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PubMed2003

Temporal lobe epilepsy surgery and preoperative factors predictive of postoperative outcome: retrospective analysis of 143 cases.

OBJECTIVE: To evaluate the long-term outcome of temporal lobe epilepsy (TLE) surgery with dipole localization and to analyze the preoperative factors predicting a satisfactory postoperative outcome of the patients. METHODS: A total of 143 patients, who underwent TLE surgery with dipole localization combined with magnetic resonance imaging between 1999 and 2001 and were followed up for at least 1 year, were enrolled in this retrospective analysis of clinical, electrophysiological, neuroimaging and surgical factors to determine the independent predictors for the clinical outcome of the patients. RESULTS: During the follow-up with a mean duration of 27.5 months, 70.6% (101) of the patients were found to be completely seizure- free or with only aura (Class I), and 14.0% (20) had only rare seizures (Class II, fewer than three seizures per year), which resulted in satisfactory seizure control in 84.6% of the cases. In addition, obvious improvement was achieved in 10.5% (15) of the cases (Class III, at least an 75% seizure reduction), while 4.9% (n=7) failed to respond to the surgical treatment (Class III, less than 75% seizure reduction), showing a rate of unsatisfactory seizure control of 15.4%. The preoperative factors contributing to the prediction of good seizure control (P <0.05) included early onset of epilepsy (before the age of five years), presence of complex partial seizure as a predominant seizure type, low seizure frequency, unilateral structural abnormality detectable on magnetic resonance images, absence of cortical dysplasia, restrained epileptic activity as detected by dipole localization, and agreement of pathological findings of the lesion with epileptogenic focus. CONCLUSION: The surgical treatment with the help of dipole localization results in satisfactory clinical outcome of the patients, and some preoperative factors in relation to the clinical findings and diagnosis may predict excellent postoperative outcome.

Electroencephalography↗

PubMed2003

[Temporal lobe epilepsy associated with cystic lesion in the temporal lobe and middle cranial fossa].

Four patients out of 52 patients with temporal lobe epilepsy (TLE), who underwent epilepsy surgery in our hospital since September of 1994, had cystic lesions in the temporal lobe and middle cranial fossa. Case 1 had old hematoma cavity in the inferior temporal gyrus and chronic subdural electrode recording revealed the ictal onset zone to be localized in the ipsilateral medial temporal region. Case 2 had cystic ganglioglioma in the temporal tip, and intraoperative electrocorticography demonstrated independent paroxysmal activities from medial temporal region and temporal tip near the cyst. Both area were resected and the patients became seizure free. Case 3 and 4 had arachnoid cysts in the middle cranial fossa. Chronic subdural electrode recording revealed that the ictal onset zone was localized in the ipsilateral inferior temporal gyrus (that had microdysgenesis) in Case 3 and contralateral medial temporal region (that had hippocampal sclerosis) in Case 4, respectively. These finding suggest that co-existence of extra-axial cyst such as Case 3 and 4 is incidental and that arachnoid cyst is less epileptogenic. However, intra-axial cyst such as Case 1 and 2 is epileptogenic and complicated physiological mechanism such as kindling phenomenon or secondary epileptogenesis may effect on the hippocampus. Comprehensive presurgical evaluation including electrocorticography is needed in the surgical treatment of TLE with cystic lesion.

Adolescent↗

PubMed2003

The significance of corpora amylacea in mesial temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) associated with mesial temporal sclerosis (MTS), mesial TLE (MTLE), is the commonest medically refractory adult epilepsy syndrome. Corpora amylacea (CoA) have been shown to be a marker of MTS. We compared 9 patients with MTS who had dense deposition of CoA in their hippocampi with 25 patients with MTS who did not have CoA. The patients with CoA were significantly older and they showed a trend towards having a significantly longer duration of epilepsy. The postoperative seizure outcome at 2 years was not different in the 2 groups. Our results could indicate the progressive nature of the pathology of MTS, probably indicating excitotoxic damage due to recurrent seizures, but they need to be verified by clinicopathological correlation among a larger number of patients with MTLE.

Adult↗

PubMed1988

Revising the Rey-Osterrieth: rating right hemisphere recall.

Recall performance of the Rey-Osterrieth Complex Figure was examined in patients with partial complex seizures originating from either the right or left temporal lobe and who underwent subsequent unilateral temporal lobectomy. A scoring system was developed to assess the types of errors frequently observed in the recall of patients with right temporal lobe epilepsy (TLE), but absent in left TLE patients. The scoring system was initially developed on a single group of patients, and then "cross-validated" on an independent sample. Performance analysis of the cross-validation group revealed a significant difference in the frequency of right hemisphere errors. In contrast, no significant difference using standard quantitative scoring was present. By applying the new scoring criteria alone, a rater blind to seizure onset correctly predicted seizure laterality in 15/18 of the cross-validation patients. These results suggest that evaluation of qualitative errors may be a valuable adjunct to standard scoring criteria, thereby extending the range of applications for this test.

