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Anterior Temporal Lobectomy (anterior + temporal_lobectomy)
Selected AbstractsMemory, Emotional and Vocational Impairments before and after Anterior Temporal Lobectomy for Complex Partial SeizuresEPILEPSIA, Issue 11 2006Mario F. Dulay Summary:,Purpose: To assess the pre- and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL. Methods: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.3 months after surgery. Results: A moderate to high frequency of memory impairment (44.4%; verbal or nonverbal), emotional disturbance (38.9%) and unemployment (27.8%) existed in the same individuals both before and after surgery. There were small to moderate rates of new onset memory (18.9%), emotional (11.1%), and vocational (7.8%) difficulties after surgery often regardless of seizure control outcome. Patients who underwent left-ATL and had emotional disturbance after surgery had the lowest verbal memory test scores. Conclusions: Results highlight the importance of taking into account emotional status when assessing memory abilities after ATL. Results replicate the finding of moderate to high frequencies of memory impairment, emotional disturbance, and unemployment both before and after ATL. Results provide support for the rationale that cognitive, psychiatric and vocational interventions are indicated to mitigate the problems that exist before and persist after ATL. [source] Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: A long-term follow-upEPILEPSIA, Issue 6 2010Michael Murphy Summary Purpose:, To assess the outcomes from temporal lobectomy for hippocampal sclerosis in patients 50 years or older. Controversy exists as to the suitability of older patients for epilepsy surgery, with most of the previous studies demonstrating a correlation between increasing age and poor outcome. However, the inclusion of temporal lobe epilepsy of multiple etiologies has confounded many previous studies of this age group. Methods:, Twenty-one patients aged 50 years or older (mean 54.9 years) at the time of surgery were included in the study group. All patients had a pathologic diagnosis of hippocampal sclerosis. A retrospective analysis was performed comparing seizure outcomes following a standardized anterior temporal lobectomy with those from 103 patients younger than 50 (mean age 34.7 years) operated upon over the same time period. The mean follow-up period for the study was 9.57 years. Results:, Twenty of the 21 patients in the older group (95.2%) had a satisfactory seizure outcome (Engel classes I and II) compared with 90.3% of the younger patients. There was no statistically significant difference in the outcomes between the two groups (p = 0.719). Across both groups of patients combined, there was no significant difference between the mean age in the patients with a satisfactory seizure outcome compared to those with an unsatisfactory outcome (38.3 vs. 34.7 years, p = 0.213). Discussion:, Patients 50 years or older with intractable seizures from hippocampal sclerosis have seizure outcomes following temporal lobectomy that are comparable to young patients over the long term. Older patients should not be denied treatment on the basis of age. [source] Changes in individual and group spatial and verbal learning characteristics after anterior temporal lobectomyEPILEPSIA, Issue 6 2009Mario F. Dulay Summary Purpose:, To evaluate the effects of anterior temporal lobectomy (ATL) on individual and group spatial and verbal learning and memory abilities as a function of side of surgery and seizure control outcome. Methods:, We evaluated pre- and postsurgical learning and memory abilities of 75 left-hemisphere language dominant individuals who underwent ATL (33 left, 42 right) using the 8-trial Nonverbal Selective Reminding test and the 12-trial Verbal Selective Reminding test. Results:, Reliable change index methods indicated that 40.5% of individuals who underwent right-ATL had a clinically significant decline in spatial memory, and 62.5% of individuals who underwent left-ATL had a significant reduction in verbal memory. Growth curve analyses indicated that both side of surgery and poor seizure outcome independently affected the learning slope in the best fitting models. Left-ATL reduced the slope, but did not affect the overall shape, of verbal learning across trials. On the other hand, poor seizure control outcome affected the slope of spatial learning regardless of the side of surgery. Discussion:, Results demonstrate both individual and group declines in spatial memory and learning after ATL. Results suggest that individuals who undergo right-ATL should be counseled regarding the likelihood of a decline in spatial memory and learning abilities after ATL. Results also suggest that individuals with poor seizure control after ATL should be referred for rehabilitation services given the significant declines in spatial and verbal memory that occurred in our sample regardless of side of surgery. [source] Balloon cells and dysmorphic neurons in the hippocampus associated with epileptic amnesic syndrome: A case reportEPILEPSIA, Issue 5 2008Se Hoon Kim Summary Recently, we encountered a 39-year-old woman with typical epileptic amnesic syndrome. The patient underwent right anterior temporal lobectomy, which removed the right hippocampus. The patient's resected hippocampus showed typical histological features of Ammon's horn sclerosis (AHS) with dysmorphic neurons. In addition, the prominent balloon cells, admixed with dysmorphic neurons, were noted in the hippocampus. To our knowledge, this is the first reported case showing AHS with balloon cells. The presence of balloon cells reinforces the hypothesis that AHS itself might be a maldevelopment disorder. [source] Memory, Emotional and Vocational Impairments before and after Anterior Temporal Lobectomy for Complex Partial SeizuresEPILEPSIA, Issue 11 2006Mario F. Dulay Summary:,Purpose: To assess the pre- and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL. Methods: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.3 months after surgery. Results: A moderate to high frequency of memory impairment (44.4%; verbal or nonverbal), emotional disturbance (38.9%) and unemployment (27.8%) existed in the same individuals both before and after surgery. There were small to moderate rates of new onset memory (18.9%), emotional (11.1%), and vocational (7.8%) difficulties after surgery often regardless of seizure control outcome. Patients who underwent left-ATL and had