OUTCOME FROM TEMPORAL LOBECTOMY FOLLOWING INVASIVE EEG MONITORING IN PATIENTS WITH DISCORDANT NON-INVASIVE PRESURGICAL STUDIES
Abstract number :
3.220
Submission category :
Year :
2002
Submission ID :
3358
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Cristina Y. Go, Cormac A. O[ssquote]Donovan, Maria C. Sam, Cesar S. Santos, William L. Bell, Steven S. Glazier. Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, NC; Neurosurgery, Wake Forest University Baptist Medical Center, Winst
RATIONALE: Temporal lobectomy for medically intractable epilepsy results in a high success rate for seizure reduction when noninvasive presurgical evaluation shows concordant data. We sought to determine the surgical outcome of patients with clinically suspected temporal lobe epilepsy who underwent invasive EEG monitoring after discordant scalp video EEG monitoring and neuroimaging studies .
METHODS: Forty-three patients were evaluated for temporal lobectomy with invasive EEG due to discordant noninvasive data.Followup ranged from three months to six years. Scalp EEG, MRI, PET and SPECT findings were analyzed to determine the predictive value of these studies in terms of surgical candicacy following invasive EEG and seizure free outcome in those who underwent temporal lobectomy. Patients were analysed in the following groups: Group A - Seizure free postop, Group B - Persistent seizures
postop, Group C - No resective surgery due to inadequate localization of seizure onset
RESULTS: Thirty patients (70%) underwent temporal lobectomy after invasive EEG monitoring of whom seventeen (56.6%) became seizure-free (Group A). Thirteen patients (30%) did not have resective surgery (Group C). Group A(seizure free) showed abnormalites on MRI in 53% , PET in 67% and SPECT in 57%. Group B(persistent seizures)showed abnormal MRI in 46%, PET in 54% and SPECT in 77% of patients. In Group C (No resective surgery due to inadequate localization of seizure onset) abnormalities were seen on MRI in 23% , PET in 54% and SPECT in 82%.
CONCLUSIONS: Temporal lobectomy following invasive EEG monitoring after discordant non-invasive data can result in significant seizure reduction. Structural and nuclear neuroimaging studies do not show high predictive value for seizure-free outcome postoperatively in these patients.