Journal Article↗

PubMed1992

Epileptic amnesic syndrome.

Thirteen patients with "epileptic amnesic syndrome" (EAS) presented with adult-senile onset of a severe memory complaint that started before or at the same time as seizures. All were diagnosed as temporal lobe epilepsy (TLE). The seizures were stereotyped, with only short loss of contact and oral automatisms, and because they were not obvious or disturbing, they remained underdiagnosed for a long time. Nine cases also presented attacks of transient anteroretrograde amnesia after the seizures--called "epileptic amnesic attacks" (EAA)--during which the patients were able to perform complex actions. EAA are similar to the attacks of transient global amnesia (TGA) but are more frequent, shorter, accompanied by clear-cut clinical and electroencephalographic epileptic manifestations, and respond favorably to antiepileptic therapy. Neuropsychological investigation ruled out global mental deterioration, showing only selective memory impairment in a few long-term tasks and dissociation between formal findings and the relevant memory complaint. These cases have uniform anamnestic, clinical, and neuropsychological characteristics and represent a particular clinical expression of TLE, namely EAS. We suggest that an epileptic origin be entertained in patients presenting repeated amnesic attacks resembling TGA or who complain of persistent memory disturbance, after more common etiologies have been excluded.

Adult↗

PubMedDate not supplied

Temporal lobe epilepsy caused by choroid plexus papilloma in the temporal horn.

Choroid plexus papilloma (CPP) arising in the temporal horn is rare in adult population, and to the best of our knowledge, there has been no report of such a case with temporal lobe epilepsy (TLE). The authors describe a unique case of a 27-year-old woman who was diagnosed as TLE and was found to have a CPP in the temporal horn. Choroid plexus papilloma of the temporal horn, even though rare, can be found in adult population and be causally related to temporal lobe epilepsy.

Adult↗

PubMed2005

Spike frequency is dependent on epilepsy duration and seizure frequency in temporal lobe epilepsy.

OBJECTIVES: We wanted to investigate factors that are associated with frequency of interictal epileptiform discharges by investigating 303 patients with temporal lobe epilepsy (TLE). METHODS: We included all patients who consecutively underwent the adult presurgical evaluation program at our center and who had intractable, medial TLE with complex partial seizures due to unilateral medial temporal lobe lesions. The interictal EEG samples were automatically recorded and stored on computer. The location and frequency of interictal epileptiform discharges were assessed by visual analysis of interictal EEG samples of 2-minute duration every hour. RESULTS: There were 303 patients (aged 16-63) who met the inclusion criteria. The median interictal epileptiform discharge frequency was 15 IED/h, the median seizure frequency was 4 seizures/month. According to univariate analyses, we found that age at monitoring, epilepsy duration, and higher seizure frequency were associated with higher interictal epileptiform discharge frequency. In the logistic regression analysis, we found that higher seizure frequency (p < 0.001) and longer epilepsy duration (p = 0.007) were independently associated with higher spike frequency, while the age at monitoring was not. CONCLUSIONS: Seizure frequency and epilepsy duration (years of patient's life with seizure activity) were independently associated with IED frequency, suggesting that IED are modulated by seizures.

Adolescent↗

PubMed2006

Avoid falling into the depths of the insular trap.

