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Variability of presentation in medial temporal lobe epilepsy: a study of 30 operated cases
C Adam1, S Clemenceau, F Semah
1Service de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
Introduction:
To evaluate the homogeneity of patients operated on for MTLE.
Material And Methods:
30 consecutive patients prospectively investigated with clinical, EEG, neuropsychology, MRI, FDG-PET criteria and eventually intracranial EEG, who underwent antero-medial temporal resection (follow-up: 24 months).
Results:
Clear and well-lateralised MTLE was non-invasively ascertained in 22 patients (73%). Eight patients (27%) had a less pure presentation due to divergent scalp EEG features (bitemporal, widespread or extratemporal), unusual auras or absence of MRI-based hippocampal sclerosis or FDG-PET hypometabolism. They were explored by invasive monitoring which confirmed medial temporal origin of seizures. Outcome was excellent in 95% of the pure cases (Engel's class I) and less favorable in the more difficult ones (65% of class I).
Conclusions:
MTLE criteria, including the strong contribution of brain imaging, permit to select accurately a large percentage of patients. However a consistant number of patients present a less pure presentation suggesting more complex epileptogenic networks.
Insights
Most patients with mesial temporal lobe epilepsy (MTLE) are accurately selected using non-invasive criteria. However, some cases present complex networks requiring further investigation.
Area of Science:
- Neurology
- Epileptology
- Neurosurgery
Background:
- Evaluating patient homogeneity is crucial for epilepsy surgery outcomes.
- Mesial temporal lobe epilepsy (MTLE) is a common epilepsy syndrome requiring precise patient selection.
Purpose of the Study:
- To assess the homogeneity of patients undergoing surgery for MTLE.
- To evaluate the effectiveness of non-invasive diagnostic criteria in patient selection for MTLE surgery.
Main Methods:
- Prospective study of 30 MTLE patients.
- Utilized clinical evaluation, EEG, neuropsychology, MRI, FDG-PET, and invasive monitoring.
- All patients underwent antero-medial temporal resection with a 24-month follow-up.
Main Results:
- Non-invasive methods accurately identified MTLE in 73% of patients.
- 27% of patients showed less typical presentations, necessitating invasive monitoring.
- Excellent outcomes (Engel's class I) were achieved in 95% of 'pure' MTLE cases versus 65% in complex cases.
Conclusions:
- Established MTLE criteria, particularly neuroimaging, effectively select a majority of surgical candidates.
- A significant subset of MTLE patients exhibit complex epileptogenic networks, challenging initial non-invasive assessments.