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Extratemporal lobectomy

René Andrade-Machado, Vanessa Benjumea-Cuartas
Background: Mesial temporal lobe epilepsy (TLE) is a remediable epileptic syndrome. About 40% of patients continue to have seizures after standard temporal lobectomy. It has been suggested that some of these patients could actually suffer from a more complex epileptogenic network. Because a few papers have been dedicated to this topic, we decided to write an article updating this theme. Methods: We performed a literature search using the following terminology: "temporal plus epilepsy and networks," "temporal plus epilepsy," "orbito-temporal epilepsy," "temporo-insular epilepsy," "temporo-parieto-occipital (TPO) epilepsy," "parieto-temporal epilepsy," "intracortical evoked potential and temporal plus epilepsy," "temporal lobe connectivity and epilepsy," "intracortical evoked potential and epilepsy surgery," "role of extratemporal structures in TLE," "surgical failure after temporal lobectomy," "Diffusion tensor imaging (DTI) and temporal epilepsy," and "positron emission tomography (PET) in temporal plus lobe epilepsy" in the existing PubMed databases...
July 6, 2016: Iranian Journal of Neurology
John D Rolston, Dario J Englot, Robert C Knowlton, Edward F Chang
Epilepsy surgery is under-utilized, but recent studies reach conflicting conclusions regarding whether epilepsy surgery rates are currently declining, increasing, or remaining steady. However, data in these prior studies are biased toward high-volume epilepsy centers, or originate from sources that do not disaggregate various procedure types. All major epilepsy surgery procedures were extracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File and the American College of Surgeons National Surgical Quality Improvement Program...
August 2016: Epilepsy Research
Kan Ding, Yunhua Gong, Pradeep N Modur, Ramon Diaz-Arrastia, Mark Agostini, Puneet Gupta, Roderick McColl, Ryan Hays, Paul Van Ness
The Wada test is widely used in the presurgical evaluation of potential temporal lobectomy patients to predict postoperative memory function. Expected asymmetry (EA), defined as Wada memory lateralized to the nonsurgical hemisphere, or a higher score after injection of the surgical hemisphere would be considered favorable in terms of postoperative memory outcome. However, in some cases, nonlateralized memory (NM) results, with no appreciable asymmetry, may occur because of impaired scores after both injections, often leading to denial of surgery...
February 2016: Epilepsy Research
Kitti Kaiboriboon, Ayham M Malkhachroum, Ahmad Zrik, Ahmad Daif, Nicholas M Schiltz, David M Labiner, Samden D Lhatoo
OBJECTIVE: To examine trends in epilepsy-related surgical procedures performed at major epilepsy centers in the US between 2003 and 2012, and in the service provision infrastructure of epilepsy centers over the same time period. METHODS: We analyzed data from the National Association of Epilepsy Centers' (NAEC) annual surveys. The total annual figures, annual average figures per center and annual rates of each surgical procedure based on US population numbers for that year were calculated...
October 2015: Epilepsy Research
Şefik Evren Erdener, F Irsel Tezer, Kader K Oğuz, Özden Kamışlı, Eser Lay Ergün, Figen Söylemezoğlu, Serap Saygi
Reflex seizures can be triggered by a variety of stimuli. We present a case with drug-resistant complex partial seizures originating in right temporal lobe triggered extensively by visual, auditory, and mental exposure to multidigit numbers. The patient was investigated in video-EEG monitoring unit and seizures were triggered by numerical stimuli. Scalp EEG findings suggested a right temporal focus but ictal semiological findings suspicious for an extratemporal area necessitated the invasive EEG study. A right anterior temporal seizure focus was established with invasive monitoring and cortical stimulation studies...
July 2016: Clinical EEG and Neuroscience: Official Journal of the EEG and Clinical Neuroscience Society (ENCS)
Leonardo Bonilha, Jens H Jensen, Nathaniel Baker, Jesse Breedlove, Travis Nesland, Jack J Lin, Daniel L Drane, Amit M Saindane, Jeffrey R Binder, Ruben I Kuzniecky
OBJECTIVE: We examined whether individual neuronal architecture obtained from the brain connectome can be used to estimate the surgical success of anterior temporal lobectomy (ATL) in patients with temporal lobe epilepsy (TLE). METHODS: We retrospectively studied 35 consecutive patients with TLE who underwent ATL. The structural brain connectome was reconstructed from all patients using presurgical diffusion MRI. Network links in patients were standardized as Z scores based on connectomes reconstructed from healthy controls...
