POSTOPERATIVE SEIZURE[ssquote]S OUTCOME IN PATIENTS WITH REFRACTORY TEMPORAL LOBE EPILEPSY ACCORDING TO THEIR MRI FINDINGS
Abstract number :
1.305
Submission category :
Year :
2002
Submission ID :
57
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Joaquim O. Vieira Jr., Arthur Cukiert, Jose A. Buratini, Cassio R. Forster, Cristine M. Baldauf, Meire Argentoni, Carla Baise, Leila Frayman, Valeria A. Mello, Paulo T. Brainner-Lima. Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paulo, Sao Paulo,
RATIONALE: Neurophysiological findings (NF), specially video-EEG recordings were the main primary tests before the introduction of MRI. This paper reports on the results obtained while using MRI instead of NF as a primary screening test in patients with temporal lobe epilepsy.
METHODS: Three hundreds and seventeen epileptic patients were studied. Age ranged from 5 to 54 years (mean 26 years). All patients had a clinical history suggestive of temporal lobe epilepsy and underwent high-resolution 1,5T MRI with thin slices perpendicular to the hippocampal axis. They were divided in 4 groups according to their MRI findings: Group I, normal MRI (n=23); Group II (n=239), unilateral mesial temporal sclerosis (MTS); Group III (n=6), bilateral MTS and Group IV (n=49), non-MTS temporal lobe lesions. All Group I patients underwent video-EEG recording. Those with unilateral interictal or ictal findings were submitted to cortico-amygdalo-hippocampectomy (CAH) at the side of the NF; those with bilateral findings were submitted to bilateral subdural grids implantation and CAH according to the invasive NF. Group II patients were submitted to CAH at the side of the MRI-defined MTS, without video-EEG monitoring or electrocorticography. Group III patients were submitted to bilateral subdural grids implantation and CAH according to the invasive NF. Group IV patients underwent lesionectomy with electrocorticographic guidance for additional margin resection without pre-operative video-EEG recording.
RESULTS: Overall, 86% of the patients were rendered seizure-free postoperatively. 73% were seizure-free in Group I, 87% in Group II, 83% in Group III and 91% in Group IV.
CONCLUSIONS: MRI seems to be a very good primary screening test in patients with refractory temporal lobe epilepsy. It is easy to perform and analyze, can be performed in an out-patients basis, is much less expensive then intensive video-EEG monitoring and obviate the need for seizure[ssquote]s recording in up to 80% of the patients with temporal lobe epilepsy.
[Supported by: Sao Paulo Secretary of Health]