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Intractable Temporal Lobe Epilepsy (intractable + temporal_lobe_epilepsy)

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Medical Sciences	100%

Selected Abstracts

Antiepileptic Drug Withdrawal after Successful Surgery for Intractable Temporal Lobe Epilepsy

EPILEPSIA, Issue 2 2005
Young Dae Kim
Summary:,Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ,1 year during the follow-up period. Results: Sixty-six (75%) patients achieved complete seizure freedom for ,1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate- and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ,1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions: Our results suggest that seizure freedom without aura at ,1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period. [source]

Excitatory amino acid transporters EAAT-1 and EAAT-2 in temporal lobe and hippocampus in intractable temporal lobe epilepsy

APMIS, Issue 4 2009
SINAN SARAC
Intractable temporal lobe epilepsy (TLE) is an invalidating disease and many patients are resistant to medical treatment. Increased glutamate concentration has been found in epileptogenic foci and may induce local over-excitation and cytotoxicity; one of the proposed mechanisms involves reduced extra-cellular clearance of glutamate by excitatory amino acid transporters (EAAT-1 to EAAT-5). EAAT-1 and EAAT-2 are mainly expressed on astroglial cells for the reuptake of glutamate from the extra-cellular space. We have studied the expression of EAAT-1 and EAAT-2 in the hippocampus and temporal lobe in 12 patients with TLE by immunhistochemistry and densitometry. The expression of EAAT-1 and EAAT-2 was reduced to approximately 40% and 25%, respectively, in CA1 of the hippocampus. In the same area, an increased expression of glial fibrillary acid protein (GFAP) at 90% reflected molecular rearrangements and upregulation of GFAP in the existing astrocytes as Ki-67 staining failed to demonstrate any signs of astrocytic proliferation. The aetiology of the reduced expression of EAAT-1 and EAAT-2 remains unclear. The downregulation of EAAT-1 and EAAT-2 may be an adaptive response to neuronal death or it may be a causative event contributing to neuronal death. Further studies of the EAATs and their function are needed to clarify the mechanisms and significance of EAAT-1 and EAAT-2 disappearance in TLE. [source]

Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome

EPILEPSIA, Issue 9 2010
Maria Thom
Summary Purpose:, Around one-third of patients undergoing temporal lobe surgery for the treatment of intractable temporal lobe epilepsy with hippocampal sclerosis (HS) fail to become seizure-free. Identifying reliable predictors of poor surgical outcome would be helpful in management. Atypical patterns of HS may be associated with poorer outcomes. Our aim was to identify atypical HS cases from a large surgical series and to correlate pathology with clinical and outcome data. Methods:, Quantitative neuropathologic evaluation on 165 hippocampal surgical specimens and 21 control hippocampi was carried out on NeuN-stained sections. Neuronal densities (NDs) were measured in CA4, CA3, CA2, and CA1 subfields. The severity of granule cell dispersion (GCD) was assessed. Results:, Comparison with control ND values identified the following patterns based on the severity and distribution of neuronal loss: classical HS (CHS; n = 60) and total HS (THS; n = 39). Atypical patterns were present in 30% of cases, including end-folium sclerosis (EFS; n = 5), CA1 predominant pattern (CA1p; n = 9), and indeterminate HS (IHS, n = 35). No HS was noted in 17 cases. Poorest outcomes were noted for no-HS, and CA1p groups with 33,44% International League Against Epilepsy (ILAE) class I at up to 2 years follow-up compared to 69% for CHS (p < 0.05). GCD associated with HS type (p < 0.01), but not with outcome. Conclusions:, These findings support the identification and delineation of atypical patterns of HS using quantitative methods. Atypical patterns may represent distinct clinicopathologic subtypes and may have predictive value following epilepsy surgery. [source]

Human herpes virus 6B: A possible role in epilepsy?

