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PubMed1986

The radiologic investigation of temporal lobe epilepsy. Value of high resolution CT with temporal orientated sections.

The value of high resolution computed tomography of the temporal lobes using temporal lobe orientated sections and intrathecal contrast is described. The results of this technique are correlated with the pathologic findings in 13 patients subsequently proven to have temporal lobe gliomas. These patients all presented with drug resistant temporal lobe epilepsy and underwent temporal lobectomy. This technique was successful in detecting the tumours in 11 of 13 patients. The average size of the tumours was just over 2 cm. The importance of detecting these small tumours is emphasised because of the profound effect this has on management.

Brain↗
PubMed2002

Interictal and postictal alterations of pulsatile secretions of luteinizing hormone in temporal lobe epilepsy in men.

Mesial temporal lobe epilepsy has been associated with abnormalities of reproductive physiology, but the mechanisms of hormonal dysregulation are not clear. Chronic effects of the epileptic state and the acute impact of seizures could alter hypothalamic function, which is represented by the downstream pulsatile secretion of luteinizing hormone. This study evaluates the interictal and postictal secretion of luteinizing hormone in mesial temporal lobe epilepsy. We characterized luteinizing hormone secretion in patients with mesial temporal lobe epilepsy during two 24-hour epochs: an interictal baseline and a postictal interval initiated by an electrographically confirmed spontaneous seizure. Males, rather than females, were studied so that menstrual cycles could not account for differences between epochs. Blood luteinizing hormone and prolactin (as a positive control) were measured every 10 minutes. Deconvolution analysis defined luteinizing hormone secretion in terms of interpulse interval, amplitude, and mass. Approximate entropy quantitated relative degradation in the orderliness of serial luteinizing hormone release. Interictal baseline epochs were compared to those of healthy controls with unpaired Student's t tests and between interictal and postictal epochs within epileptic patients with paired t tests. Ten epileptic men completed both interictal and postictal epochs. Interictally, seizure patients had lower mean concentrations, slower pulse rates, and higher peak amplitudes than healthy male controls. Within epileptic patients, mean interpulse interval, pulse amplitude, and pulse mass were not affected by the occurrence of seizures, whereas the orderliness of pulse mass decreased postictally. Acute seizures induced timing irregularity in luteinizing hormone secretion, whereas chronic epilepsy was associated with changes in luteinizing hormone pulse frequency, amplitude, and mass. Altered timing and regularity of neuroendocrine pulse patterns may underlie other disorders of homeostasis in mesial temporal lobe epilepsy.

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↗
PubMed1981

Multiple personality and related dissociative phenomena in patients with temporal lobe epilepsy.

Many patients with temporal lobe epilepsy also experience dissociative episodes. Three patients with multiple personality exhibited alterations in speech pattern, personality, handedness, and sense of personal identity and claimed amnesia for the dissociative episodes. Another 10 patients identified alternative personalities or demons as motivators of ego-alien behavior. Of clinic patients with temporal lobe epilepsy, 33% exhibited some dissociative phenomena, which had no apparent association with individual seizures but always followed the development of the seizure disorder. The authors propose that intensified, dystonic affects, characteristic of the interictal period in temporal lobe epilepsy, may predispose some individuals to dissociative reactions.

Adult↗
PubMed2000

A study of the relationship between the seizure focus and 1H-MRS in temporal lobe epilepsy and frontal lobe epilepsy.

Several studies of temporal lobe epilepsy (TLE) patients have investigated the relationship between the seizure focus and 1H magnetic resonance spectroscopy (1H-MRS). There have also been a few reports in other types of partial epilepsy. We examined the relationship between the seizure focus and the reduction in N-acetylaspartate: creatine (NAA : Cr) ratio using 1H-MRS in both TLE and frontal lobe epilepsy (FLE) patients. We studied 21 patients with unilateral TLE and seven patients with unilateral FLE. We used a 1.5 Tesla magnetic resonance unit (Signa Horizon; General Electric). Approximately 15 x 15 x 20 mm3 voxel of interest (VOI) was placed over the anterior portion of the bilateral hippocampus in the TLE patients, and the anterodorsal position of bilateral frontal lobe in the FLE patients. The seizure focus was identified by interictal scalp electro-encephalogram (EEG). In the TLE patients the NAA : Cr ratios were reduced in the seizure focus, while in the FLE patients they were not always reduced in the seizure focus. In the TLE patients the coincidence rate between the seizure focus and the reduction in the NAA:Cr ratio was 90% (19 of 21 patients), while in the FLE patients the coincidence rate was only 57% (four of seven patients).

