EFFECT OF AMYGDALA RESECTION ON SEIZURE OUTCOME IN PATIENTS UNDERGOING SURGERY FOR MEDICALLY REFRACTORY TEMPORAL LOBE EPILEPSY
Abstract number :
1.438
Submission category :
Year :
2003
Submission ID :
4021
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Cornelia Drees, Joseph Kulas, Gordon Chelune, Richard A. Prayson, Elaine Wyllie, William Bingaman, Hans O. Lüders, Imad Najm Neurology, Cleveland Clinic Foundation, Cleveland, OH; Neuropsychology, Cleveland Clinic Foundation, Cleveland, OH; Neurosurgery,
Anterior temporal lobectomy (ATL) is an effective treatment for patients with medically refractory temporal lobe epilepsy (TLE). Whether amygdala resection influences seizure outcome is not known. This may be relevant since the amygdala are one of the most sensitive structures from which to induce kindling, i.e. a process whereby repeated, intermittent sub-convulsant electrical stimulation, eventually elicits a generalized seizure, and eventually lowers the seizure threshold.
We reviewed charts and post-operative magnetic resonance images of 178 patients who had undergone surgery for medically refractory temporal lobe epilepsy between 1990 and 2000. The linear extent of resection of each temporal gyrus, the fusiform gyrus, the parahippocampal gyrus, the hippocampus and amygdala were measured. The patients were grouped into those without and those with complete amygdala resection. Seizure outcome was assessed at least 6 months after the procedure.
Out of 178 patients, a group of 42 cases without ipsilateral amygdala resection (Group A) and a group of 89 with complete amygdala resection (Group B) were selected. The rest had a variable amount of amygdala resected and did not enter our analysis. The demographic data for both groups were comparable. In both groups the majority of patients had undergone ATL (86% in Group A, 97% in Group B). There were more cortical resections in Group A (12%). Pathology revealed a higher percentage of cortical lesions and heterotopia in Group A (36% vs. 15% in Group B) and a larger number of patients with hippocampal sclerosis (HS) in Group B (65% vs. 40% in Group A). The number of patients who were seizure free at 6 months follow-up was slightly higher in the group with complete amygdala resection (67% vs. 72% in Group A), however, this difference was not statistically significant (p 0.998).
This retrospective study shows that patients who undergo surgery for temporal lobe epilepsy and have a complete amygdala resection may have a slightly better chance of post-operative seizure control. However, statistical analysis did not show any significant difference in seizure outcome between the two groups. A prospective study will be needed to validate these results.