EPILEPSIA, Issue 11 2008
William H. Theodore
Summary Human herpes virus 6 (HHV6) infection is nearly ubiquitous in childhood and may include central nervous system invasion. There are two variants, HHV6A and HHV6B. Usually asymptomatic, it is associated with the common, self-limited childhood illness roseola infantum and rarely with more severe syndromes. In patients with immune compromise, subsequent reactivation of viral activity may lead to severe limbic encephalitis. HHV6 has been identified as a possible etiologic agent in multiple sclerosis, myocarditis, and encephalitis. A preponderance of evidence supports an association between HHV6 and febrile seizures. An ongoing multicenter study is investigating possible links between HHV6 infection, febrile status epilepticus, and development of mesial temporal sclerosis (MTS). Investigation of temporal lobectomy specimens showed evidence of active HHV6B but not HHV6A replication in hippocampal astrocytes in about two-thirds of patients with MTS but not other causes of epilepsy. It has been suggested that HHV6B may cause "excitotoxicity" by interfering with astrocyte excitatory amino acid transport. Although conventional inflammatory changes are not found in most MTS specimens, inflammatory modulators may play a role in neuronal injury leading to MTS as well. If the link between early viral infection, complex or prolonged febrile seizures, and later development of intractable temporal lobe epilepsy is confirmed, new therapeutic approaches to a common intractable epilepsy syndrome may be possible. [source]

Predictors of pharmacoresistant epilepsy: Pharmacoresistant rats differ from pharmacoresponsive rats in behavioral and cognitive abnormalities associated with experimentally induced epilepsy

EPILEPSIA, Issue 10 2008
Alexandra M. Gastens
Summary Purpose:, Patients with intractable temporal lobe epilepsy (TLE) exhibit an increased risk of psychiatric comorbidity, including depression, anxiety, psychosis, and learning disorders. Furthermore, a history of psychiatric comorbidity has been suggested as a predictor of lack of response to therapy with antiepileptic drugs (AEDs) in patients with epilepsy. However, clinical studies on predictors of pharmacoresistant epilepsy are affected by several confounding variables, which may complicate conclusions. In the present study, we evaluated whether behavioral alterations in epileptic rats are different in AED nonresponders versus responders. Methods:, For this purpose, we used an animal model of TLE in which AED responders and nonresponders can be selected by prolonged treatment of epileptic rats with phenobarbital (PB). Behavioral and cognitive abnormalities were compared between responders and nonresponders as well as between epileptic rats and nonepileptic controls in a battery of tests. Results:, Fifteen epileptic rats with spontaneous recurrent seizures (SRS) either responding (11 rats) or not responding (4 rats) to PB were used for this study. The nonresponders differed markedly in behavioral and cognitive abnormalities from responders and nonepileptic controls in tests of anxiety (open field, elevated-plus maze test), behavioral hyperexcitability (approach-response, touch-response, pick-up tests), and learning and memory (Morris water maze). Discussion:, Our hypothesis that AED-resistant rats will show more severe behavioral and cognitive changes than AED-responsive rats was confirmed by the present experiments. The data substantiate that rodent models of TLE are useful to delineate predictors of pharmacoresistant epilepsy. [source]

Antiepileptic Drug Withdrawal after Successful Surgery for Intractable Temporal Lobe Epilepsy

Neocortical Temporal FDG-PET Hypometabolism Correlates with Temporal Lobe Atrophy in Hippocampal Sclerosis Associated with Microscopic Cortical Dysplasia

EPILEPSIA, Issue 4 2003
Beate Diehl
Summary: ,Purpose: Medically intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS), with or without cortical dysplasia (CD), is associated with atrophy of the hippocampal formation and regional fluorodeoxyglucose positron-emission tomography (FDG-PET) hypometabolism. The relation between areas of functional and structural abnormalities is not well understood. We investigate the relation between FDG-PET metabolism and temporal lobe (TL) and hippocampal atrophy in patients with histologically proven isolated HS and HS associated with CD. Methods: Twenty-three patients underwent en bloc resection of the mesial and anterolateral neocortical structures. Ten patients were diagnosed with isolated HS; 13 patients had associated microscopic CD. Temporal lobe volumes (TLVs) and hippocampal volumes were measured. Magnetic resonance imaging (MRI) and PET were co-registered, and regions of interest (ROIs) determined as gray matter of the mesial, lateral, and anterior temporal lobe. Results: All patients (HS with or without CD) had significant ipsilateral PET hypometabolism in all three regions studied (p < 0.0001). In patients with isolated HS, the most prominent hypometabolism was in the anterior and mesial temporal lobe, whereas in dual pathology, it was in the lateral temporal lobe. TLVs and hippocampal volumes were significantly smaller on the epileptogenic side (p < 0.05). The PET asymmetries ipsilateral/contralateral to the epileptogenic zone and TLV asymmetries correlated significantly for the anterior and lateral temporal lobes (p < 0.05) in the HS+CD group, but not in the isolated HS group. Mesial temporal hypometabolism was not significantly different between the two groups. Conclusions: Temporal neocortical microscopic CD with concurrent HS is associated with more prominent lateral temporal metabolic dysfunction compared with isolated HS in TL atrophy. Further studies are needed to confirm these findings and correlate the PET hypometabolic patterns with outcome data in patients operated on for HS with or without CD. [source]

