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Outcome after temporal lobectomy in bilateral temporal lobe epilepsy
J I Sirven1, B L Malamut, J D Liporace
1Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Annals of Neurology
|December 24, 1997
Summary
Magnetic resonance imaging (MRI) and the Wada test predict seizure freedom after temporal lobectomy for independent bilateral temporal lobe seizures. These noninvasive tests offer prognostic value beyond intracranial EEG.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Independent bilateral temporal lobe (IBTL) seizures present a surgical challenge.
- Predicting outcomes after temporal lobectomy for IBTL seizures is crucial for patient selection.
Purpose of the Study:
- To identify noninvasive presurgical predictors of seizure freedom following temporal lobectomy in patients with IBTL complex partial seizures.
Main Methods:
- Retrospective analysis of 28 patients with IBTL seizures on intracranial EEG (iEEG).
- Fifteen patients underwent temporal lobectomy; 13 did not.
- Correlation of presurgical data (MRI, Wada test, scalp EEG, epilepsy history, IQ) with seizure outcomes.
Main Results:
- Ten of 15 surgically treated patients achieved seizure freedom.
- A lateralized Wada test result or unilateral hippocampal sclerosis on MRI predicted seizure freedom (7/10 seizure-free patients).
- Scalp EEG findings, seizure onset laterality, epilepsy risk factors, epilepsy duration, and IQ did not predict outcomes.
Conclusions:
- Magnetic resonance imaging (MRI) and the Wada test are valuable prognostic indicators for temporal lobectomy in IBTL epilepsy.
- These noninvasive methods provide prognostic information independent of intracranial EEG findings.