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PubMed2001

Time estimation in patients with right or left medial-temporal lobe resection.

Patients with either left or right antero-medial-temporal lobe (MTL) resection were investigated as to their ability to reproduce and produce three durations (5, 14, or 38 s) in three conditions (silence, counting, articulatory suppression). The results showed that patients with unilateral MTL lesions did not differ from controls when they had to encode the duration of a visual stimulus in order to reproduce it. By contrast, patients with right MTL lesions underestimated all three durations, compared with controls and with patients with left MTL resection, when they had to produce durations given in chronometric units. This finding suggests that the right MTL retains long-term representations of the conventional units necessary to the accurate production of durations.

Adolescent↗
PubMed1997

Periventricular nodular heterotopia and intractable temporal lobe epilepsy: poor outcome after temporal lobe resection.

We describe 5 women and 5 men with periventricular nodular heterotopia and electroclinical features suggestive of temporal lobe epilepsy, who were surgically treated for control of medically refractory seizures. Magnetic resonance imaging revealed bilateral periventricular nodular heterotopia in 7 of the 10 patients. Because of the lack of clear localization, 6 patients were studied with intracranial depth electrode recordings. Seizures were of hippocampal onset (3 patients), regional temporal lobe onset (2 patients), or occipital-temporal onset (1 patient). Anterior temporal lobectomy was performed in 6 patients; selective amygdalohippocampectomy, in 1; and anterior temporal lobectomy plus resection of the heterotopic tissue, in 3. None of the 9 patients followed for more than 12 months postoperatively were seizure free. Two patients were initially seizure free for approximately 18 months, but then seizures recurred. One patient had a major reduction in seizure frequency at a 39-month follow-up after most of the unilateral heterotopic tissue was included in the temporal resection. Temporal resection did not lead to a long-term favorable outcome in this group of patients with periventricular nodular heterotopia and epileptogenic discharges involving the temporal lobe. This suggests a more widespread disorder with epileptogenic activity possibly originating in or near the heterotopic tissue. The clinical and electrographic features of periventricular nodular heterotopia pointing to temporal lobe origin are misleading and temporal resection does not result in long-term cessation of seizures.

Adult↗
PubMed1996

Relation between intracarotid amobarbital memory asymmetry scores and hippocampal sclerosis in patients undergoing anterior temporal lobe resections.

The intracarotid amobarbital procedure (IAP) is used to evaluate memory function preoperatively in candidates for anterior temporal lobe resections (ATL). We examined IAP memory asymmetry scores in 30 patients undergoing ATL (17 R, 13 L), as a function of the presence (HS+) or absence (HS-) of hippocampal sclerosis. Ictal onset zones were determined by extraoperative recording with subdural strip electrodes in all but 3 patients in whom magnetic resonance imaging (MRI) scan showed HS. MRI scans were otherwise normal. All patients were left hemisphere dominant for language except 1, in whom language was represented bilaterally. IAP memory testing involved presentation of eight subjects during anesthesia of each hemisphere, followed by recognition testing after patients recovered from amobarbital effects. A score of 1 was given for each correctly recognized object, and 0.5 was deducted for each false-positive identification. There were 16 foils. A total asymmetry score was calculated, which was positive if there was agreement between the direction of the symmetry and side of operation and negative if reversed. The mean asymmetry score for HS- (n = 8) was 0.9; that for HS+ (n = 22) was 4.1 (p < 0.01). IAP memory performance provided lateralizing information (asymmetry score > or = + or -2) in 73% of cases; among these, the lateralization was correct in 91%. Our data indicate that IAP memory asymmetry predicts both laterality of ictal onset and the presence of HS.

Adolescent↗
PubMed1995

Temporal lobe resections in children.

Often, seizures in childhood are intractable to medical therapy. Intractable seizures and prolonged anticonvulsant medication can adversely affect intellectual development and psychosocial maturation in children. Temporal lobe resections for complex partial seizures and focal epilepsy in children can be performed with minimal morbidity. The higher morbidity lies with prolonged observation of these children with intractable seizures. The final result of surgical treatment shows that children can significantly benefit from an early developmental period without anticonvulsant medication or intractable seizures with improvements in both IQ and behavioral interactions. With improvements in neuroimaging techniques and evaluation procedures, more children can be identified who might benefit from a resective procedure. It is thus advocated that early evaluation and surgical intervention be performed to gain improvement in seizure control and psychosocial development.

Adolescent↗
PubMed1977

Temporal lobe epilepsy. Follow-up investigation of 74 temporal lobe resected patients.

