Temporal Lobe Epilepsy Due to Pathologically Proven Hippocampal Sclerosis Versus Temporal Lobe Lesion: Clinical, Electroencephalographic, and Neuroimaging Findings, and Surgical Outcome.
Abstract number :
2.293
Submission category :
Year :
2001
Submission ID :
2305
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
K. Kim, MD, Neurology, Kosin University College of Medicine, Busan, Korea; M. Waruingi, MD, Epilepsy Service, Massachusetts General Hospital, Boston, MA; R. Cosgrove, MD, FRCS (C), Neurosurgery, Massachusetts General Hospital, Boston, MA; D.B. Hoch, MD, P
RATIONALE: To determine the clinical, EEG, and neuroimaging characteristics and surgical outcome in patients with medically refractory temporal lobe epilepsy due to hippocampal sclerosis(HS) compared to patients with temporal lobe lesion(TLL). Knowledge obtained from this is important when deciding the surgical intervention.
METHODS: Records of 122 consecutive patients who underwent surgery for epilepsy from 1993 to the present were retrieved from the MGH Epilepsy Surgery Database. Fifty eight patients with temporal lobe epilepsy due to pathologically proven hippocampal sclerosis or temporal lobe lesions were identified and clinical, presurgical interictal and ictal electroencepahlographic, MRI and FDG-PET data were reviewed. Patients with dual or normal pathology were excluded. Histopathological impression was maintained as the gold standard for diagnosis of structural abnormality.
RESULTS: Pathologically proven HS was present in 32, and 26 patient has temporal neocortical lesions(cortical dysplasia, vascular malformation, gliomas, DNET, heterotopia). Mean age at onset was 12.6 years in HS group and 19.6 years in TLL group (p=0.012). Mean duration of epilepsy was 20.6 years in HS and 11.6 years in TNC (p=0.001). Febrile convusions was present in 28.1% in HS and 3.8% in TLL group (p=0.002). Family history was more frequent in HS group but not statistically significant. Interictal EEG abnormality was on the resected side in 56.2 % in HS and 80.7% in the TLL group (p=0.048). Ictal EEG and neuroimaging sensitivity, in FDG-PET and MRI, were not statistically different between the two groups. Furthermore, there was no significant difference in at least one year follow-up surgical outcome between the two groups.
CONCLUSIONS: Epilepsy due to HS had a significantly earlier onset, and patients lived with the seizure disorder for a significantly longer duration. Presence of febrile convulsions was significantly associated with HS. Presurgical investigational findings, except interictal EEG, and surgical outcome were not different between HS and TLL groups.
Support: M.W. a research fellow at MGH epilepsy Service supported by NIH/WHO grant number F5NS10975A