative responses. The possible reasons for "frontal-like" performance in CPS patients with documented temporal-lobe pathology are discussed and a specific hypothesis is suggested.

Adult↗

PubMed2003

Factors predicting outcome of surgery for intractable epilepsy with pathologically verified mesial temporal sclerosis.

PURPOSE: To examine the subgroup of patients with medically intractable epilepsy receiving temporal lobectomies who have pathologically verified mesial temporal sclerosis (MTS) and to determine the relation of demographic and clinical factors, results of diagnostic testing, and details of the surgical procedure with prognosis for achieving control of seizures. METHODS: All patients receiving surgical treatment for intractable epilepsy between 1991 and 1998 at the University of Washington were reviewed. There were 118 patients who met inclusion criteria of adequate pathological analysis showing MTS without a progressive process and a minimum of 1-year follow-up. RESULTS: Only personal history of status epilepticus demonstrated significant (p = 0.0276) prediction of outcome, increasing the risk of surgical failure. No other factors were significant predictors of outcome, including history of febrile seizures, possible etiologic factors, EEG, magnetic resonance imaging (MRI) or neuropsychological testing results, or extent of resection. CONCLUSIONS: Many factors that have been previously described to predict favorable outcome in the overall group of patients receiving temporal lobe resections for intractable epilepsy are, in fact, predictors of MTS and lose their predictive value when the subgroup of patients with confirmed MTS is examined. Neurosurgical treatment of MTS can be very effective even in the presence of significant etiologic factors, or of bilateral or extratemporal abnormalities on EEG or MRI.

Adult↗

PubMed2006

Extent of preoperative abnormalities and focus lateralization predict postoperative normalization of contralateral 1H-magnetic resonance spectroscopy metabolite levels in patients with temporal lobe epilepsy.

BACKGROUND AND PURPOSE: Magnetic resonance (MR) spectroscopy can be used to determine the side of seizure onset in patients with temporal lobe epilepsy. Some patients with abnormal MR spectroscopy findings also have contralateral abnormalities, which in some cases have been reported to normalize after temporal lobe resection. With the aim of better understanding the mechanisms underlying abnormal MR spectroscopy findings, the current study was performed to define patient features that would predict this postoperative normalization. METHODS: Fifteen patients with temporal lobe epilepsy were subjected to preoperative and postoperative 1H-MR spectroscopy investigations, and the preoperative and postoperative metabolite levels in the contralateral hippocampus and contralateral lateral temporal lobe (CLTL) were determined. RESULTS: In the CLTL, postoperative normalization was more pronounced for patients showing extensive preoperative ipsilateral and contralateral abnormalities on MR spectroscopy. A second factor that influenced the degree to which the metabolite levels changed postoperatively was the focus lateralization. Surgery tended to have a more pronounced effect on the contralateral metabolite levels in patients with a right temporal focus, whereas in patients with left temporal foci, postoperative metabolite levels were virtually unchanged. In the contralateral hippocampal region, neither preoperative abnormalities nor focus side was related to postoperative normalization. CONCLUSIONS: We have thus identified 2 different factors (widespread preoperative MR spectroscopy abnormalities and right-sided focus) that predict postoperative normalization of contralateral MR spectroscopy abnormalities. We suggest that both factors indicate a more generalized epileptic disease (ie, that the patients in whom the MR spectroscopy abnormalities normalize are recovering from a more severe impairment).

Adult↗

PubMed1993

Interictal heart rate patterns in partial seizure disorders.

Epileptogenic mesial temporal damage may alter interictal autonomic patterning. Analysis of heart rate variability in 19 patients with complex partial seizures revealed cases of persistent, high-amplitude, 4 to 9 per minute fluctuations in heart rate during alert waking. This pattern was most pronounced in poor candidates for anterior temporal lobe resection (2/19). The 4 to 9 per minute heart-rate variability pattern may emerge following diffuse, extratemporal, or bilateral mesial temporal damage, which interferes with descending forebrain influences on cardiovascular regulation.

Adolescent↗

PubMed2004

The application of functional MRI of memory in temporal lobe epilepsy: a clinical review.

Functional MRI (fMRI) is a useful tool for noninvasively localizing areas in the brain involved in specific cognitive functions. Since its introduction, there has been considerable speculation regarding the role it may play in the presurgical assessment of temporal lobe epilepsy (TLE). This review considers the progress made to date in using fMRI to investigate memory processing in the medial temporal lobe in normal subjects and in those with TLE. Results so far suggest that fMRI will be incorporated into the presurgical assessment of TLE in the coming years to improve definition of eloquent cerebral areas, with the objective of minimizing the adverse cognitive sequelae of anterior temporal lobe resection.

Brain Mapping↗

PubMed2003

Temporal lobectomy in congenital porencephaly associated with hippocampal sclerosis.

