Premium
Outcome after corticoamygdalohippocampectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis without preoperative ictal recording
Author(s) -
Cukiert Arthur,
Cukiert Cristine Mella,
Argentoni Meire,
BaiseZung Carla,
Forster Cássio Roberto,
Mello Valeria Antakli,
Burattini José Augusto,
Mariani Pedro Paulo
Publication year - 2009
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2008.01738.x
Subject(s) - temporal lobe , ictal , epilepsy , magnetic resonance imaging , epilepsy surgery , medicine , electroencephalography , surgery , refractory (planetary science) , hippocampal sclerosis , psychology , radiology , psychiatry , physics , astrobiology
Summary Purpose: We report on the surgical outcome obtained in patients with refractory temporal lobe epilepsy with mesial temporal sclerosis (MTS) who were evaluated preoperatively without ictal recording and were submitted to corticoamygdalohippocampectomy. Methods: Two hundred twelve patients with refractory temporal lobe epilepsy were evaluated by means of clinical history, neurological examination, interictal electroencephalography (EEG), magnetic resonance imaging (MRI), and neuropsychological testing. MRI disclosed unilateral MTS in all patients. All patients were submitted to corticoamygdalohippocampectomy at the side determined by MRI. Results: Interictal EEG showed unilateral temporal lobe spiking in 176 patients; in 36 patients, bilateral discharges were found. Mean follow‐up time was 2.7 years. One hundred ninety‐four patients (92%) were classified as Engel's class I. Eighteen patients (8%) were rated as Engel's class II. Thirty‐two out of 36 patients, in whom bilateral discharges were found, were in Engel's class I. Sixty percent of the patients had an improvement in memory function related to the nonoperated temporal lobe. Fifty‐nine percent of the patients had a 10‐point increase in general IQ postoperatively. Verbal memory decline was noted in three patients. Pathological examination showed MTS in all patients. Conclusions: It is possible to adequately select good surgical candidates for temporal lobe resection using MRI and interictal EEG alone. In patients with MRI‐defined MTS, we should expect a 90% postoperative remission rate. Cognitive decline was very rarely seen in this patient population. The finding of MTS on MRI is the single most important prognostic factor for good outcome after temporal lobe surgery.