VALUE OF INTERICTAL EEG AND EXTENT OF HIPPOCAMPAL RESECTION IN THE SURGICAL TREATMENT OF TEMPORAL LOBE EPILEPSY
Abstract number :
1.449
Submission category :
Year :
2003
Submission ID :
577
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Li Min Li, Leonardo Bonilha, Eliane Kobayashi, Donizete Cesar Honorato, Fernando Cendes Laboratory of Neuroimaging, State University of Campinas, Campinas, Sao Paulo, Brazil
Unilateral hippocampal atrophy is indicator of good surgical prognosis in patients with temporal lobe epilepsy (TLE). Some patients however do not become seizure free after surgery. We assessed if i) interictal EEG and ii) the extent of hippocampal and amygdala resection are associated with outcome.
Thirty patients with TLE with unilateral or clearly asymmetric hippocampal atrophy who underwent surgical treatment were evaluated concerning preoperative clinical variables and interictal EEG abnormalities. Amygdala and hippocampal resection was evaluated by post-operative MRI. We compared seizure free versus non-seizure free patients, and patients with good outcome (Engel[rsquo]s classes I and II) versus patients with poor outcome.
All patients underwent anterior temporal lobe resection plus amygdalo-hippocampectomy ipsilateral to side of hippocampal atrophy or predominant atrophy. Two patients (7%) had null resection of the amygdala, 20 (66%) had partial resection and 8 (27%) had complete resection. Three patients (10%) had null resection of the hippocampus, 11 (37%) had incomplete resection of the anterior portion of the hippocampus, 10 (33%) had complete resection of the anterior portion without resection of the posterior portion and 6 (20%) had complete resection of the anterior portion with partial resection of the posterior portion.
The extent of amygdala resection did not correlate with the outcome. Conversely, the extent of hippocampal resection showed significant association with the good outcome (p[lt]0.001) and seizure-free outcome (p[lt]0.001).
Interictal EEG was not predictive of surgical outcome. The extent of hippocampal resection, in turn, was associated with post-operative seizure-control.
[Supported by: FAPESP (00/04710-2)]