Long-term epilepsy surgery outcomes in patients with MRI-negative temporal lobe epilepsy
| Autor: | Marja Äikiä, Ritva Vanninen, Arto Immonen, Matti Vapalahti, Reetta Kälviäinen, Aki Ikonen, Leena Jutila, Esko Vanninen, Salla Lamusuo, Anu Muraja-Murro, Esa Mervaala, Irina Alafuzoff, Jyrki T. Kuikka |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Magnetic resonance imaging Electroencephalography medicine.disease Surgery Temporal lobe Central nervous system disease Epilepsy Neurology Positron emission tomography medicine Epilepsy surgery Neurology (clinical) business Anterior temporal lobectomy |
| Zdroj: | Epilepsia. 51:2260-2269 |
| ISSN: | 0013-9580 |
| Popis: | Summary Purpose: The outcome of surgery in patients with temporal lobe epilepsy (TLE) and normal high-resolution magnetic resonance imaging (MRI) has been significantly worse than in patients with unilateral hippocampal damage upon MRI. The purpose of this study was to determine the long-term outcomes of consecutive true MRI-negative TLE patients who all underwent standardized preoperative evaluation with intracranial electroencephalography (EEG) electrodes. Methods: In this study we present all adult MRI-negative TLE surgery candidates evaluated between January 1990 and December 2006 at Kuopio Epilepsy Center in Kuopio University Hospital, which provides a national center for epilepsy surgery in Finland. During this period altogether 146 TLE surgery candidates were evaluated with intracranial electrodes, of whom 64 patients with normal high-resolution MRI were included in this study. Results: Among the 38 patients who finally underwent surgery, at the latest follow-up (mean 5.8 years), 15 (40%) were free of disabling seizures (Engel class I) and 6 (16%) were seizure-free (Engel class IA). Twenty-one (55%) of 38 patients had poor outcomes (Engel class III–IV). Outcomes did not change compared to 12-month follow-up. Histopathologic examination failed to reveal any focal pathology in 68% of our MR-negative cases. Only patients with noncongruent positron emission tomography (PET) results had worse outcomes (p = 0.044). Discussion: Our results suggest that epilepsy surgery outcomes in MRI-negative TLE patients are comparable with extratemporal epilepsy surgery in general. Seizure outcomes in the long-term also remain stable. Modern imaging techniques could further improve the postsurgical seizure-free rate. However, these patients usually require chronic intracranial EEG evaluation to define epileptogenic areas. |
| Databáze: | OpenAIRE |
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