BACKGROUND: Clinical and neuroimaging features of patients with epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis have been previously described. OBJECTIVE: To present the clinical characteristics and surgical outcome of 6 patients with intractable epilepsy and coexisting extratemporal porencephaly and hippocampal sclerosis. PATIENTS AND METHODS: Twenty-four patients with porencephaly and epilepsy were studied. Of these, 6 had an epileptogenic focus in the temporal region. All patients underwent video electroencephalogram monitoring, magnetic resonance imaging studies, and neuropsychological evaluation. Of the subset of patients with temporal lobe epilepsy, 1 patient underwent intracranial electroencephalogram monitoring. Temporal lobe resection was performed in 5 patients. Outcomes were evaluated using the Engel classification. RESULTS: Freedom from seizures was achieved in all patients. Pathologic analysis of the resected tissue confirmed the presurgical diagnosis of mesial temporal sclerosis. CONCLUSION: Patients with extratemporal porencephaly and intractable seizures should be evaluated early and be considered for temporal lobectomy if clinical, magnetic resonance imaging, and electroencephalogram findings support the diagnosis of temporal lobe onset seizures.

Adolescent↗

PubMed1996

Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal.

We studied 74 consecutive patients with temporal lobe epilepsy who were treated surgically and in whom the volumes of mesial temporal structures were determined preoperatively by magnetic resonance imaging. We divided the patients into three groups according to the volumetric findings: unilateral (63.5% of the patients), bilateral (23%), or no atrophy (13.5%) of the amygdala-hippocampal formation. Two distinct surgical approaches were used: selective amygdalohippocampectomy (n = 37) or anterior temporal lobe resection (n = 37). Outcome was assessed at least 1 year after surgery, according to Engel's modified classification. Patients with unilateral mesial temporal atrophy had significantly better results compared with the other two groups (p < 0.001): We found excellent results (class I or II outcome) in 93.6% of the patients with unilateral atrophy, in 61.7% of those with bilateral atrophy, and in 50% of the group with no significant atrophy of mesial temporal structures. The two different surgical techniques were equally effective, regardless of the pattern of atrophy. In conclusion, magnetic resonance volumetric studies in temporal lobe epilepsy proved to be an important preoperative prognostic tool for surgical treatment, but they did not provide guidance for selecting one surgical approach compared to the other.

Adult↗

PubMed2004

Neuronavigation and complication rate in epilepsy surgery.

The role of neuronavigation for complications in temporal lobe epilepsy surgery was evaluated. Thirty-seven patients operated on with neuronavigation (group N: 38 operations; mean age 33.9 years; etiology: cryptogenetic 31, symptomatic 7; lateralization: 22 right, 16 left) and 22 patients operated on without neuronavigation (group NN: 23 operations; mean age 29.7 years; etiology: cryptogenetic 9, symptomatic 14; lateralization: 13 right; 10 left) were analyzed. The minimal follow-up time was 2 years. There was a clear difference in the number of complications (N 7.9%; NN 21.7%), which consisted of hemiparesis (N: 1; NN: 2), cranial nerve palsy (N: 1; NN: 2), aphasia (N: 1; NN: 0), and postoperative infection (N: 0; NN: 1). In addition, there was a reduced need for temporal re-resection after intraoperative electrocorticography (N 30.6%; NN 47.1%). Operation time (N: 239+/-9.4 min; NN: 208+/-12.1 min), duration of postoperative in-hospital and in-ICU stay [N: 16.9+/-1.1 days (1.0+/-0.0 days); NN: 17.2+/-2.8 days (1.1+/-0.1 days)], extension of temporal lobe resection from polar (N: 41.2+/-1.5 cm; NN: 42.9+/-3.9 cm), and postoperative seizure frequency reduction (N 90.4%; NN 94.7%) were not different. Because of the trend towards a reduction of complications and re-resections after electrocorticography, the authors recommend neuronavigation despite its higher costs as an additional tool in epilepsy surgery.

Adolescent↗

PubMed2003

Is the cell death in mesial temporal sclerosis apoptotic?