Adult↗
PubMed1997

A cost-effectiveness analysis of anterior temporal lobectomy for intractable temporal lobe epilepsy.

Patients with medically intractable temporal lobe epilepsy are potential candidates for anterior temporal lobectomy (ATL), in which epileptogenic temporal lobe tissue is localized and surgically removed. This surgical approach can eliminate or drastically reduce seizures in the majority of patients. The authors used a decision-analysis model to examine the cost-effectiveness of a surgical evaluation and treatment protocol for medically intractable temporal lobe epilepsy. This model compared a cohort treated with the new protocol with a continuation of their immediate preoperative medical management and projected these differences over the patient's lifetime. The Markov model incorporated postoperative seizure status, patient quality of life, death from surgical and natural causes, discounting, and the direct medical costs associated with outpatient evaluation, hospitalization, surgery, antiepileptic drugs, and lifetime outpatient treatment. The intent-to-treat analysis included patients who underwent evaluation but were not eligible for ATL. Sensitivity analyses were also performed on the variables in the model. Data from the baseline model indicated that evaluation for ATL provided an average of 1.1 additional quality-adjusted life years (QALYs) compared with continued medical management, at an additional cost of $29,800. Combining the clinical and economic outcomes yielded a cost-effectiveness ratio of $27,200 per QALY. This value is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($16,700/QALY) or coronary artery balloon angioplasty ($40,800/QALY). Sensitivity analyses demonstrate that the results are critically dependent on postoperative seizure status and improvement in quality of life. Although further work is necessary to quantify the improvement in quality of life after epilepsy surgery better, the present data indicate that ATL for treatment of intractable temporal lobe epilepsy is a cost-effective use of medical resources.

Adult↗
PubMed1999

Reorganized cerebral metabolic interactions in temporal lobe epilepsy.

Patients with left temporal lobe epilepsy demonstrate language impairments that are not well understood. To explore abnormal patterns of brain functional connections with respect to language processing, we applied a principal component analysis to resting regional cerebral metabolic data obtained with positron emission tomography in patients with right- and left-sided temporal lobe epilepsy and controls. Two principal components were expressed differentially among the groups. One principal component comprised a pattern of metabolic interactions involving left inferior frontal and left superior temporal regions-corresponding to Broca's and Wernicke's areas, respectively-and right mesial temporal cortex and right thalamus. Functional couplings between these brain regions were abnormally enhanced in the left-sided epilepsy patients. The right thalamic left superior temporal coupling was also abnormally enhanced in the right-sided epilepsy patients, but differentially from that in the left-sided patients. The other principal component was characterized by a pattern of metabolic interactions involving right and left mid prefrontal and right superior temporal cortex. Although both the right- and left-sided epilepsy patients showed decreased functional couplings between left mid prefrontal and the other brain regions, a weaker right-left mid prefrontal coupling in the left-sided epilepsy patients best distinguished them from the right-sided patients. The two mutually independent, abnormal metabolic patterns each predicted verbal intelligence deficits in the patients. The findings suggest a site-dependent reorganization of two independent, language-subserving pathways in temporal lobe epilepsy.

Adolescent↗
PubMed2005

Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy.

OBJECTIVE: To evaluate the suppressive effect of electric cortical stimulation upon the seizure onset zone and the non-epileptic cortex covered by subdural electrodes in patients with neocortical epilepsy and mesial temporal lobe epilepsy (MTLE). METHODS: Four patients with medically intractable focal epilepsy had implanted subdural electrodes for preoperative evaluation. Cortical functional mapping was performed by intermittently repeating bursts of electric stimulation, which consisted of 50 Hz alternating square pulse of 0.3 ms duration, 1-15 mA, within 5 s. The effect of this stimulation on the seizure onset zones and on the non-epileptic areas was evaluated by comparing spike frequency and electrocorticogram (ECoG) power spectra before and after stimulation. A similar comparison was performed in stimulation of 0.9 Hz of the seizure onset zones for 15 min. RESULTS: When the seizure onset zone was stimulated with high frequency, spike frequency decreased by 24.7%. Logarithmic ECoG power spectra recorded at stimulated electrode significantly decreased in 10-32 Hz band by high frequency stimulation of the seizure onset zone, and in 14-32 Hz band by high frequency stimulation of the non-epileptic area. Low frequency stimulation of the seizure onset zone produced 18.5% spike reduction and slight power decrease in 12-14 Hz. CONCLUSIONS: Both high and low frequency electric cortical stimulation of the seizure onset zone have a suppressive effect on epileptogenicity. Reduction of ECoG fast activities after electric cortical stimulation suggests the augmentation of inhibitory mechanisms in human cortex.

