The study of relationship between intelligence impairment and interictal epileptiform discharges spreading in mesial temporal lobe epilepsy / 中国神经精神疾病杂志

Objective To investigate the relationship between intelligence impairment and interictal epileptiform discharges spreading in mesial temporal lobe epilepsy(mTLE)patients. Method We assessed 145 patients diagnosed as mTLE and their general materials, analyzed the relationship between intelligence impairment and interictal epileptiform discharges spreading. Results ①Patients with mTLE with longer disease course and higher frequencies of epilepsy tended to have a severe impairment in the total intelligence quotient (IQ), verbal intelligence quotient (vIQ) and performance intelligence quotient (pIQ). ② IQ of was negatively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral central and parietal region in patients with left lesion; pIQ was negatively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral frontal region, while positively correlated with the condition that interictal epileptiform discharges spreading to the ipsilateral occipital region in patients with right lesion. Conclusion ①Intelligence impairment of mTLE patients is related with courses and frequencies.②Total IQ is more severely impaired by interictal epileptiform discharges spreading to the ipsilateral central and parietal region in left mTLE patients, and the pIQ is more severely impaired by interictal epileptiform discharges spreading to the ipsilateral frontal region in right mTLE patients.

Anticonvulsant effect of ceftriaxone sodium in temporal lobe epilepsy / 基础医学与临床

Objective To study the effects of ceftriaxone sodium(Cef) on the seizures and the expression of glutamate transporter (GLT-1) in kainic acid (KA) epilepsy model.Methods Firstly, a chronic spontaneous seizure mouse model was established by unilateral hippocampal injection of KA and monitored by vEEG technique to record seizures.The experimental group received intraperitoneal injection of Cef 200 mg/(kg·d) and the control group received normal saline.Seizure frequency, interictal spike waves and histological phenotypes were recorded to evaluate the function of Cef.Then we use the Western blot to detect the effect of expression for GLT-1.Results Unilateral hippocampal injection of KA 200 ng successfully established the mesial temporal lobe epilepsy model.Cef can reduce the seizures from 2.145 times/day to 1.597 times/day, decreased by 31.2% with a statistical significance(P<0.05).Cef treatment did not significantly enhance the expression of GLT-1.Conclusions Intraperitoneal injection of Cef partially inhibites the seizures of KA model, but the expression of GLT-1 in hippocampus is not enhanced.It is suggested that ceftriaxone may inhibit seizures through other mechanisms.

Distribution of Astrocytic Syntrophin in Hippocampus from Human Mesial Temporal Lobe Epilepsy / 中国康复理论与实践

Objective To investigate the expression changes of astrocytic syntrophin in hippocampus from human mesial temporal lobe epilepsy (MTLE). Methods From April, 2015 to July, 2016, 17 cases of hippocampus, collected from temporal lobectomy, were divided into MTLE group (n=13) and non-MTLE group (n=4) according to hematoxylin and eosin staining, glial fibrillary acidic protein and neuronal nu-clei immunohistochemical staining. Immunofluorescence double labeling and immunofluorescence histochemistry were used to observe the expression of syntrophin. Results The proliferation of astrocytes increased and neurons reduced in the hippocampus of MTLE group. Syntro-phin was found in the membrane and foot processes of astrocyte, that was enriched along perivascular astrocyte end-feet domain in non-MTLE group, but lost in MTLE group. While the whole expression of syntrophin was more in MTLE group than in non-MTLE group (t=5.421, P<0.001). Conclusion The distribution of syntrophin in hippocampus astrocytes may be related to the development of MTLE.

