Temporal lobe surgery in medically refractory epilepsy

A comparison between populations based on MRI findings

Tsz Lau, Timothy Miller, Travis Klein, Selim R. Benbadis, Fernando Vale Diaz

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction High resolution MRI findings suggestive of mesial temporal sclerosis (MRI-MTS) correlate with good outcome after surgery. However, a large group of patients present with normal brain MRI (N-MRI) and temporal lobe epilepsy (TLE). We aim to compare pre-operative ictal EEG patterns in predicting surgical outcomes in the population with MRI-MTS vs. N-MRI after selective anterior-mesial temporal lobe (AMTL) resection. Methods 241 patients with unilateral anterior ictal EEG findings underwent selective AMTL resection. 143 MRI-MTS and 98 N-MRI patients were identified. Outcome was based on the modified Engel classification, ictal EEG pattern at seizure onset, demographics and MRI findings. Results Seizure-free outcome was seen in the MRI-MTS in 79% of patients, compared to 59.1% (p <.005) of the N-MRI group. No significant difference was identified in ictal EEG patterns at presentation between groups. Class I outcome was achieved in 78.9% of patients that had theta rhythm and MRI-MTS compared to 57.9% of patients that had theta rhythm and N-MRI (p < 0.05). Discussion and conclusion Surgical treatment for mesial TLE is effective. Positive MRI suggestive of mesial temporal sclerosis (MTS) predicts better seizure control after surgery. Theta rhythm is the most common ictal pattern and seems to carry the best prognosis for TLE. However, a well-selected group of patients with N-MRI will benefit from surgical intervention, and similar outcome to MRI-MTS patients can be achieved if delta ictal EEG pattern is presented at initial onset. Early referral to an epilepsy center cannot be emphasized enough, even in situations when high-resolution brain MRI is normal.

Original languageEnglish (US)
Pages (from-to)20-24
Number of pages5
JournalSeizure
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Temporal Lobe
Sclerosis
Epilepsy
Stroke
Electroencephalography
Theta Rhythm
Brain
Population
Temporal Lobe Epilepsy
Seizures
Referral and Consultation
Demography

Keywords

  • Epilepsy surgery
  • Ictal EEG
  • Negative MRI
  • Nonlesional
  • Outcomes
  • Temporal lobe

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Temporal lobe surgery in medically refractory epilepsy : A comparison between populations based on MRI findings. / Lau, Tsz; Miller, Timothy; Klein, Travis; Benbadis, Selim R.; Vale Diaz, Fernando.

In: Seizure, Vol. 23, No. 1, 01.01.2014, p. 20-24.

Research output: Contribution to journalArticle

Lau, Tsz ; Miller, Timothy ; Klein, Travis ; Benbadis, Selim R. ; Vale Diaz, Fernando. / Temporal lobe surgery in medically refractory epilepsy : A comparison between populations based on MRI findings. In: Seizure. 2014 ; Vol. 23, No. 1. pp. 20-24.
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abstract = "Introduction High resolution MRI findings suggestive of mesial temporal sclerosis (MRI-MTS) correlate with good outcome after surgery. However, a large group of patients present with normal brain MRI (N-MRI) and temporal lobe epilepsy (TLE). We aim to compare pre-operative ictal EEG patterns in predicting surgical outcomes in the population with MRI-MTS vs. N-MRI after selective anterior-mesial temporal lobe (AMTL) resection. Methods 241 patients with unilateral anterior ictal EEG findings underwent selective AMTL resection. 143 MRI-MTS and 98 N-MRI patients were identified. Outcome was based on the modified Engel classification, ictal EEG pattern at seizure onset, demographics and MRI findings. Results Seizure-free outcome was seen in the MRI-MTS in 79{\%} of patients, compared to 59.1{\%} (p <.005) of the N-MRI group. No significant difference was identified in ictal EEG patterns at presentation between groups. Class I outcome was achieved in 78.9{\%} of patients that had theta rhythm and MRI-MTS compared to 57.9{\%} of patients that had theta rhythm and N-MRI (p < 0.05). Discussion and conclusion Surgical treatment for mesial TLE is effective. Positive MRI suggestive of mesial temporal sclerosis (MTS) predicts better seizure control after surgery. Theta rhythm is the most common ictal pattern and seems to carry the best prognosis for TLE. However, a well-selected group of patients with N-MRI will benefit from surgical intervention, and similar outcome to MRI-MTS patients can be achieved if delta ictal EEG pattern is presented at initial onset. Early referral to an epilepsy center cannot be emphasized enough, even in situations when high-resolution brain MRI is normal.",
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