May 5, 2015: Neurology
Barbara C Jobst, Gregory D Cascino
IMPORTANCE: Epilepsy surgery is indicated for patients with focal seizures who do not respond to appropriate antiepileptic drug therapy consisting of 2 or more medications. OBJECTIVES: To review resective surgery outcomes for focal epilepsy, to identify which patients benefit the most, and to discuss why epilepsy surgery may not be universally accepted. EVIDENCE REVIEW: Medline and Cochrane databases were searched between January 1993 and June 2014 for randomized clinical trials, meta-analyses, systematic reviews, and large retrospective case series (>300 patients) using Medical Subject Headings and indexed text terms...
January 20, 2015: JAMA: the Journal of the American Medical Association
Odeya Bennett-Back, Ayako Ochi, Elysa Widjaja, Shohei Nambu, Akio Kamiya, Cristina Go, Sylvester Chuang, James T Rutka, James Drake, O Carter Snead, Hiroshi Otsubo
OBJECT: Porencephalic cyst/encephalomalacia (PC/E) is a brain lesion caused by ischemic insult or hemorrhage. The authors evaluated magnetoencephalography (MEG) spike sources (MEGSS) to localize the epileptogenic zone in children with intractable epilepsy secondary to PC/E. METHODS: The authors retrospectively studied 13 children with intractable epilepsy secondary to PC/E (5 girls and 8 boys, age range 1.8-15 years), who underwent prolonged scalp video-electroencephalography (EEG), MRI, and MEG...
September 2014: Journal of Neurosurgery. Pediatrics
Jason Stretton, Meneka K Sidhu, Gavin P Winston, Philippa Bartlett, Andrew W McEvoy, Mark R Symms, Matthias J Koepp, Pamela J Thompson, John S Duncan
Working memory is a crucial cognitive function that is disrupted in temporal lobe epilepsy. It is unclear whether this impairment is a consequence of temporal lobe involvement in working memory processes or due to seizure spread to extratemporal eloquent cortex. Anterior temporal lobe resection controls seizures in 50-80% of patients with drug-resistant temporal lobe epilepsy and the effect of surgery on working memory are poorly understood both at a behavioural and neural level. We investigated the impact of temporal lobe resection on the efficiency and functional anatomy of working memory networks...
May 2014: Brain: a Journal of Neurology
Satoru Sakuma, William C Halliday, Ruka Nomura, Ayako Ochi, Hiroshi Otsubo
Pediatric focal epilepsies often involve more extratemporal regions than adult epilepsies. This study aims to investigate the population of oligodendroglia-like cells (OLCs) in the pediatric focal epilepsy patients requiring surgery. We hypothesize that OLCs are one of the factors that extend the pediatric epileptic network in intractable epilepsy. Thirty (18 female) patients (1.8-16.9 years old with a mean of 9.7 years), who underwent resective surgery for the intractable epilepsy from 2010 to 2012 were retrospectively studied...
April 30, 2014: Neuroscience Letters
Collin C Tebo, Alexander I Evins, Paul J Christos, Jennifer Kwon, Theodore H Schwartz
OBJECT: Surgical interventions for medically refractory epilepsy are effective in selected patients, but they are underutilized. There remains a lack of pooled data on complication rates and their changes over a period of multiple decades. The authors performed a systematic review and meta-analysis of reported complications from intracranial epilepsy surgery from 1980 to 2012. METHODS: A literature search was performed to find articles published between 1980 and 2012 that contained at least 2 patients...
June 2014: Journal of Neurosurgery
Gavin P Winston, Jason Stretton, Meneka K Sidhu, Mark R Symms, John S Duncan
Anterior temporal lobe resection (ATLR) is an effective treatment for refractory temporal lobe epilepsy (TLE). Widespread abnormalities in diffusion parameters involving the ipsilateral temporal lobe white matter and extending into extratemporal white matter have been shown in cross-sectional studies in TLE. However longitudinal changes following surgery have been less well addressed. We systematically assess diffusion changes in white matter in patients with TLE in comparison to controls before surgery and look at the longitudinal changes following ATLR at two timepoints (3-4 months, 12 months) using a whole brain approach...