This survey covers 74 patients with temporal lobe epilepsy, resistant to medication, who underwent unilateral temporal lobectomy during the years 1960-1969 at Rigshospitalet, Copenhagen. Preoperatively all patients were socially incapacitated. In all patients a unilateral or predominantly unilateral temporal EEG focus was found. No tumour or gross vascular malformation had been recognized before or during operation. At follow-up 45 patients were free from seizures. A further 15 had obtained a reduction in their seizure frequencies by at least 75%, while the remaining 10 survivors, only obtained a slight improvement or remained unchanged. There were four deaths. The operation also favourably influenced the psychiatric status, which was found closely related to relief from seizures. Prognostically favourable factors were: i) preoperative presence of a single type of seizure, ii) duration of epilepsy of less than four years, iii) operation in or before early adulthood, iv) an anterior temporal or sphenoidal electrode focus, or both, on the EEG. The prognostically unfavourable factors regarding complete relief from seizures were: i) preoperative presence of grand mal, ii) age at onset of epilepsy or of the first grand mal seizure between 5 and 19 years of age, iii) preoperative duration of epilepsy of over ten years and of grand mal of over one year. Prognostically unfavourable factors regarding psychiatric normalization were: i) preoperative presence of psychosis, ii) ictal-affective attacks or automatisms of a complex nature, iii) impairment of intellectual functions. The eventual neuropathological conclusion was that the more specific and circumscribed the histological abnormality the better the final outcome. The social rehabilitation was found to be significantly improved by operation at an early age.

Adolescent↗
PubMed2002

Temporal Lobe Resections in Children with Epilepsy: Neuropsychiatric Status in Relation to Neuropathology and Seizure Outcome.

The purpose of this work was to relate clinical neuropsychiatric findings to histopathological diagnoses and seizure outcome in a retrospective study of 16 children undergoing temporal lobe resections due to medically intractable epilepsy. These children constitute a heterogeneous group in which neuropsychiatric symptoms were common. The results of this study indicate a correlation between malformations of cortical development, less chance of seizure freedom, and neuropsychiatric problems in children with pharmacoresistant temporal lobe epilepsy. It is important to include neuropsychiatric assessments pre- and postoperatively and to inform parents that symptoms of autism spectrum disorders may or may not be improved after epilepsy surgery.

Journal Article↗
PubMed1997

Cerebellar atrophy and prognosis after temporal lobe resection.

OBJECTIVE: Experimental data indicate inhibitory effects of the cerebellum on seizure activity. Structural damage such as cerebellar atrophy, which is a common finding in patients with chronic epilepsy, may reduce these effects. METHODS: Outcome after temporal lobectomy was studied in 78 consecutive patients, with or without cerebellar atrophy diagnosed by MRI. RESULTS: Thirty five patients (45%) showed cerebellar atrophy. At a mean follow up of 14.6 (range, 6-40) months, 50 patients (64%) had no postoperative seizures. In these patients, the frequency of cerebellar atrophy was significantly lower (34%) than in patients who relapsed (64%, p < 0.01). Occurrence of generalised tonic-clonic seizures (GTCS) within two years before surgery, occurrence of GTCS at any time preoperatively, long duration of epilepsy, and older age at surgery were also associated with recurrence of seizures. Multiple logistic regression analysis suggested occurrence of GTCS within two years before surgery and cerebellar atrophy as the main predictive indicators. When both factors were present, the percentage of patients remaining seizure free since surgery fell to 30%, compared with 60% when only GTCS were present, 78.6% when only cerebellar atrophy was present, and 87.5% when both factors were absent. CONCLUSIONS: Cerebellar atrophy shown by MRI was a frequent finding in surgically treated patients with temporal lobe epilepsy. The presence of cerebellar atrophy seems to worsen the prognosis after temporal lobe resection.

Adolescent↗
PubMed1993

Seizure outcome in patients undergoing temporal lobe resections for epilepsy.

This article reviews the results of surgical treatment of temporal lobe epilepsy based on retrospective reviews: more recent surveys from 91 centers on the outcomes from the surgical treatment of epilepsy and preliminary data from the authors' institution's 5-year retrospective review of nearly 100 surgical patients matched to medically treated epileptics. Surgical outcomes from resections in other areas, including extratemporal resections, and the efficacy of lesionectomy versus epilepsy surgery for structural lesions are detailed elsewhere in this issue.

Epilepsy, Temporal Lobe↗
PubMed1989

Acute hippocampal recording and pathology at temporal lobe resection and amygdalo-hippocampectomy for epilepsy.

An electrocorticographic (ECoG) study is reported of patients undergoing surgery for epilepsy of temporal lobe origin. During 22 en bloc resections and six out of a total of 18 amygdalo-hippocampectomies, the activity of the hippocampus was also recorded by a multipolar strip electrode placed along its axis on the ventricular surface. Patients with mesial temporal pathology, chiefly mesial temporal sclerosis, made up the majority of those selected for amygdalo-hippocampectomy. They showed a characteristic ECoG pattern, with spikes localised to the mid part of the second and third convolutions and inferior aspect of the temporal lobe. Typically, this was associated with hippocampal discharges showing an anterior maximum. Pathology involving lateral temporal neocortex and non-specific findings were associated with more widespread temporal spikes and a maximum discharge amplitude over the mid and posterior parts of the hippocampus. It is suggested that intraoperative recording of the ECoG and hippocampal activity may provide a guide to the choice between en bloc resection and amygdalo-hippocampectomy.