Recent data have demonstrated that insular seizures can mimic those encountered in temporal lobe epilepsy (TLE), as well as nocturnal hypermotor attacks suggestive of nocturnal frontal lobe epilepsy (NFLE). To illustrate some of the issues raised by these observations, we report our first two patients with suspected TLE and NFLE, respectively, in whom we originally demonstrated an insular ictal onset zone. Patient 1 suffered from daytime seizures characterised by a rising and distressing epigastric sensation rapidly followed by oro-alimentary automatisms, associated with right temporal scalp-EEG ictal discharge. Neuroimaging showed consistent right temporal abnormalities, including MRI signs of hippocampal sclerosis, anterior and mesial glucose hypometabolism, and mesial decrease of benzodiazepine receptors. Intra-cerebral EEG investigation was primarily performed because of several ictal signs and symptoms suggesting a rapid involvement of the perisylvian region, and showed that the patient suffered two types of seizure, one of which arose from the mesial temporal structures, the other was sleep-related and originated in the posterior-inferior portion of the insula. Anterior temporal lobectomy failed to control this second type of seizure. Patient 2 suffered from brief, nocturnal, hypermotor seizures characterised by an indefinable aura followed by agitation, body rolling, scream and pelvic thrust. Interictal and ictal scalp-EEG failed to detect epileptiform discharges, whereas neuroimaging showed left mesial frontal, glucose hypometabolism and decreased benzodiazepine receptors associated with a left fronto-basal arachnoidal cyst. Invasive EEG monitoring was performed with the aim of identifying an orbital or mesial frontal ictal onset, but eventually demonstrated that the seizure originated in the anterior-superior portion of the left insula. The patient did not undergo surgery and died of SUDEP two years later. We discuss the heterogeneity of insular seizure semiology according to functional anatomy, the clinical signs and symptoms that might suggest an insular ictal onset, the indications and types of invasive EEG monitoring that are needed to identify an insular epileptogenic zone definitively, as well as potential surgical treatment.

Adult↗

PubMed2006

[Temporal lobe epilepsy--state of art review].

The temporal lobe epilepsy (TLE) is the most important kind of partial epilepsy both from practical and research point of view, where studies brought many new results in the last years. This article is a state of art review with a special emphasis on medial temporal lobe epilepsy (MTLE). We show the clinical symptoms, EEG and neuroimaging signs, the psychiatric co-morbidities and psyhosocial consequences. Etiological factors, among them hippocampal sclerosis and hippocampal reorganisation is assessed in a more detailed form. The possibilities of pharmacological and surgical treatment are also shown, together with the brief outline of the Hungarian situation. TLE is presented as a model for the development of partial epilepsies.

Anterior Temporal Lobectomy↗

PubMed1991

[Quantitative and qualitative MRI changes in temporal lobe epilepsy. A comparison with normal parameters of nuclear magnetic resonance tomography].

Magnetic resonance imaging (MRI) often reveals no pathology in patients with temporal lobe epilepsy (TLE) who are candidates for surgery, even though post-surgery histology reveals atrophy or sclerosis. To differentiate these pathologies in MRI, we performed a standardized acquisition and a quantitative analysis of MRI data (qMRI). The standard values of 43 healthy subjects (both sex, left and right handed) were compared with those of 10 patients with TLE and unilateral EEG focus. A reduced estimated total brain extension, a significant atrophy of both temporal lobes with accentuation on the focus side and a significant hippocampal atrophy on focus-side were seen even in patients with no visually detectable pathology. The analysis of the signal intensities did not give additional information. Thus, qMRI is a helpful additional tool in the course of presurgical evaluation for focus lateralization.

Adolescent↗

PubMed1988

[Long-term survival of surgically treated lympho-epithelial thymomas].

The authors report the results of a multi-centre trial on 500 cases of lymph-epithelial thymoma (TLE) treated by 14 surgical teams. Most typically a tumour of the adult in the fifth decade, occurring most commonly in women (60%), one in every two cases of TLE occurs in auto-immune disease: usually myasthenia. Most often (3 times out of 4) the disease is latent and occupies the middle (40%) or superior mediastinum (30%). In 15% of cases the pulmonary radiograph is normal. Radical surgery is possible in 75% of cases, otherwise it is incomplete or even reduced to a simple biopsy. The 15 year prognosis obtained using actuarial survival curves is based on the surgical-anatomical classification of the study group of thymic tumours (GETT) giving: for stage I: a survival of 80% for stage II to IVA of 40% and for stages III to IVB of around 10%. Finally it should be noted that existence of a recurrence after a complete surgical excision (stage I) poses the problem of post-operative radiotherapy and the associated total thymectomy. Also, the identical prognosis after biopsy or incomplete surgery (IIIA and IIIB) with an increased morbidity for incomplete surgery. Finally the confirmation that pleural involvement (IVA) is not as adverse a factor as one would have supposed.

Adolescent↗

PubMed1982

[Use of stationary-growth broth cultures for obtaining Escherichia enterotoxins. I. Study of the preparations from reference strains of enterotoxigenic Escherichia].

Experiments with standard enterotoxigenic E. coli (ETEC) strains 06:H16, 015:H11, 078:H11, 0148:H28 and 26 nonenterotoxigenic enterobacterial strains used for control were carried out. As a result, the preparation, simple in manufacture and containing thermolabile enterotoxin (TLE) and thermostable enterotoxin (TSE), was obtained: the supernatant fluid (SF) of 48-hour ETEC culture grown at 37 degrees C in flasks with Hottinger's broth without shaking. the possibility of using SF obtained by the centrifugation of the cultures 2 times for 1 hour at 8,000-10,000 r. p. m. was shown. The comparison with the control preparation indicated that the SF thus obtained possessed high biological activity and induced specific reactions in the paw edema test in mice for detecting TLE and in the anal test in suckling mice for detecting TSE.

