Pathology of temporal lobectomy for refractory seizures in children

1993 ◽  
Vol 79 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Venita Jay ◽  
Laurence E. Becker ◽  
Hiroshi Otsubo ◽  
Paul A. Hwang ◽  
Harold J. Hoffman ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Pathological Study ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Neuronal Migration Disorders ◽  
Transitional Forms ◽  
Refractory Seizures ◽  
Mixed Tumors ◽  
Neuronal Heterotopia

✓ Significant pathological abnormalities were encountered in a series of 20 temporal lobectomies in children with intractable complex partial seizures. In particular, “dual pathology” (mesial temporal sclerosis with other lesions) was found rather than mesial temporal sclerosis as the only lesion. Unusual pathological findings included capillary penetration of neurons in a neuronal heterotopia in one patient, and foci of extensive cortical disorganization in some cases of mixed tumors and gangliogliomas. A high proportion of neuronal migration disorders was also seen with overlapping pathological features between cortical dysplasia and tuberous sclerosis. In this correlative clinical, radiological, electroencephalographic, and pathological study, some of the pathological lesions in children did not fit the classical categories of neoplasia and malformation and transitional forms were rarely encountered.

Intractable epilepsy following radiosurgery for arteriovenous malformation

2001 ◽  
Vol 95 (5) ◽  
pp. 888-892 ◽  
Author(s):  
Aatif M. Husain ◽  
Melissa Mendez ◽  
Allan H. Friedman
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Posterior Quadrant ◽  
Original Size ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ Radiosurgery is often used to treat arteriovenous malformations (AVMs) located in deep brain locations. Most of these procedures are successful not only in obliterating the AVM but also in decreasing the frequency and severity of associated seizures. Although radiosurgery is occasionally associated with the development of easy-to-control seizures immediately postoperatively, there have been no reports of intractable epilepsy developing after radiosurgery. In this report, however, a case is presented in which a patient underwent gamma knife surgery (GKS) for an AVM, after which intractable epilepsy and mesial temporal sclerosis (MTS) gradually developed. A 37-year-old right-handed woman underwent GKS for a right mesial parietotemporooccipital AVM. One year later, the AVM had reduced in size, but the patient began to experience complex partial seizures (CPSs). These CPSs initially occurred at a frequency of one per month, but 6 months later they were occurring every other week. She also started having secondarily generalized tonic—clonic seizures (GTCSs) once per month. Over the next year the frequency of her seizures gradually increased to several CPSs per day and two to three GTCSs per week, despite treatment with various combinations of antiepileptic drugs. By this time her AVM had decreased to one half of its original size. Video-electroencephalography monitoring demonstrated that both the CPSs and GTCSs were arising from the right posterior quadrant. Magnetic resonance imaging revealed not only the presence of the right-sided AVM, but also right-sided MTS. The patient underwent surgical resection of the AVM and right temporal lobectomy. She has been free from seizure for longer than 1 year. Radiosurgery may be associated with intractable epilepsy and MTS.

Significance of surgery for temporal lobe epilepsy in childhood and adolescence

1970 ◽  
Vol 33 (3) ◽  
pp. 233-252 ◽  
Author(s):  
Murray A. Falconer
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Childhood And Adolescence ◽  
Content Type ◽  
Pathological Lesion ◽  
Fine Print

✓ The problem of childhood temporal lobe epilepsy is reviewed and illustrated from three cases in which the patients were freed from fits by temporal lobectomy. The pathological lesion (mesial temporal sclerosis) is discussed and the likelihood that many adult cases have gone unrecognized in childhood is emphasized.

scholarly journals Complete remission of epileptic psychosis after temporal lobectomy: case report

2001 ◽  
Vol 59 (3B) ◽  
pp. 802-805 ◽  
Author(s):  
Renato Luiz Marchetti ◽  
Alexandre Garcia Tavares ◽  
Gary Gronich ◽  
Lia Arno Fiore ◽  
Renata Barbosa Ferraz
Keyword(s):  
Refractory Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Wada Test ◽  
Comprehensive Investigation ◽  
Complex Partial Seizures ◽  
Therapeutic Measure ◽  
Intensive Monitoring ◽  
Video Eeg

We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.

scholarly journals Local distribution and toxicity of prolonged hippocampal infusion of muscimol

