SEIZURE OUTCOME FOLLOWING TEMPORAL LOBECTOMY IN TEMPORAL LOBE CORTICAL DYSPLASIA
Abstract number :
3.252
Submission category :
Year :
2002
Submission ID :
3008
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Teeradej Srikijvilaikul, William E. Bingaman, Imad M. Najm. Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH; Neurology, The Cleveland Clinic Foundation, Cleveland, OH
RATIONALE: Objective: At the end of this activity the participants should be able to discuss the seizure outcome following temporal lobectomy in temporal lobe cortical dysplasia.
Rationale: Standard temporal lobectomy achieves favorable result in medically intractable epilepsy with hippocampal sclerosis. Cortical dysplasia(CD) is increasingly recognized as a cause of drug resistant epilepsy. We report the seizure outcome of temporal lobectomy in patients with temporal lobe cortical dysplasia.
METHODS: All data on patients who underwent temporal lobectomy from 1990 to 2001 with pathologically verified cortical dysplasia were reviewed. The patients who had multilobar CD, tumor associated with CD or tuberous sclerosis were excluded.
RESULTS: There were 45 patients who underwent temporal lobectomy and had pathological evidence of cortical dysplasia. There were 23 patients (51.1%) who had cortical dysplasia and hippocampal sclerosis. The mean age at surgery was 27.2 years (range; 1-65 years). The mean age at seizure onset was 10.5 years (range; 3 months-47 years) and the mean duration of epilepsy was 16.6 years (range;7 months-56 years). The MRI was abnormal in 16 patients with CD and 21 patients with CD & HS.Six patients had invasive monitoring (2 depth electrodes and 4 subdural electrodes). Standard temporal lobectomy was performed in 42 patients. Lateral temporal lobectomy and selective amygdalohippocampectomy were performed in 2 and 1 patients respectively. The mean duration of follow-up was 2.1 years (range; 6 months-6 years).Twenty nine of 45 patients (64.4%) were seizure free and 4 patients (8.9%) were seizure free but had aura only. Six patients (13.3%) had rare seizure,4 patients (8.9%) had 50-90% seizure reduction and 2 patients (4.4%) had no worthwhile improvement. There was no significant different in seizure outcome between patients with CD and CD & HS (p[gt]0.05). There were no mortality or major morbidity.
CONCLUSIONS: Temporal lobectomy for temporal lobe cortical dysplasia had favorable seizure outcome. Cortical dysplasia appears to be an important cause of temporal lobe epilepsy and should be considered in those patients without evidence of hippocampal sclerosis on preoperative MRI.