PURPOSE: Mesial temporal sclerosis (MTS) is characterized by neuronal loss in the hippocampus. Studies on experimental models and patients with intractable epilepsy suggest that apoptosis may be involved in neuronal death induced by recurrent seizures. METHODS: We searched evidence for apoptotic cell death in temporal lobes resected from drug-resistant epilepsy patients with MTS by using the terminal deoxynucleotidyl transferase (TdT) and digoxigenin-11-dUTP (TUNEL) method and immunohistochemistry for Bcl-2, Bax, and caspase-cleaved actin fragment, fractin. The temporal lobe specimens were obtained from 15 patients (six women and nine men; mean age, 29 +/- 8 years). RESULTS: Unlike that in normal adult brain, we observed Bcl-2 immunoreactivity in some of the remaining neurons dispersed throughout the hippocampus proper as well as in most of the reactive astroglia. Bax immunopositivity was increased in almost all neurons. Fractin immunostaining, an indicator of caspase activity, was detected in approximately 10% of these neurons. Despite increased Bax expression and activation of caspases, we could not find evidence for DNA fragmentation by TUNEL staining. We also could not detect typical apoptotic changes in nuclear morphology by Hoechst-33258 or hematoxylin counterstaining. CONCLUSIONS: These data suggest that either apoptosis is not involved in cell loss in MTS, or a very slow rate of cell demise may have precluded detecting TUNEL-positive neurons dying through apoptosis. Increased Bax expression and activation of caspases support the latter possibility.

Actin Cytoskeleton↗

PubMed1996

Pharyngeal dysesthesia as an aura in temporal lobe epilepsy.

PURPOSE: Because oral, buccal, and sometimes oral-pharyngeal manifestations in epilepsy are linked to the central-temporal region, we studied 3 patients with childhood-onset partial seizures that consistently began with pharyngeal dysesthesias, described as either throat tingling or burning, to localize seizure onset. METHODS: Because of an intractable clinical course, each patient underwent invasive video-EEG monitoring, which localized the epileptogenic zone to the mesial temporal lobe. The 3 patients underwent temporal lobe resections. RESULTS: All 3 patients achieved remission of the pharyngeal auras and a 90-100% reduction in the frequency of their seizures. CONCLUSIONS: Pharyngeal dysesthesias can be the initial manifestation of complex partial seizures (CPS) of temporal lobe origin.

Adolescent↗

PubMed1995

The asymmetric mamillary body: association with medial temporal lobe disease demonstrated with MR.

PURPOSE: To determine whether mamillary body atrophy is caused by deafferentation of the mamillary body in patients with mesial temporal sclerosis. METHODS: We studied 36 patients with thin-section MR to assess mamillary body symmetry. These patients included 10 control subjects without seizures and 26 patients with a history of seizures. Thin-section T1 scans were available for all cases. The patients with epilepsy underwent axial and coronal T2 scans as well. RESULTS: In five of eight cases with prior medial temporal lobe resection for intractable epilepsy, there was evidence of unilateral mamillary body atrophy ipsilateral to the resection. Similar findings were evident in three of six patients with MR findings of mesial temporal sclerosis without surgery. Two patients with medial temporal stroke or tumor also had ipsilateral mamillary body atrophy. CONCLUSION: These findings provide support for the proposed mechanism of mamillary body atrophy caused by prior medial temporal lobe injury.

Adult↗

PubMed1999

Effect of propofol on the electrocorticogram in epileptic patients undergoing cortical resection.

We have compared the effect of clinical doses of propofol with thiopental on epileptiform activity in the electrocorticograms (ECoG) of 20 epileptic patients undergoing temporal lobe resection. After baseline ECoG had been obtained, with inspired concentrations of 0.5-1% isoflurane and 70% nitrous oxide to provide background anaesthesia, subjects were allocated randomly to receive boluses of either thiopental 25 mg or propofol 20 mg i.v. every 30 s to a maximum of 5 mg kg-1 or until burst suppression was seen. The ECoG was recorded throughout administration and for 10 min thereafter. After return of baseline ECoG tracings, the alternate agent was administered. The amount of epileptiform activity was recorded on an ordinal rating scale, an increase being indicated by either a rise of at least one category on the scale or discharges occurring at a minimum of one new site. Activation occurred more frequently with thiopental but the difference was not significant. This study suggests that propofol has no greater proconvulsive effect than thiopental, a drug commonly used in managing status epilepticus.

Adolescent↗

PubMed1994

Posterior temporal epilepsy: electroclinical features.

In the course of evaluating children with posterior temporal lobe epilepsy with subdural electrodes, we observed that their seizures commonly arose from basal rather than convexity foci and that they followed a stereotyped clinical sequence. Seizures characteristically began with behavioral arrest that coincided with basal temporal seizure discharges and progressed to motor signs as the seizure activity spread to the ipsilateral cortical convexity. Behavioral automatisms were observed in approximately half the patients, but were never the first or most prominent ictal manifestation. Focal lesions were identified preoperatively in 7 patients. We performed tailored temporal lobe resections in 14 patients, 10 (71%) of whom were seizure free (N = 9) or had occasional auras (N = 1) at a mean follow-up of 2 years. These findings suggest that in childhood, posterior temporal seizures frequently arise from basal cortex and have a consistent and recognizable ictal and electrographic semiology. In medically refractory patients, tailored temporal resection is an effective therapy.

Adolescent↗