2005 ◽  
Vol 103 (6) ◽  
pp. 1035-1045 ◽  
Author(s):  
John D. Heiss ◽  
Stuart Walbridge ◽  
Paul Morrison ◽  
Robert R. Hampton ◽  
Susumu Sato ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Fluid Distribution ◽  
Electrode Placement ◽  
Distribution Data ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Mr Images ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Fine Print

Object. The activity of γ-aminobutyric acid (GABA), the principal inhibitory neurotransmitter, is reduced in the hippocampus in patients with complex partial seizures from mesial temporal sclerosis. To provide preliminary safety and distribution data on using convection-enhanced delivery of agents to treat complex partial seizures and to test the efficacy and safety of regional selective neuronal suppression, the authors infused muscimol, a GABA-A receptor agonist, directly into the hippocampus of nonhuman primates using an integrated catheter electrode. Methods. Ten rhesus monkeys were divided into three groups: 1) use of catheter electrode alone (four monkeys); 2) infusion of escalating concentrations of muscimol followed by vehicle (three monkeys); and 3) infusion of vehicle and subsequent muscimol mixed with muscimol tracer (three monkeys). Infusions were begun 5 days after catheter electrode placement and continued for 5.6 days before switching to the other agent. Head magnetic resonance (MR) images and electroencephalography recordings were obtained before and during the infusions. Brain histological studies and quantitative autoradiography were performed. Neurological function was normal in controls and when muscimol concentrations were 0.125 mM or less, whereas higher concentrations (0.5 and 1 mM) produced reversible apathy and somnolence. Fluid distribution was demonstrated on MR images and muscimol distribution was demonstrated on autoradiographs throughout the hippocampus and adjacent white matter. Conclusions. Targeted modulation of neuronal activity is a reasonable research strategy for the investigation and treatment of medically intractable epilepsy.

Influence of the type of initial precipitating injury and at what age it occurs on course and outcome in patients with temporal lobe seizures

1995 ◽  
Vol 82 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Gary W. Mathern ◽  
James K. Pretorius ◽  
Thomas L. Babb
Keyword(s):  
Mr Imaging ◽  
Temporal Lobe ◽  
Mossy Fiber ◽  
Molecular Layer ◽  
Temporal Lobectomy ◽  
Hippocampal Damage ◽  
Mesial Temporal Sclerosis ◽  
Mossy Fiber Sprouting ◽  
En Bloc ◽  
Content Type

✓ The type of initial precipitating injury and the age at which it occurred in 20 patients with nonlesional temporal lobe epilepsy (TLE) were related to clinical features, presurgical neuroimaging, quantified hippocampal pathologies, and seizure outcomes. Clinical data, neuroimaging records, and seizure outcomes were abstracted from medical records and confirmed with patient and family contacts. Hippocampal neuron losses and mossy fiber reactive synaptogenesis were quantified independently. Results showed that the type of initial precipitating injury and the patient's age at which it occurred were related to the clinicopathological features of TLE. An initial precipitating injury occurred in 18 patients (90%), all of whom had mesial temporal sclerosis (MTS). Patients with a prolonged initial seizure or a nonseizure initial precipitating injury before age 5 years were significantly more likely to have unilateral hippocampal atrophy (p < 0.05) shown on magnetic resonance (MR) imaging, and had significantly greater inner molecular layer mossy fiber puncta densities (p < 0.001) than patients with nonprolonged childhood initial precipitating injuries and/or seizures after age 5 years. Furthermore, nonseizure injuries in patients before age 5 years had significantly longer latent periods (p < 0.05), and the patients did not respond to surgical treatment as well as other MTS patients. Those with an initial precipitating injury after age 5 years had MTS but showed significantly less inner molecular layer mossy fiber sprouting (p < 0.05) than patients whose injuries appeared before age 5 years. Patients without an initial precipitating injury (idiopathic TLE) had significantly fewer neuron losses (p < 0.05) and inner molecular layer mossy fiber puncta densities (p < 0.05) and had worse outcomes following en bloc temporal lobectomy compared to patients with MTS who had experienced initial precipitating injuries. Patients with unilateral hippocampal abnormalities on MR imaging did not show significant differences in neuron losses or aberrant mossy fiber puncta densities compared to patients without asymmetry. These results support the hypothesis that the type of initial precipitating injury and the age at which the injury occurred initiates and influences the pathophysiological process that eventually develops into MTS. These data support the notion that the pathophysiology of hippocampal damage and mossy fiber sprouting after an initial precipitating injury may be a progressive process.

