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Surgery for intractable epilepsy secondary to viral encephalitis
K G Davies1, B P Hermann, A R Wyler
1Epi-Care Center, Baptist Memorial Hospital Memphis, Departments of Neurosurgery, University of Tennessee, Memphis, USA.
British Journal of Neurosurgery
|January 1, 1995
Summary
Viral encephalitis can cause multifocal epilepsy in patients undergoing craniotomy. Chronic electrocorticography (ECoG) is recommended for diagnosis, and anterior temporal lobectomy (ATL) may be effective for unilateral hippocampal sclerosis.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Intractable epilepsy presents diagnostic and therapeutic challenges.
- Viral encephalitis is a potential, though uncommon, cause of chronic epilepsy.
- Multifocal epilepsy may arise from widespread cerebral inflammation.
Purpose of the Study:
- To investigate the incidence and characteristics of epilepsy secondary to viral encephalitis.
- To evaluate the utility of chronic electrocorticography (ECoG) in these cases.
- To assess the outcomes of surgical interventions for epilepsy post-encephalitis.
Main Methods:
- Retrospective analysis of 668 craniotomy cases for intractable epilepsy.
- Identification of 11 patients with presumed viral encephalitis etiology.
- Review of chronic ECoG findings, surgical procedures (corpus callosotomy, anterior temporal lobectomy), and histopathology.
- Assessment of postoperative seizure outcomes.
Main Results:
- 1.6% of cases (11 patients) were attributed to prior viral encephalitis.
- Chronic ECoG revealed diverse seizure onsets, including generalized, bilateral temporal, and unilateral mesial temporal.
- Surgical resection (primarily ATL) in 8 patients yielded seizure freedom in 37.5% and no change in 37.5% at mean 3 years.
- Pathologies included hippocampal sclerosis and neocortical gliosis.
Conclusions:
- Viral encephalitis should be considered in the etiology of intractable epilepsy, potentially leading to multifocal epilepsy.
- Chronic ECoG is a valuable tool for characterizing seizure onset in post-encephalitic epilepsy.
- Anterior temporal lobectomy can be effective for surgically treatable lesions like unilateral hippocampal sclerosis.