Adult↗
PubMed2003

N-methyl-D-aspartate receptor blockade after status epilepticus protects against limbic brain damage but not against epilepsy in the kainate model of temporal lobe epilepsy.

Most patients with temporal lobe epilepsy (TLE), the most common type of epilepsy, show pronounced loss of neurons in limbic brain regions, including the hippocampus. The massive neurodegeneration in the hippocampus is known as hippocampal sclerosis, and is considered one of the hallmarks of this type of difficult-to-treat epilepsy. There is a long and ongoing debate on whether this sclerosis is the result of an initial pathological event, such as a status epilepticus (S.E.), stroke or head trauma, which often precedes the development of TLE, or is caused by the spontaneous recurrent seizures (SRS) once epilepsy has developed. At present, pharmacological prevention of limbic sclerosis is not available. In a clinical situation, such prevention would only be possible if delayed cell death developing after an initial pathological event is involved. Assuming that sclerotic brain lesions provoke epileptogenesis and that delayed cell death is involved in these lesions, it should be possible to prevent both the lesions and the epilepsy by a prophylactic treatment after an initial insult such as an S.E. In order to test this hypothesis, we used a rat model of TLE in which limbic brain lesions and epilepsy with SRS develop after a kainate-induced S.E. A single low dose of the N-methyl-D-aspartate (NMDA) receptor blocker dizocilpine (MK-801) significantly reduced the damage in limbic regions, including the hippocampus and piriform cortex, and completely protected several rats from such damage when given after an S.E. of 90 min induced by kainate, strongly suggesting that delayed cell death is involved in the damage. This was substantiated by the use of molecular and immunohistochemical markers of delayed active ("programmed") cell death. However, the neuroprotection by dizocilpine did not prevent the development of SRS after the S.E., suggesting that structures not protected by dizocilpine may play a role in the genesis of SRS or that epileptogenesis is not the consequence of structural lesions in the limbic system. The only brain regions that exhibited neuronal damage in all rats with SRS were the hilus of the dentate gyrus and the mediodorsal thalamus, although treatment with dizocilpine reduced the severity of damage in the latter region. The data indicate that NMDA receptor blockade immediately after a prolonged S.E. is an effective means to reduce the damage produced by a sustained S.E. in several brain regions, including the hippocampus, but show that this partial neuroprotection of the limbic system does not prevent the development of epilepsy.

Animals↗
PubMed2001

Late onset temporal lobe epilepsy with MRI evidence of mesial temporal sclerosis following acute neurocysticercosis: case report.

UNLABELLED: The objective of this case report is to describe magnetic resonance imaging (MRI) evidence of mesial temporal sclerosis (MTS) in a patient with new onset temporal lobe epilepsy (TLE) and acute neurocysticercosis with multiple cysts. A 56 years old man with new onset headache, Simple Partial Seizures and Complex Partial Seizures underwent CT scan and lumbar puncture as diagnose proceeding. Multiple cysts and meningitis were identified, with a positive immunology for cysticercosis. Seizures were recorded over the left temporal region in a routine EEG. Treatment with albendazole was performed for 21 days, with clinical improvement and seizure remission after 4 months. An MRI scan 11 months after treatment, showed complete resolution of those cystic lesions and a left hippocampal atrophy (HA) with hyperintense T2 signal. The presence of HA and hyperintense T2 signal in this patient has not, to date, been associated with a poor seizure control. CONCLUSIONS: This patient presented with MRI evidence of left MTS after new onset partial seizures of left temporal lobe origin. Although we did not have a previous MRI scan, it is likely that this hippocampal abnormality was due to the acute inflammatory response to cysticercosis associated to repeated partial seizures. This suggests that acute neurocysticercosis associated with repeated seizures may cause MTS and late onset TLE.

Acute Disease↗
PubMed1995

Spatio-temporal characteristics of paroxysmal interictal events in human temporal lobe epilepsy.