Animals↗

PubMed1993

[Changes in epileptiform activities during sleep and sleep structures in temporal lobe epilepsy].

We investigated the distribution of epileptiform activities (EA) and ictal discharges, and sleep characteristics in 23 patients with temporal lobe epilepsy (TLE) using polysomnography (PSG) for two consecutive nights. The cassette EEG system devised by our group was employed throughout the study to minimize th untoward effects of overnight recording. The patients consisted of nine men and fourteen women, aged from 17 to 60. Fourteen of them had been taking antiepileptic drugs for long periods of time. The remaining 9 were the untreated patients and examined before and after the commencement of drug therapy. Sleep characteristics of patients were compared to those of age and sex matched healty subjects. The following findings were obtained: 1) EA were found more often during NREM sleep than REM sleep in both treated and untreated patients. The frequency of EA increased in stage 3 + 4 compared to stage 1 or 2. 2) Changes of EA numbers during the consecutive sleep cycles were investigated. Twelve of 14 patients in the treated group showed curves which had decreasing tendency throughout the night. 3) Ictal discharges were observed exclusively in the stage REM or within 10 minutes before and after the REM stage. These phenomena were recognized in both treated and untreated groups. 4) Sleep characteristics of both treated and untreated patients indicated significantly decreased sleep efficiency and increase of % awakening. Moreover, % stage 4 significantly increased in untreated patients compared to healthy subjects. These findings were discussed in terms of the clinical characteristics with TLE and antiepileptic drugs on epileptic activities during sleep as well as sleep structures.

Adolescent↗

PubMedDate not supplied

Investigation of P300 in various forms of epilepsy.

The problem of the late EP components generator localization has not yet been solved. This study aims to find out if a focal cortical epilepsy of the frontal (FLE) or of the temporal lobe (TLE) can modify the P300 component of the evoked response (either visual or auditory). Our data rely mainly on the selective differentiation test of an 80 dB click alternatively applied on the right or left ear, the patient having to give a motor response to those stimuli which have been chosen as target stimuli (probability of administration, 1:4). Under these circumstances, in normal subjects, evoked potentials showed deep P300 and an attenuated N2b in case of target stimulation and high, delayed N2b and an attenuated P300 for the nontarget stimulation, FLE did not abolish the late components of the EP; on the contrary, these were significantly augmented by the task. TLE, in exchange, severely attenuated differences between N2b-P300 components recorded from the scalp in case of target and nontarget stimulation. P300 was even higher at rest (possibly an effect of defective habituation). Rare or rapid stimuli application which was separately investigated gave another type of EPs modification compared to that specific for the auditory discrimination task. These facts are corroborated with the complete abolition of late EP components after lateral brain stem lesions. The conclusion is that N2a component has a reticular brain stem generator while N2b and P3 have initial generators in the temporal lobe (hippocampus).

Adolescent↗

PubMed1997

Individual patient prediction of seizure lateralization in temporal lobe epilepsy: a comparison between neuropsychological memory measures and the Intracarotid Amobarbital Procedure.

Neuropsychological assessment has been extensively used in the presurgical evaluation of temporal lobe epilepsy (TLE) patients to assist in determining lateralization of seizure onset. Very few studies have examined the accuracy with which commonly used neuropsychological instruments provide this information in the individual patient. In 81 patients (49 right-, 32 left-TLE) without space-occupying lesions in whom correct seizure lateralization was inferred on the basis of postsurgical seizure-free status, we compared the frequency with which discrepancies between the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) Verbal and Visual Memory Indices, Warrington Recognition Memory Test (WRMT; Warrington, 1984) Words and Faces scaled scores, and Intracarotid Amobarbital Procedure (IAP) hemispheric memory scores correctly predicted seizure lateralization in the individual patient. Using both clinical analysis and discriminant function analyses (DFA), the IAP was found to be a clearly superior predictor of seizure laterality to the neuropsychological measures, whether used individually or in combination with one another. Using clinical analysis the WRMT was found to be a superior predictor to the WMS-R, which frequently gave false lateralizing information. Using all 3 measures in combination with one another, 87.1% of patients were correctly lateralized using DFA. Correctly lateralized patients were older and had longer durations of seizure disorder.