Asymmetric Gray Matter Volume Changes Associated with Epilepsy Duration and Seizure Frequency in Temporal-Lobe-Epilepsy Patients with Favorable Surgical Outcome

BACKGROUND AND PURPOSE: This study aimed to estimate the changes in gray matter volume (GMV) and their hemispheric difference in patients with mesial temporal lobe epilepsy (MTLE) using a voxel-based morphometry (VBM) methodology, and to determine whether GMV changes are correlated with clinical features. METHODS: VBM analysis of brain MRI using statistical parametric mapping 8 (SPM8) was performed for 30 left MTLE (LMTLE) and 30 right MTLE (RMTLE) patients and 30 age- and sex-matched healthy controls. We also analyzed the correlations between GMV changes and clinical features of MTLE patients. RESULTS: In SPM8-based analyses, MTLE patients showed significant GMV reductions in the hippocampus ipsilateral to the epileptic focus, bilateral thalamus, and contralateral putamen in LMTLE patients. The GMV reductions were more extensive in the ipsilateral hippocampus, thalamus, caudate, putamen, uncus, insula, inferior temporal gyrus, middle occipital gyrus, cerebellum, and paracentral lobule in RMTLE patients. These patients also exhibited notable reductions of GMV in the contralateral hippocampus, thalamus, caudate, putamen, and inferior frontal gyrus. We observed that GMV reduction was positively correlated with several clinical features (epilepsy duration and seizure frequency in RMTLE, and history of febrile seizure in LMTLE) and negatively correlated with seizure onset age in both the RMTLE and LMTLE groups. CONCLUSIONS: Our study revealed GMV decreases in the hippocampus and extrahippocampal regions. Furthermore, the GMV reduction was more extensive in the RMTLE group than in the LMTLE group, since it included the contralateral hemisphere in the former. This difference in the GMV reduction patterns between LMTLE and RMTLE may be related to a longer epilepsy duration and higher seizure frequency in the latter.

Depression in patients with refractory temporal lobe epilepsy / Depressão em pacientes com epilepsia de lobo temporal refratária

OBJECTIVE: To evaluate the comorbidity of depressive disorders in patients with refractory temporal lobe epilepsy (TLE). METHOD: We evaluated 25 consecutive patients with refractory TLE (16 women and 9 men), using semi-structured psychiatric interviews, according to the International Classification of Diseases (ICD-10), and the Beck Depression Inventory. RESULTS: Seventeen of 25 patients (68 percent) had depressive disorder: 6 with dysthymia, three with major depressive episodes and 8 with recurrent depressive disorders. Two (8 percent) were diagnosed with mixed anxiety and depression. Only 5 of 17 patients (29.4 percent) were previously diagnosed with depressive disorder and received prior antidepressant treatment. Duration of epilepsy was significantly higher in patients with depressive disorder (p=0.016), but there was no relationship between depression and seizure frequency. CONCLUSION: This study confirmed that depressive disorders are common and underdiagnosed in patients with TLE refractory to AEDs. Patients with longer duration of epilepsy are at higher risk of having depression.

OBJETIVO: Avaliar os transtornos depressivos em comorbidade com a epilepsia do lobo temporal (ELT) em pacientes refratários às drogas antiepiléticas (DAE). MÉTODO: Avaliamos 25 pacientes consecutivos (16 mulheres e 9 homens) utilizando entrevista psiquiátrica semiestruturada, conferindo diagnóstico segundo a Classificação Internacional de Doenças (CID-10) e o Inventário de Depressão de Beck (BDI). RESULTADOS: Dezessete dos 25 pacientes (68 por cento) apresentaram transtorno depressivo: 6 com distimia, 3 com episódio depressivo maior e 8 com transtorno depressivo recorrente. Dois (8 por cento) apresentaram transtorno misto de ansiedade e depressão. Apenas 5 dos 17 pacientes (29,4 por cento) com transtorno depressivo receberam tratamento antidepressivo prévio. A duração da epilepsia foi significativamente maior nos pacientes com transtorno depressivo (p=0,016), porém não houve associação entre depressão e frequência de crises. CONCLUSÃO: Este trabalho confirma que o transtorno depressivo é frequente e subdiagnosticado em pacientes com ELT refratária às DAEs. Maior duração da epilepsia aumenta o risco de depressão.

Corpora amylacea deposition in the hippocampus of patients with mesial temporal lobe epilepsy: A new role for an old gene.

