Premium
Periventricular nodular heterotopia and intractable temporal lobe epilepsy: Poor outcome after temporal lobe resection
Author(s) -
Li L. M.,
Dubeau F.,
Andermann F.,
Fish D. R.,
Watson C.,
Cascino G. D.,
Berkovic S. F.,
Moran N.,
Duncan J. S.,
Olivier A.,
Leblanc R.,
Harkness W.
Publication year - 1997
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410410516
Subject(s) - temporal lobe , epilepsy , anterior temporal lobectomy , magnetic resonance imaging , medicine , heterotopia (medicine) , central nervous system disease , epilepsy surgery , electroencephalography , temporal cortex , psychology , surgery , radiology , pathology , neuroscience , psychiatry
We describe 5 women and 5 men with periventricular nodular heterotopia and electroclinical features suggestive of temporal lobe epilepsy, who were surgically treated for control of medically refractory seizures. Magnetic resonance imaging revealed bilateral periventricular nodular heterotopia in 7 of the 10 patients. Because of the lack of clear localization, 6 patients were studied with intracranial depth electrode recordings. Seizures were of hippocampal onset (3 patients), regional temporal lobe onset (2 patients), or occipital‐temporal onset (1 patient). Anterior temporal lobectomy was performed in 6 patients; selective amygdalohippocampectomy, in 1; and anterior temporal lobectomy plus resection of the heterotopic tissue, in 3. None of the 9 patients followed for more than 12 months postoperatively were seizure free. Two patients were initially seizure free for approximately 18 months, but then seizures recurred. One patient had a major reduction in seizure frequency at a 39‐month follow‐up after most of the unilateral heterotopic tissue was included in the temporal resection. Temporal resection did not lead to a long‐term favorable outcome in this group of patients with periventricular nodular heterotopia and epileptogenic discharges involving the temporal lobe. This sugests a more widespread disorder with epileptogenic activity possibly originating in or near the heterotopic tissue. The clinical and electrographic features of periventricular nodular heterotopia pointing to temporal lobe origin are misleading and temporal resection does not result in long‐term cessation of seizures.