scholarly journals Congenital porencephaly and hippocampal sclerosis

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1382-1388 ◽  
Author(s):  
S. S. Ho ◽  
R. I. Kuzniecky ◽  
F. Gilliam ◽  
E. Faught ◽  
M. Bebin ◽  
...  
Keyword(s):  
Hippocampal Formation ◽  
Hippocampal Sclerosis ◽  
Vascular Occlusion ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Partial Seizures ◽  
Perinatal Complications ◽  
Complex Partial Seizures ◽  
Intractable Seizures ◽  
Temporal Localization

We studied clinical features and seizure localization in 14 patients with porencephaly and intractable seizures. Perinatal complications were present in nine patients, childhood febrile convulsions in two, congenital hemiparesis in 12, and intellectual impairment in seven. Ten patients had psychoparetic complex partial seizures (CPS), three had sensorimotor simple partial seizures, and one had generalized tonic-clonic seizures. Surface EEG showed temporal onset in nine patients (one bitemporal) and extratemporal onset in four. MRI showed porencephaly in the distribution of the middle cerebral artery in eight patients, posterior cerebral in three, internal carotid in one, and multiple vessels in two. MR-based volumetry revealed hippocampal formation atrophy in 13 patients (eight unilateral and five bilateral) and amygdalar atrophy in 10 patients (nine unilateral and one bilateral). Hippocampal formation atrophy was concordant with CPS semiology in 10 patients (71%) and with EEG temporal localization in nine patients. Two patients had pathologic confirmation of mesial temporal sclerosis and were seizure free after temporal lobectomy. We conclude that mesial temporal sclerosis often coexists with porencephaly and is the likely seizure focus in the presence of concordant electro-clinical data. This recognition implies that effective surgical intervention can be offered to certain patients with porencephaly-related seizure disorders. The dual pathology and association with perinatal cerebral vascular occlusion suggest a common ischemic pathogenesis.

Temporal lobectomy in children with epilepsy

1986 ◽  
Vol 64 (3) ◽  
pp. 371-376 ◽  
Author(s):  
Fredric B. Meyer ◽  
W. Richard Marsh ◽  
Edward R. Laws ◽  
Frank W. Sharbrough
Keyword(s):  
Intelligence Quotient ◽  
Age At Onset ◽  
Temporal Lobectomy ◽  
Social Outcome ◽  
Seizure Onset ◽  
Intelligence Scale ◽  
Content Type ◽  
Scale Scores ◽  
Before And After ◽  
Refractory Seizures

✓ The results of temporal lobectomy for medically refractory seizures are analyzed in 29 boys and 21 girls with a mean age of 15.8 years. The average age at onset of seizures was 7.5 years, and the time between onset and surgery averaged 8.3 years. Postoperatively, 27 patients (54%) were seizure-free, 12 patients (24%) had only occasional auras without loss of consciousness, five patients (10%) had fewer seizures, and six (12%) were unchanged. Therefore, 78% were essentially seizure-free and 88% benefited significantly from the operation. There was no significant change in the Wechsler Intelligence Scale scores before and after surgery; however, the shorter the time between seizure onset and surgery, the greater the likelihood of improvement in verbal and perceptual intelligence quotient. Social outcome was significantly improved, and a large percentage of patients were either in school or actively employed. Early consideration of temporal lobectomy in children with medically refractory seizures is recommended.

Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy

1998 ◽  
Vol 89 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Bhaskara Rao Malla ◽  
Terence J. O'Brien ◽  
Gregory D. Cascino ◽  
Elson L. So ◽  
Kurupath Radhakrishnan ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Content Type ◽  
Excellent Outcome ◽  
Prognostic Importance ◽  
Fine Print

Object. Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizures (APOS) occurring in the 1st postoperative week following anterior temporal lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance. Methods. One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a lower rate of favorable outcome with respect to seizure control at the last follow-up examination than patients without APOS (62.5% compared with 83.6%, p < 0.05). The type of APOS was of prognostic importance, with patients whose APOS were similar to their preoperative habitual seizures having a significantly worse outcome than those whose APOS were auras or were focal motor and/or generalized tonic—clonic seizures (excellent outcome: 14.3%, 77.8%, and 75%, respectively, p < 0.05). Only patients who had APOS similar to preoperative habitual seizures were less likely to have an excellent outcome than patients without APOS (14.3% compared with 75%, p < 0.05). Timing of the APOS and identification of a precipitating factor were of no prognostic importance. Conclusions. The findings of this study may be useful in counseling patients who suffer from APOS following ATL for temporal lobe epilepsy.