Action Potentials↗
PubMed1992

Neuropathological changes in resected temporal lobe of patients with cryptogenic epilepsy.

The study was performed on cerebral tissue resected during temporal lobectomy in 16 patients whose long-standing cryptogenic epilepsy did not submit to anticonvulsive drugs. Cases presenting definite etiological factors such as CNS trauma, infection or neoplasm were excluded. Neuropathological investigations disclosed microangiomas and focal vascular malformations in the meninges and tissue in 7 patients. Neuronal heterotopias in the white matter and of the white matter in the cortex were observed in 3 cases. Main cortical changes were: neuronal loss, chronic neuronal degeneration, perineuronal satellitosis, and GFAP-positive submeningeal gliosis, especially at the bottom of sulci, perivascular gliosis and laminar or diffuse gliosis. The changes in the hippocampus were most enhanced in the end-plate and in the sector H3 of the pyramidal layer. Astrocytic gliosis in the white matter presented distinct GFAP and S-100 immunostaining; the latter involved in some cases a wider area than the GFAP reaction. The above named changes are analysed with regard to the presumed epileptogenic factors and to the postepileptic damage.

Adolescent↗
PubMed1994

The effect of presentation rate on the comprehension and recall of speech after anterior temporal-lobe resection.

Twenty-two patients who had undergone unilateral anterior resection of either the left (LT) or right (RT) temporal lobe and 13 normal control (NC) subjects were tested on a lexical-decision task and a story-memory task. Stimuli were presented aurally, and, in the latter task, at five different speech rates ranging from 125 words per minute (wpm) to 325 wpm. Memory for stories in the LT group was not abnormally sensitive to the effect of increasing rate, although it was inferior to that of the NC group at all speeds. This argues against the hypothesis that the verbal memory deficit evident after LT resection is partially attributable to an abnormally slow processing of verbal information. But LT subjects were impaired at judging the lexicality of words and nonwords presented aurally, suggesting that the left anterior temporal region plays a special role in the processing of speech sounds.

Adult↗
PubMed2001

Human "memories" can be evoked by stimulation of the lateral temporal cortex after ipsilateral medial temporal lobe resection.

A patient with medically intractable seizures and mesial temporal sclerosis underwent a left anterior temporal lobectomy and amygdalohippocampectomy. After 4 months, his seizures recurred and a left temporal, subdural grid of electrodes was placed to localise his seizure focus. Stimulation through the grid evoked four distinct "memories", or experiential phenomena, despite absence of the ipsilateral medial temporal lobe. To our knowledge, this is the first documented case of experiential phenomena evoked by cortical stimulation in the absence of the ipsilateral medial temporal lobe.

Adult↗
PubMedDate not supplied

[Nonverbal visual memory after unilateral temporal lobe resection].

The results of investigations on the retention on non-verbal visual material differentiated with respect to the easiness of verbalization, i.e. codability, are presented. Three groups of 20 subjects each were tested: two groups after unilateral resections of the anterior parts of the temporal lobe and a control groups without brain lesions. The effectiveness of retention depended on the degree of material codability, on the location of resection, and on the degree of difficulty of the memorization task. The obtained results suggested lower effectiveness of the verbalization process of the material, and less effective perception after resection, which was compensated for in cases of right-sided lesions by less impaired verbalization process.

Adolescent↗
PubMed1976

Temporal lobe epilepsy and neuro-ophthalmology. Ophthalmological findings in 74 temporal lobe resected patients.

A survey is presented of the ophthalmological findings in 74 patients with drug-resistant temporal lobe epilepsy, who underwent unilateral anterior temporal lobectomy 1960-1969 at Rigshospitalet, Copenhagen. At follow-up, 1970-1971, one to ten years following the operation, 81% of the patients had no or only few seizures. Preoperatively 11% of the patients suffered from strabismus as compared to an expected frequency of 5%, but this trend just falls short of statistical significance. The visual acuity remained unchanged in all patients following the operation. Preoperatively a visual field defect was observed in 2 patients. At follow-up 51 patients had homonymous hemianopias, in 38 of them this was limited to the upper quadrants, and in 13 patients also included the lower quandrants, but was characterized as a total homonymous hemianopia in only 6 patients. The presence and extent of the visual field defects were correlated to surgical results, age at onset of epilepsy, age at operation, preoperative duration of epilepsy, presence of grand mal, preoperative complications, and neuropathological findings, but without observing any statistically significant conclusions. On the other hand, the extent of the postoperative visual field defect was significantly influenced by the side of the operation, with more and larger defects following right-sided lobectomies. In the 51 patients with postoperative hemianopias, this defect was either unobserved by the patient or regarded as a considerably less important handicap than the frequent and socially invalidating preoperative seizures...

Adolescent↗