2014: NeuroImage: Clinical
Wyatt L Ramey, Nikolay L Martirosyan, Corinne M Lieu, Hasnain A Hasham, G Michael Lemole, Martin E Weinand
Epilepsy is one of the most common neurologic disorders in the world. While anti-epileptic drugs (AEDs) are the mainstay of treatment in most cases, as many as one-third of patients will have a refractory form of disease indicating the need for a neurosurgical evaluation. Ever since the first half of the twentieth century, surgery has been a major treatment option for epilepsy, but the last 10-15 years in particular has seen several major advances. As shown in relatively recent studies, resection is more effective for medically intractable epilepsy (MIE) than AED treatment alone, which is why most clinicians now endorse a neurosurgical consultation after approximately two failed regimens of AEDs, ultimately leading to decreased healthcare costs and increased quality of life...
December 2013: Clinical Neurology and Neurosurgery
Leonardo Bonilha, Joseph A Helpern, Rup Sainju, Travis Nesland, Jonathan C Edwards, Steven S Glazier, Ali Tabesh
OBJECTIVES: The objective of this study was to evaluate whether patients with surgically refractory medial temporal lobe epilepsy (MTLE) exhibit a distinct pattern of structural network organization involving the temporal lobes and extratemporal regions. METHODS: We retrospectively studied 18 healthy controls and 20 patients with medication refractory unilateral MTLE who underwent anterior temporal lobectomy for treatment of seizures. Patients were classified as seizure-free or not seizure-free at least 1 year after surgery...
November 5, 2013: Neurology
Alexander G Weil, Werner Surbeck, Ralph Rahme, Alain Bouthillier, Adil Harroud, Dang Khoa Nguyen
Purpose. Somatosensory (SSA) and pharyngolaryngeal auras (PLA) may suggest an extratemporal onset (e.g., insula, second somatosensory area). We sought to determine the prognostic significance of SSA and PLA in temporal lobe epilepsy (TLE) patients undergoing epilepsy surgery. Methods. Retrospective review of all patients operated for refractory TLE at our institution between January 1980 and July 2007 comparing outcome between patients with SSA/PLA to those without. Results. 158 patients underwent surgery for pharmacoresistant TLE in our institution...
2013: ISRN Neurology
Dario J Englot, Jonathan D Breshears, Peter P Sun, Edward F Chang, Kurtis I Auguste
While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra-temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy...
August 2013: Journal of Neurosurgery. Pediatrics
Dirk van Roost
The presurgical evaluation in cases of extratemporal epilepsy is much less stereotypic than it is for mesial temporal lobe epilepsy. The finding of even a tiny structural lesion may be relevant but needs verification that it matches the seizure onset zone. Often invasive analysis is necessary to produce such evidence and to assess the relationship to adjacent eloquent cortex. Invasive analysis exposes the patient to an additional surgical procedure and to the morbidity associated with it. Therapeutic resections may comprise lesionectomy, topectomy, or lobectomy...
2012: Handbook of Clinical Neurology
Taíssa Ferrari-Marinho, Luís Otávio S F Caboclo, Murilo M Marinho, Ricardo S Centeno, Rafael S C Neves, Maria Teresa C G Santana, Fernanda S Brito, Henrique Carrete Junior, Elza Márcia T Yacubian
We examined the relationship between presence and frequency of different types of auras and side of lesion and post surgical outcomes in 205 patients with medically intractable mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal sclerosis (HS). With respect to the number of auras, multiple auras were not associated with side of lesion (p=0.551). The side of HS was not associated with the type of auras reported. One hundred fifty-seven patients were operated. The occurrence of multiple auras was not associated with post-surgical outcome (p=0...
May 2012: Epilepsy & Behavior: E&B
Fernando L Vale, Glen Pollock, Selim R Benbadis
OBJECT: The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis. METHODS: A systematic review of the literature was performed for the years 1999-2010 to assess the cause of failure and to identify potential reoperation candidates. RESULTS: Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures...
March 2012: Neurosurgical Focus
Mario F Dulay, Robyn M Busch
Resection of seizure foci is an effective treatment for the control of medically intractable epilepsy. However, cognitive morbidity can occur as a result of surgical intervention. This morbidity is dependent on several factors, including location and extent of resection, disease characteristics, patient demographic characteristics, and functional status of the tissue to be resected. In this review article, the authors provide a summary of the neurocognitive outcomes of epilepsy surgery with an emphasis on presurgical predictors of postsurgical cognitive decline...
March 2012: Neurosurgical Focus
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