A spatio-temporal mapping technique was applied to stereotactically-implanted depth electrode recordings (SEEG). This technique was used to study the interictal activity in 13 epileptic patients with temporal lobe epilepsies during the pre-surgical evaluation of their epileptogenic zone prior to surgery. The method further provided the precise localization of distinct interictal activities in each explored structure. The high sensitivity of the technique is showed and has demonstrated the evidence of multiple sources during one single sequence of interictal activity. The stability of such an activity was also demonstrated in each patient. A temporal relationship existed between the activity recorded in different structures. Paroxysmal interictal activity thus appeared as an ordered and successive activation of different interictal loci overlapping each other. In this way it was possible to distinguish two different types of activities: primary foci that are activated independently of each other, and secondary foci activated by the primary foci. Finally, in addition to the source localization of interictal activity, the problem of detection and discrimination of the different components must be considered.

Brain Mapping↗
PubMed1998

Intracranial EEG seizure-offset termination patterns: relation to outcome of epilepsy surgery in temporal lobe epilepsy.

PURPOSE: Studies using stereo-EEG (SEEG) and electrocorticography (ECoG) should not only identify a patient's epileptogenic zone, but also should provide prognostic information for surgical outcome. In this respect, seizure-offset patterns have so far been the subject of only one study, in which they were shown to be associated with poor outcome when recorded over cortical areas outside the temporal lobe of seizure onset. To clarify whether seizure-offset patterns are reliable in predicting seizure outcome, we studied SEEG/ECoG in a similar group of patients with temporal lobe epilepsy (TLE). METHODS: SEEG/ECoG records of 44 patients with refractory TLE were analyzed. The areas of seizure termination were classified as ipsilateral or contralateral (mesial and/or lateral) temporal, (temporal and) frontal, and diffuse/bilateral. Patients were classified with respect to seizure outcome as either seizure-free (UCLA class 1a) or not seizure free (UCLA class 2-4); both groups were correlated with specific seizure-offset categories using Fisher's exact probability test and analysis of variance (ANOVA). RESULTS: Of the 44 patients, the majority (n = 36) had at least part of their seizure offsets in the ipsilateral temporal lobe, whereas 8 patients manifested no seizure offsets in this lobe. Only 9 patients (20%) showed exclusive offsets in the ipsilateral temporal lobe. No statistically significant difference was evident between patients with all seizure offsets in the ipsilateral temporal lobe and those with offsets elsewhere. Similarly, no statistically significant difference was evident between patients with a diffuse seizure offset and those with seizure offsets of a different category. CONCLUSIONS: Seizure-offset patterns in SEEG/ECoG are unreliable in predicting seizure outcome after resective activity surgery for TLE.

Adolescent↗
PubMed1986

Odor perception in temporal lobe epilepsy patients with and without temporal lobectomy.

The investigation employed monorhinic (single nostril) olfactory testing to decide whether patients with unilateral anterior temporal lobe resection (N = 16) and patients with unoperated temporal lobe epilepsy (N = 18) have impaired ability to detect, remember, and identify odors. A shape memory task accompanied the odor memory task for comparison. The lobectomy patients showed a minor bilateral depression of absolute sensitivity but still fell within the clinically normal range. The lobectomy patients showed impairment of odor recognition memory but strictly via the nostril ipsilateral to the resected lobe. A similar ipsilateral-contralateral asymmetry characterized the performance of these patients in odor identification. In that case, however, performance via the contralateral nostril showed some impairment too. Nonsurgery patients also exhibited some impairment in odor identification, but bilaterally. Finally, both groups of patients fell somewhat below normals in recognition memory for amorphous shapes. The various results implied that temporal lobe epilepsy alone takes some toll on olfactory information processing and that temporal lobe resection exacerbates the problem, but only on the side of surgery.

Adult↗
PubMed1998

Insular epilepsy. Similarities to temporal lobe epilepsy. Case report.

Insular epilepsy has been rarely reported and its clinical and electrographic features are poorly understood. The electrographic study of the insula is difficult since it is hidden from the brain surface by the frontal and temporal lobe. A 48 years-old woman started having simple partial autonomic and complex partial seizures with automatisms and ictal left arm paresis 8 years prior to admission. Seizure's frequency was 1 per week. Pre-operative EEG showed a right temporal lobe focus. Neuropsychological testing disclosed right fronto-temporal dysfunction. MRI showed a right anterior insular cavernous angioma. Intraoperative ECoG obtained after splitting of the sylvian fissure showed independent spiking from the insula and temporal lobe and insular spikes that spread to the temporal lobe. The cavernous angioma and the surrounding gliotic tissue were removed and the temporal lobe was left in place. Post-resection ECoG still disclosed independent temporal and insular spiking with a lower frequency. The patient has been seizure-free since surgery. Insular epilepsy may share many clinical and electroencephalographic features with temporal lobe epilepsy.

Brain Neoplasms↗