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Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients
Published on: December 18, 2016
[Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal
T Morioka1, S Nishio, T Kawamura
1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Abstract:
We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL.
Insights
Non-invasive tests like EEG and FDG-PET can identify patients with intractable medial temporal lobe epilepsy (MTLE) for anterior temporal lobectomy (ATL) surgery, leading to successful seizure control.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Context:
- Intractable medial temporal lobe epilepsy (MTLE) poses significant challenges in patient management.
- Surgical intervention, such as anterior temporal lobectomy with hippocampectomy (ATL), is considered for refractory cases.
- Minimally invasive diagnostic methods are crucial for patient selection.
Purpose:
- To evaluate the efficacy of non-invasive diagnostic tools in selecting patients with intractable MTLE for ATL.
- To correlate seizure semiology, EEG, and neuroimaging findings with surgical outcomes.
Summary:
- This retrospective study analyzed 8 patients with intractable MTLE who underwent ATL without invasive monitoring.
- Key findings included oral automatism in all patients, unilateral temporal onset on EEG, and temporal lobe hypometabolism on FDG-PET.
- Post-surgery, 7 out of 8 patients achieved seizure freedom.
Impact:
- Non-invasive evaluations, particularly ictal EEG and FDG-PET, are effective in identifying suitable candidates for ATL in MTLE.
- Concordant findings from these non-invasive methods can guide surgical decisions and improve patient outcomes.
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