Language-Related Potentials in Temporal Lobe Epilepsy Before and After Surgical Treatment

EPILEPSIA, Issue 2000
Toshihiko Ito
Purpose: Temporal lobectomy has contributed to treatment for medically intractable epilepsies. However, influence of the surgical treatment on cognitive function is not still clear, especially from the electrophysiological viewpoint. N400, an event related potential (ERP) named for its negative polarity and peak latency of 400 ms, is reported to be an electrophysiological sign of neural activities associated with semantic priming in language perception. In the present study, ERPs are applied to evaluate the cognitive function of temporal lobe epilepsy before and after temporal lobectomy. Methods: Two patients with intractable temporal lobe epilepsy participated in this study. Fifteen normal subjects served as controls. The incongruous sentence task (Kutas and Hillyard 1980) was used to record N400 components in an auditory modality. Two types of sentences (40 Japanese sentences for each type) were prepared, in which the terminal words were either semantically congruent or incongruent. The scntences were randomly presented at approximately 65 dB SPL peak intensity. ERPs were recorded according to the international 10,20 system, with a balanced non-cephalic electrode reference and 2 1 channels. The band-pass filter was set from 0.5 to 30 Hz, and the ERPs were sampled at 500 Hz from 200 ms before the onset of terminal words to 824 ms post-stimulus. Waves were calculated by subtracting ERPs in the congruent condition from those in the incongruent condition. N400 was scored as the most negative point between 250 and 450 ms in the subtraction waves. Amplitudes were measured from the baseline of 100 ms before the terminal words. Motor responses were also measured with a right index finger, to estimate the accuracy of understanding sentences. Results: Case I was a 22-year-old male who had intractable epilepsy for 7 years. Magnetic resonance imaging (MRI) showed high-intensity signals in the right amygdalo-hippocampal region. The epileptic seizures were confirmed to originate from the region hy electroencephalography/closed-circuit television monitoring, and single-photon-emission computed tomography. ERPs were recorded I month before and after the right anterior temporal lobectomy. Before the surgery, the rate of correct responses showed no difference between the patient (96 %) and the controls (96 %). The amplitudes of N400 for the patient reduced in the right frontal and central areas (F4, C4), comparing to 99 % confidence limit for control subjects. After the surgery, the rate of correct responses was 97 %, and the amplitudes reduced in the right central, parietal, and posterior temporal areas (C4, P4, 0 2, T6). Case 2 (37-year-old female) had intractable epilepsy for 30 years. MRI showed brain atrophy in the right hippocampal region. The epileptic seizures were confirmed to originate from the region. N400 was recorded 3 months after the resection. The rate of correct responses was 95 %. The amplitudes of N400 were lower in the right frontal, parietal, and temporal areas (electrodes Fp2, F4, P4, T6, Pz), comparing to 99 % confidence limit of controls. Conclusions: Before the lpbectomy, the reduction of amplitudes of N400 indicated that the pathogenesis of intractable temporal lobe epilepsy would influence the process of semantic priming in language perception. After the resection, it was suggested that the right temporal lobectomy might affect the cognitive function in the brain from electrophysiological aspects. We could benefit from further study including analysis of the discrepancy between the amplitudes of N400 and behavioral responses. [source]