emotional disturbance after surgery had the lowest verbal memory test scores. Conclusions: Results highlight the importance of taking into account emotional status when assessing memory abilities after ATL. Results replicate the finding of moderate to high frequencies of memory impairment, emotional disturbance, and unemployment both before and after ATL. Results provide support for the rationale that cognitive, psychiatric and vocational interventions are indicated to mitigate the problems that exist before and persist after ATL. [source] Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal AnalysisEPILEPSIA, Issue 8 2005Sang-Wuk Jeong Summary:,Purpose: Determining long-term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis. Methods: Two hundred twenty-seven patients with MTLE were included in this study. The primary outcome variable was patient status 1,5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic-regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5-year follow-up period were used. Results: The seizure-free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic-regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43,0.81], absence of secondarily generalized tonic,clonic seizure (2°GTCS; OR, 0.45; 95% CI, 0.26,0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11,5.26) were significant predictors of a good surgical outcome. Conclusions: Age at surgery, presence of 2°GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed. [source] Functional MRI Predicts Memory Performance after Right Mesiotemporal Epilepsy SurgeryEPILEPSIA, Issue 2 2005Jozsef Janszky Summary:,Purpose: Anterior temporal lobe resection (ATR) is a treatment option in drug-resistant epilepsy. An important risk of ATR is loss of memory because mesiotemporal structures contribute substantially to memory function. We investigated whether memory-activated functional MRI (fMRI) can predict postoperative memory loss after anterior temporal lobectomy in right-sided medial temporal lobe epilepsy (MTLE). Methods: We included 16 patients (10 women) aged 16,54 years. The mean age at epilepsy onset was 12.5 years (range, 1,26 years). The patients' mean Wechsler IQ score was 95.2 (range, 62,125). The activation condition of fMRI consisted of retrieval from long-term memory induced by self-paced performance of an imaginative walk. All but one patient had left-sided speech dominance according to speech-activated fMRI. Outside the scanner, we evaluated the pre- and postoperative visual memory retention by using Rey Visual Design Learning Test. Results: We found a correlation between the preoperative asymmetry index of memory- fMRI and the change between pre- and postsurgical measures of memory retention. Reduced activation of the mesiotemporal region ipsilateral to the epileptogenic region correlated with a favorable memory outcome after right-sided ATR. Conclusions: In light of the postoperative results, the theoretical implication of our study is that fMRI based on a simple introspective retrieval task measures memory functions. The main clinical implication of our study is that memory- fMRI might replace the invasive Wada test in MTLE by using a simple fMRI paradigm. Predictive power, however, will be studied in larger patient samples. Other studies are required for left-sided MTLE and neocortical epilepsies to assess the clinical usefulness of memory- fMRI. [source] Prognostic Implication of Contralateral Secondary Electrographic Seizures in Temporal Lobe EpilepsyEPILEPSIA, Issue 11 2000Ki Hyeong Lee Summary: Purpose: Interhemispheric propagation of seizures in temporal lobe epilepsy is frequently noted during intracranial EEG monitoring. We hypothesized that a distinct secondary electrographic seizure (DSES) in the temporal lobe contralateral to primary seizure onset may be an unfavorable prognostic indicator. Methods: We reviewed intracranial depth electrode EEG recordings, 1-year outcome, and medical records of 51 patients (M 29, F 22: age 15,64 years) who underwent anterior temporal lobectomy during 1988,96. We defined DSES as a seizure that spread to the contralateral temporal lobe and produced distinct contralateral EEG features. The distinct feature was focal involvement of one or two electrode contacts at onset, which starts and evolves independently from the ipsilateral temporal lobe. We considered DSES as the predominant seizure pattern when it occurred in more than one half of the patients' recorded seizures. Results: Only nine of 19 (47%) patients with predominant DSES had a 1-year seizure-free outcome, whereas 27 of 32 (84%) patients without predominant DSES had a 1-year seizure-free outcome (p <0.01). Bitemporal independent seizures were more common in patients with predominant DSES (9/19 versus 0/32; p <0.001). Conclusion: Our results suggest that distinct contralateral secondary electrographic seizure is a predictor of unfavorable outcome and is also more likely to be associated with bitemporal seizures. [source] Language-Related Potentials in Temporal Lobe Epilepsy Before and After Surgical TreatmentEPILEPSIA, Issue 2000Toshihiko 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] Predictors of seizure outcome after temporal lobectomy for intractable epilepsyACTA NEUROLOGICA SCANDINAVICA, Issue 4 2004K. Stavem Objectives , To assess predictors of outcome of temporal lobectomy for intractable epilepsy. Material and methods , In 63 adult patients operated with anterior temporal lobectomy during 1988,92, we used logistic regression analysis to assess predictors of being seizure-free (Engel's class I) 2 years after surgery. As potential predictors, we included the following variables: gender, age at operation, age at onset of seizures, epilepsy duration, etiology, generalized vs not generalized seizures, seizure frequency, intelligence quotient, ictal electroencephalography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), side of resection, and extent of the resection. Results , About 44% of the surgery patients were seizure-free (Engel's class I) 2 years after surgery. In multivariate analysis (n = 55), MRI pathology defined as atrophy in the temporal lobe, angioma, tumor or mesial temporal sclerosis (odds ratio, OR 7.4, 95%CI: 1.7,32.9) and extent of the hippocampal resection (increase of 1 cm) (OR 2.2, 95%CI: 1.1,4.6) predicted being seizure-free. Conclusion , Focal pathology in preoperative MRI and the extent of the hippocampal resection were the only significant predictors of being seizure-free after 2 years. [source] | ||||||||||