Surgical outcome in patients with refractory epilepsy associated to MRI-defined unilateral mesial temporal sclerosis

Arquivos de Neuro-Psiquiatria

Cristine Mella Baldauf¹  Arthur Cukiert¹  Meire Argentoni¹  Carla Baise-zung¹  Cássio Roberto Forster¹  Valeria Antakli Mello¹  José Augusto Burattini¹  Pedro Paulo Mariani¹  Ródio Brandão Câmara¹  Lauro Seda¹ 

[1] ,Hospital Brigadeiro Serviço de Cirurgia de Epilepsia São Paulo SP ,Brazil

关键词: refractory temporal lobe epilepsy;    hippocampal sclerosis;    surgery;    electroencephalography;    magnetic resonance image;    epilepsia do lobo temporal refratária;    esclerose hipocampal;    cirurgia;    eletrencefalografia;    ressonância magnética;   

DOI  :  10.1590/S0004-282X2006000300003

来源: SciELO

【 摘 要 】

INTRODUCTION: Several pre-operative work-up protocols have been used while selecting epileptic patients for surgery among different centers. The relative value of the different available pre-operative tests is still under discussion. OBJECTIVE: We report on the surgical outcome obtained in patients with refractory temporal lobe epilepsy associated to mesial temporal sclerosis (MTS) and who were evaluated pre-operatively by interictal EEG and MRI alone. METHOD: Forty one patients with refractory unilateral temporal lobe epilepsy were evaluated using interictal EEG and MRI. MRI disclosed unilateral MTS in all patients. All patients had at least 4 interictal EEG recordings. All patients were submitted to cortico-amygdalo-hippocampectomy at the side determined by MRI. RESULTS: Interictal EEG showed unilateral epileptiform discharges compatible with MRI findings in 37 patients; in four out of the 41 patients, bilateral discharges were found. Mean follow-up time was 4.3±1.1 years. Thirty-nine patients (95.1%) were classified as Engel’s Class I (70.6% Engel I-A). Two patients (4.9%) were rated as Engel's Class II. All patients in whom bilateral discharges were found were in Engel’s Class I. Pathological examination showed MTS in all patients. CONCLUSION: 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 postoperative remission rate higher then 90%. The finding of MTS on MRI is the most important good prognostic factor after temporal lobe resection.

【 授权许可】

CC BY   
 All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License