Long Term Outcome of Temporal Lobe Surgery in Cases with Structural Lesions Versus Mesial Temporal Sclerosis.
Abstract number :
2.298
Submission category :
Year :
2001
Submission ID :
2127
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
D.A. McMackin, BA, PhD MPsychSc, Dept of Neuropsychology, Beaumont Hospital, Dublin, Ireland; K. Murphy, MB, Epilepsy Surgery Programme, Beaumont Hospital, Dublin, Ireland; M. Farrell, MB, Dept of Neuropathology, Beaumont Hospital, Dublin, Ireland; J.P. P
RATIONALE: Epilepsy surgery is now recognised as a standard treatment for intractable partial epilepsy. Mesial temporal sclerosis (MTS) is the most common pathological substrate in temporal lobe epilepsy and is usually present in approximately 60% of resected specimens. The long term outcome in non-MTS lesional epilepsy has not been studied in depth. The aim of this study is to assess long term outcome in this subgroup of patients in terms of seizure status, neuropsychological and psychosocial functioning in comparison to a random selection of patients with MTS pathology.
METHODS: All data on patients who underwent temporal lobe resections since the inception of epilepsy surgery programme in Beaumont Hospital were reviewed 1988-2000). Twenty patients were identified as having non-MTS lesional epilepsy with a minimum of five years follow-up (Mean follow-up =7.5 years, range = 5 to12 years). Pathology in this group included cortical dysplasia, gangliogliomas, astrocytomas and Dysembryoplastic Neuroepithelial Tumours. This was compared to a random selection of patients with MTS pathology who underwent a selective amygdalo-hippocampectomy and who also had a minimum of five years follow-up. Outcome measures included seizure status (Engel[scquote]s classification) quality of life (WPSI) and standard neuropsychological assessment
(WAIS-III, WMS-III, Complex Figure, list learning, Wisconsin Card Sorting Test).
RESULTS: Seizure outcome in the lesional non-MTS subgroup of patients was significantly poorer at long term follow-up (55% seizure free) compared to those with MTS pathology (75% seizure free) (p[lt].05). Improvement in cognitive and psychosocial functioning was highly dependent on seizure cessation and was not related to specific pathologies. Recurrence tended to occur after one year of seizure freedom in 20 % of the non-MTS lesional patients. Recurrence after six months post surgery was not evident in the MTS group.
CONCLUSIONS: This study suggests that regardless of the underlying pathology those with lesional non-MTS epilepsy have significantly poorer surgical outcome than patients with MTS pathology.