Fentanyl-induced electrocorticographic seizures in patients with complex partial epilepsy

1992 ◽  
Vol 77 (2) ◽  
pp. 201-208 ◽  
Author(s):  
René Tempelhoff ◽  
Paul A. Modica ◽  
Kerry L. Bernardo ◽  
Isaac Edwards
Keyword(s):  
Temporal Lobe ◽  
Seizure Activity ◽  
Epileptiform Activity ◽  
Temporal Lobectomy ◽  
Electrode Arrays ◽  
Complex Partial Seizures ◽  
Content Type ◽  
Temporal Lobe Seizures ◽  
Eeg Recordings ◽  
The Right

✓ Although electrical seizure activity in response to opioids such as fentanyl has been well described in animals, scalp electroencephalographic (EEG) recordings have failed to demonstrate epileptiform activity following narcotic administration in humans. The purpose of this study was to determine whether fentanyl is capable of evoking electrical seizure activity in patients with complex partial (temporal lobe) seizures. Nine patients were studied in whom recording electrode arrays had been placed in the bitemporal epidural space several days earlier to determine which temporal lobe gave rise to their seizures. The symptomatic temporal lobe was localized by correlating clinical and electrical seizure activity obtained during continuous simultaneous videotape and epidural EEG monitoring. In each patient, clinical seizures and electrical seizure activity were consistently demonstrated to arise unilaterally from one temporal lobe (four on the right, five on the left). During fentanyl induction of anesthesia in preparation for secondary craniotomy for anterior temporal lobectomy, eight of the nine patients exhibited electrical seizure activity at fentanyl doses ranging from 17.7 to 35.71 µg · kg−1 (mean 25.75 µg · kg−1). More importantly, four of these eight seizures occurred initially in the “healthy” temporal lobe contralateral to the surgically resected lobe from which the clinical seizures had been shown to arise. These findings indicate that, in patients with complex partial seizures, moderate doses of fentanyl can evoke electrical seizure activity. The results of this study could have important implications for neurosurgical centers where electrocorticography is used during surgery for the purpose of determining the extent of the resection.

Temporal lobectomy in children: cognitive outcome

2000 ◽  
Vol 92 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Michael Westerveld ◽  
Kimberlee J. Sass ◽  
Gordon J. Chelune ◽  
Bruce P. Hermann ◽  
William B. Barr ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Intellectual Functioning ◽  
Significant Loss ◽  
Significant Decline ◽  
Cognitive Outcome ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. The authors sought to determine the impact of early temporal lobectomy (in patients younger than age 17 years) on intellectual functioning. The efficacy of temporal lobectomy for treating seizures is well established and the procedure is becoming more acceptable as a treatment for children whose seizures are intractable. However, cognitive outcomes of temporal lobectomy in children and adolescents are largely unreported. The present study takes advantage of a unique multicenter collaboration to examine retrospectively intellectual functioning in a large sample of children who underwent temporal lobectomy.Methods. Intellectual functioning was assessed before and after temporal lobectomy for treatment of medication-resistant seizures in 82 patients at eight centers of epilepsy surgery. All children underwent standard presurgical examinations, including electroencephalography—video monitoring, magnetic resonance (MR) imaging, and neuropsychological testing, at their respective centers.Forty-three children underwent left temporal lobectomy and 39 underwent right temporal lobectomy. For the entire sample, there were no significant declines in intelligence quotient (IQ) following surgery. Children who underwent left temporal lobectomy demonstrated no significant loss in verbal intellectual functioning and improved significantly in nonverbal intellectual functioning. Children who underwent right temporal lobectomy did not demonstrate significant changes in intellectual functioning. Although group scores showed no change in overall IQ values, an analysis of individual changes revealed that approximately 10% of the sample experienced a significant decline and 9% experienced significant improvement in verbal functioning. Significant improvement in nonverbal cognitive function was observed in 16% of the sample and only 2% of the sample showed significant declines. Risk factors for significant decline included older patient age at the time of surgery and the presence of a structural lesion other than mesial temporal sclerosis on MR imaging.Conclusions. The present study provides preliminary data for establishing the risk of cognitive morbidity posed by temporal lobectomy performed during childhood. With respect to global intellectual functioning, a slight improvement was significantly more likely to occur than a decline. However, there were several patients in whom significant declines did occur. It will be necessary to study further the factors associated with such declines. In addition, further study of more specific cognitive functions, particularly memory, is needed.

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