Clinical characteristics, surgical and neuropsychological outcomes in drug resistant tumoral temporal lobe epilepsy
| Autor: | Urvashi Shah, Vivek Iyer, Pranjali Pradhan, Yogesh Godge, Dattatraya Muzumdar, Sangeeta Ravat, Neeraj Jain |
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| Rok vydání: | 2015 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Adolescent medicine.medical_treatment Drug Resistance Hippocampus Electroencephalography Temporal lobe 03 medical and health sciences Epilepsy 0302 clinical medicine Quality of life Monitoring Intraoperative Medicine Humans Child Anterior temporal lobectomy medicine.diagnostic_test business.industry Neuropsychology General Medicine Drug Resistant Epilepsy medicine.disease Surgery 030104 developmental biology Epilepsy Temporal Lobe Quality of Life Female business 030217 neurology & neurosurgery |
| Zdroj: | International journal of surgery (London, England). 36 |
| ISSN: | 1743-9159 |
| Popis: | Glioneuronal tumors are found in nearly one third patients who undergo surgery for pharmacoresistant epilepsy with temporal lobe being the most common location. Few studies, however have concentrated on the neurological and neuropsychological outcomes after surgery, hitherto none from India.We studied 34 patients with temporal lobe tumors and drug resistant epilepsy. These patients underwent anterior temporal lobectomy or lesionectomy based on the involvement of the hippocampus and mesial temporal structures. The clinical history, EEG, neuropsychology profile and MRI were compared. Seizure outcome was categorized using Engel's classification.At a mean follow up of 62 months, 85.29% of the patients were seizure free (Engel's Class I). All 8 patients with intraoperative electrocorticography (ECoG) guided resection were seizure free.Presence of a residual lesion was significantly associated with persistence of seizures post surgery (p = 0.002). Group analysis revealed no significant shifts in IQ and memory scores postoperatively. There was a significant improvement in the quality of life scores (total and across all subdomains) in all patients (p 0.001). Postoperative EEG abnormalities predicted unfavorable seizure outcome.Surgery for temporal lobe tumors and refractory epilepsy offers complete seizure freedom in majority. Complete surgical excision of the epileptogenic zone is of paramount importance in achieving seizure freedom. Intraoperative electrocorticography (EcoG) is a useful adjunct to ensure complete removal of epileptogenic zone, thus achieving optimal seizure freedom. There is a significant improvement in the quality of life scores (p 0.001) with no negative impact of surgery on memory and intelligence. Even the patients who are not seizure free can achieve worthwhile improvement post surgery. |
| Databáze: | OpenAIRE |
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