Results of Surgery in Patients with Temporal Lobe Epilepsy (TLE), Bilateral Independent Temporal Lobe Spiking (BITLS) and Unilateral Mesial Temporal Sclerosis (MTS) Contralateral to the Prevailing Interictally Discharging Temporal Lobe.
Abstract number :
2.280
Submission category :
Year :
2001
Submission ID :
1942
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
C. Baudaulf, MD, Neurology, Hospital Brigadeiro, Sao Paulo, Brazil; C. Forster, MD, Neurology, Hospital Brigadeiro, Sao Paulo, Brazil; M. Argentoni, MD, Neurology, Hospital Brigadeiro, Sao Paulo, Brazil; A. Cukiert, MD, PhD, Neurosurgery, Hospital Brigade
RATIONALE: The relative value of neurophysiological and neuroanatomic findings for focus localization have been extensively discussed and reviewed after the introduction of MRI in the clinical practice. Conflicting MRI and neurophysiological data often complicate the surgical decision making process in patients with temporal lobe epilepsy (TLE). This is especially true when MRI-defined MTS is present contralateral to interictal and ictal EEG findings. This paper discusses a series of such patients.
METHODS: Seven adult patients with TLE were studied. All had simple (4 autonomic, 2 poorly defined, 1 psychic) and complex partial seizures. MRI showed unilateral mesial temporal sclerosis (MTS) in all patients. Interictal EEG showed bilateral independent temporal lobe spiking (BITLS) with a clear unilateral predominance ([gt]90%) in all patients, contralateral to the MR findings. Ictal EEG showed non-lateralizing seizures in 5 patients and in 2, seizures appeared to arise from the side contralateral to the MRI-defined MTS. All patients were submitted to a cortico-amygdalo-hippocampectomy at the side defined by MRI. Mean follow-up time was 18 months.
RESULTS: Six patients have been rendered seizure-free after surgery. One patient had a 90% decrease in seizure frequency.
CONCLUSIONS: MRI anatomical findings seem to be more relevant for focus localization then non-invasive neurophysiology in this sub-set of patients. Non-congruent neurophysiological data might not be a contra-indication for surgery in patients with clearcut MRI-defined MTS.