Multiple hippocampal transections for intractable hippocampal epilepsy: Seizure outcome.

Autor: Koubeissi MZ; George Washington University, Washington, DC, United States., Kahriman E; University Hospitals Case Medical Center, Cleveland, OH, United States., Fastenau P; University Hospitals Case Medical Center, Cleveland, OH, United States., Bailey C; University Hospitals Case Medical Center, Cleveland, OH, United States., Syed T; University Hospitals Case Medical Center, Cleveland, OH, United States., Amina S; University Hospitals Case Medical Center, Cleveland, OH, United States., Miller J; University Hospitals Case Medical Center, Cleveland, OH, United States., Munyon C; University Hospitals Case Medical Center, Cleveland, OH, United States., Tanner A; Trinity Health System, Grand Rapids, MI, United States., Karanec K; Trinity Health System, Grand Rapids, MI, United States., Tuxhorn I; University Hospitals Case Medical Center, Cleveland, OH, United States., Lüders H; University Hospitals Case Medical Center, Cleveland, OH, United States.
Jazyk: angličtina
Zdroj: Epilepsy & behavior : E&B [Epilepsy Behav] 2016 May; Vol. 58, pp. 86-90. Date of Electronic Publication: 2016 Apr 08.
DOI: 10.1016/j.yebeh.2016.03.004
Abstrakt: Purpose: The purpose of this study was to evaluate the seizure outcomes after transverse multiple hippocampal transections (MHTs) in 13 patients with intractable TLE.
Methods: Thirteen patients with normal memory scores, including 8 with nonlesional hippocampi on MRI, had temporal lobe epilepsy (TLE) necessitating depth electrode implantation. After confirming hippocampal seizure onset, they underwent MHT. Intraoperative monitoring was done with 5-6 hippocampal electrodes spaced at approximately 1-cm intervals and spike counting for 5-8min before each cut. The number of transections ranged between 4 and 7. Neuropsychological assessment was completed preoperatively and postoperatively for all patients and will be reported separately.
Results: Duration of epilepsy ranged between 5 and 55years. There were no complications. Intraoperatively, MHT resulted in marked spike reduction (p=0.003, paired t-test). Ten patients (77%) are seizure-free (average follow-up was 33months, range 20-65months) without medication changes. One of the 3 patients with persistent seizures had an MRI revealing incomplete transections, another had an additional neocortical seizure focus (as suggested by pure aphasic seizures), and the third had only 2 seizures in 4years, one of which occurred during antiseizure medication withdrawal. Verbal and visual memory outcomes will be reported separately. Right and left hippocampal volumes were not different preoperatively (n=12, p=0.64, Wilcoxon signed-rank test), but the transected hippocampal volume decreased postoperatively (p=0.0173).
Conclusions: Multiple hippocampal transections provide an effective intervention and a safe alternative to temporal lobectomy in patients with hippocampal epilepsy.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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