Adolescent↗

PubMed1996

Recent advances related to basic mechanisms of epileptogenesis.

A variety of clinical observations suggest that certain forms of epilepsy are due to long-term, progressive changes in neural networks that eventually provoke spontaneous and recurring seizures. This process of network transformation, known as epileptogenesis, is a potentially important therapeutic target and also serves as an extremely interesting model of central nervous system plasticity. This article reviews some of the significant, recent advances in our understanding of mechanisms underlying epileptogenesis in different forms of epilepsy. The most substantial progress has been made in work related to temporal lobe epilepsy (TLE), where the biochemical, electrophysiological and anatomical changes in the hippocampus have been intensively studied. This has led to a number of cogent and testable hypotheses, including the concept that dentate granule cell hyperexcitability in TLE is due to a selective loss of hilar neurons that renders inhibitory cells 'dormant.' Studies of other forms of focal epilepsy suggest that a seizure focus may develop as a result of axonal reorganization or immune-mediated effects on membrane channels. Epileptogenesis in generalized epilepsies remains poorly understood, although recent work using models of absence epilepsy point to the critical role of GABAB or T-type calcium channels in the thalamus. Also, new transgenic mouse lines with epilepsy phenotypes have introduced candidate genes, such as those encoding the serotonin 5-HT2C receptor or the alpha subunit of calcium/calmodulin kinase II, that may be responsible for epileptogenesis. Finally, a large amount of investigation has focused on seizure-induced gene expression and it is now clear that seizures can cause a cascade of changes in the expression of gene products that are likely to play a role in network plasticity. Progress in developing 'anti-epileptogenic' therapies will require further advances in understanding the mechanistic roles of these various biochemical and anatomical changes in the transformation of normal to hyperexcitable neural networks.

Animals↗

PubMed1997

Frontal functions in juvenile myoclonic epilepsy.

The authors investigated cognition in juvenile myoclonic epilepsy (JME), focusing on frontal functions as suggested by maximal spatial distribution of epileptiform activity seen over frontocentral regions. Fifteen patients with JME (mean age, 34.3 years; mean estimated IQ 101) were administered a battery of tests sensitive to frontal dysfunction. The number of patients with impaired test performance and the frequency of impairment per test were calculated. Performance on selected tests was compared with that of 15 patients with temporal lobe epilepsy (TLE) who were matched for estimated IQ using paired t-tests. Although the performance of the group with JME was not uniform--some patients showed marked impairment whereas others showed little or no deficit--a high frequency of impairment was found on tests of concept formation-abstract reasoning and mental flexibility, cognitive speed, and planning and organization. Significant differences were found between the group with JME and the group with TLE on tests requiring mental flexibility and concept formation-abstract reasoning. In conjunction with studies demonstrating intractable seizures in approximately 20% of patients, the results from this study suggest that JME is not a uniformly benign condition. Frontal deficits may have maladaptive behavioral consequences suggestive of personality dysfunction, as described anecdotally by previous investigators.

Adolescent↗

PubMed1997

Morphology of dentate granule cells in the human epileptogenic hippocampus.

Hippocampal dentate granule cells in temporal lobe epilepsy (TLE) patients with mesial sclerosis (MTLE) are reported to be hyperexcitable compared to those in patients with a mass lesion outside the hippocampus (MaTLE) (Williamson, Clin Neurosci 1994;2: 47-52). To determine if such hyperexcitability is associated with an altered morphology of these neurons, Lucifer Yellow-filled granule cells from MTLE patients were compared with those from MaTLE. The morphology of granule cells in both subject groups resembles closely that of human granule cells described previously by Golgi studies. About 40% of human granule cells have basal dendrites. Additionally their apical dendrites are much more limited in their spread in the longitudinal axis of the hippocampus contributing perhaps to a much more narrow lamellar organization than in rats. Analysis of variance computed on 21 morphometric parameters reveals a significant increase in the length of the portion of the dendrite in the inner molecular layer (IML), and a decrease in length in the outer third of the molecular layer in MTLE, compared to MaTLE. Factor analysis performed on the morphometric features of each group of neurons reveals that in the MaTLE neurons the most distinctive feature is the total dendritic length and the overall distribution of spines on them, whereas in MTLE a lengthening and elaboration of the dendrites in the IML is most distinctive. Previous observations of increased synaptic terminals containing neuropeptides, and neurotransmitter receptors in the IML taken in conjunction with an elaboration of granule cell dendrites in this region, suggest considerable synaptic reorganization within the IML of the MTLE hippocampus which may contribute to its epileptogenicity.

Dendrites↗