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Conditions for Omitting Invasive Long‐Term Monitoring before Surgical Resection in Patients with Temporal Lobe Epilepsy
Author(s) -
Mihara Tadahiro,
Matsuda Kazumi,
Tottori Takayasu,
Baba Khoichi,
Inoue Yushi,
Hiyoshi Toshio,
Watanabe Yutaka,
Yagi Kazuichi,
Seino Masakazu
Publication year - 1992
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/j.1440-1819.1992.tb00867.x
Subject(s) - ictal , temporal lobe , epilepsy , stereoelectroencephalography , electroencephalography , epilepsy surgery , medicine , scalp , lesion , neuroimaging , atrophy , surgery , psychology , neuroscience , pathology
The omission of invasive long‐term monitoring before surgical resection in patients with epilepsy should be permitted only for those in whom the epileptogenic focus is presumed to localize unilaterally in the mesial aspect of the temporal lobe. The localization may well be confirmed through noninvasive measures. Retrospective analyses of data obtained from noninvasive investigations (scalp‐recorded and sphenoidal EEG, neu‐rolmages, and electroclinical seizure manifestations) were carried out in 58 :patients. The localization of their epileptogenic focus was subsequently confirmed by the implantation of both intracerebral and subdural electrodes; the focus had an amygdalohippocampal origin in 41 :patients and a lateral temporal origin in 17 :patients. From the comparison of noninvasive Andings between these two groups, we propose the following indispensable conditions for omitting an invasive evaluation: 1. Appearance of focal epileptic discharges unilaterally in the sphenoidal lead observed during the simple phase of partial seizures, or unilateral discharges with predominancy in the sphenoidal lead during the early phase of complex partial seizures. 2. Interictal spikes on scalp‐recorded EECs localizing unilaterally in the anterior region of the temporal lobe, and if bilaterally independent, presenting with unilateral predominancy in a ratio of greater than 41. 3. Presence of autonomic signs in the initial phase of signal symptoms. 4. Neuroimaging Andings in the mesial temporal region: elongated T2 on MRI and hippocampal atrophy, or a tumorous lesion. The lateralhation conforms to interictal and ictal paroxysmal EEC findings. There were 8 :patients with seizures of amygdalohippocampal origin who satisfied all the indispensable condition, but not a single patient with seizures of lateral temporal origin. Thus, the conditions we propose are surely useful for determining whether patienta with lateral temporal seizures should be excluded from invasive long‐term monitoring before surgical resection.