Nocturnal Seizures and Temporal Lobe Epilepsy Surgery.
Abstract number :
3.211
Submission category :
Year :
2001
Submission ID :
2990
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
V. Pella, MD, Neurology Department, Head Epilepsy Clinic,Hospital Angeles del Pedregal, Col Heroes de Padierna, CP, Mexico; I. Madrazo, MD, Department Neurosurgery, Hospital Angeles del Pedregal, Mexico City, Mexico; E. Mart[iacute]nez, MD, Department Neu
RATIONALE: 19 patients were studied from intractable Temporal Lobe Epilepsy(TLE) from January 1998 to December 2000. All of them went under an Epilepsy surgery (ES), at the Angeles del Pedregal Hospital, in Mexico City.
To analyze clinical, electrophysiological, neuroradiologic characteristics and prognostic factors, during stage sleep, in a group of patients were Temporal Lobe Epilepsy Surgery(TLES). The Temporal Lobe Epilepsy (TLE) associated with seizures occuring only or predominantly during sleep is common.
METHODS: 19 patients with intractable Temporal Lobe Epilepsy to medical treatment. They were all studied with video EEG and sphenoidal electrodes, from 2 to 5 days and polisomnography, MRI high resolution 1.5 tesla, FLAIR and 3D, ictal SPECT, Wada test, neurophysiological testing and psychiatric evaluation and acute electrocorticography. All the patients went under Epilepsy Surgery.
RESULTS: 19 patients, 10 male and 9 female, average age 28, (median 27), 19 years with seizures, (median 18), 7 patients had previuos febrile seizures and all of the patients did not have familial history of epilepsy. The video EEG monitoring 10 patients were diagnosed as having right Mesial Temporal Lobe (MTS) and left (MTL) 7, left neocortical temporal lobe epilepsy 2. Findings in the MRI were left temporal mesial sclerosis 3, right temporal mesial sclerosis 3, one of them presented gliosis of the 2nd rigth frontal giros, left hippocampal hypotrophy 3, one of them with temporal frontal occipital gliosis, right hippocampal hypotrophy 6, left arachnoid cyst 2, billateral hippocampal hypotrophy 1, normal 1.
The most common seizures were aura epigastric 7, contralateral distonic movements 10, versive seizures 12, automotor seizures 17, language arrest 10, 9 ictal vomiting in the rigth temporal lobe were frequent, generalized secondarely TCG 8, 42 seizures were present during the awake, at diurnal sleep 6 and nocturnal sleep 15 at an 88.8% at the II stage NREM sleep. Anterior temporal lobectomy and amygdalohippocampectomy left 6, and right 10, left multilobar lobectomy and amygdalohippocampectomy1, marsupialization of arachnoid cyst 2. The postoperative results by Engel scale classification are type I (15), II (3), IV (1).
CONCLUSIONS: The family history of the patients with temporal lobe epilepsy is weird, there are no significant changes in relation to the prognosis in respect to the nocturnal seizures. A favorable control occurs at 79.9% of the cases, it is important to identify the aura, lateralization, versive seizures and contralateral distonic movements.