BACKGROUND: Mesial temporal lobe epilepsy (MTLE) is the most common medically refractory epilepsy syndrome in adults, and hippocampal sclerosis (HS) is the most frequently encountered lesion in patients with MTLE. Premature accumulation of corpora amylacea (CoA), which plays an important role in the sequestration of toxic cellular metabolites, is found in the hippocampus of 50–60% of the patients who undergo surgery for medically refractory MTLE-HS. However, the etiopathogenesis and clinical importance of this phenomenon are still uncertain. The ABCB1 gene product P-glycoprotein (P-gp) plays a prominent role as an antiapoptotic factor in addition to its efflux transporter function. ABCB1 polymorphism has been found to be associated with downregulation of P-gp expression. We hypothesized that a similar polymorphism will be found in patients with CoA deposition, as the polymorphism predisposes the hippocampal neuronal and glial cells to seizure-induced excitotoxic damage and CoA formation ensues as a buffer response. MATERIALS AND METHODS: We compared five single nucleotide polymorphisms in the ABCB1 gene Ex06+139C/T (rs1202168), Ex 12 C1236T (rs1128503), Ex 17-76T/A (rs1922242), Ex 21 G2677T/A (rs2032582), Ex26 C3435T (rs1045642) among 46 MTLE-HS patients of south Indian ancestry with and without CoA accumulation. RESULTS: We found that subjects carrying the Ex-76T/A polymorphism (TA genotype) had a five-times higher risk of developing CoA accumulation than subjects without this genotype (Odds ratio 5.0, 95% confidence intervals 1.34-18.55; P = 0.016). CONCLUSION: We speculate that rs1922242 polymorphism results in the downregulation of P-gp function, which predisposes the hippocampal cells to seizure-induced apoptosis, and CoA gets accumulated as a buffer response.

Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment? / Emprego e qualidade de vida na epilepsia do lobo temporal mesial com esclerose do hipocampo: há uma mudança após a cirurgia?

PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9 percent) it remained unchanged, in six (10.3 percent) it improved, and one patient (1.7 percent), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5 percent) were seizure-free, seven (31.8 percent) had only rare auras, and five (22.7 percent) had seizures. In the group of improvement, 12 patients (70.5 percent) had no-formal employment and five (29.5 percent) had a formal job before surgery. After three years, 14 (63.6 percent) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of ...

OBJETIVO: Avaliar o estado empregatício e a qualidade de vida (QV) de indivíduos com epilepsia do lobo temporal mesial (ELTM) com esclerose do hipocampo (EH) antes e três anos após a realização de corticoamigdalohipocampectomia e verificar as variáveis demográficas e clínicas associadas ao emprego. METODOLOGIA: 58 pacientes com ELTM com EH submetidos a corticoamigdalohipocampectomia foram avaliados antes e três anos após a cirurgia. Todos responderam ao Epilepsy Surgery Inventory (ES-I55) - versão brasileira como medida da QV, bem como a um breve questionário contendo dados sociodemográficos e clínicos. Alterações na situação de emprego após a cirurgia foram classificadas do seguinte modo: (i) melhora: indivíduos desempregados, com emprego não-formal, estudantes, donas-de-casa e aqueles que nunca haviam trabalhado e que estavam empregados três anos após a cirurgia; (ii) nenhuma mudança: aqueles que não obtiveram modificações em sua situação ocupacional. Esta categoria compreendeu indivíduos que permaneceram empregados, continuaram com atividades domésticas, estudantes, em auxílio doença, aposentados e os que nunca trabalharam; e (iii) piora: perda do emprego. RESULTADOS: A situação de emprego não mudou significativamente após a cirurgia: 51(87.9 por cento) permaneceram com o mesmo estado empregatício anterior à cirurgia, seis (10.3 por cento) tiveram melhora, e um paciente (1.7 por cento), que estava empregado antes da cirurgia, aposentou-se. No subgrupo dos 22 pacientes empregados após três anos, dez (45.5 por cento) estavam livres de crises, sete (31.8 por cento) tinham apenas auras esporádicas e cinco (22.7 por cento) permaneceram com crises. No grupo que obteve melhora, 12 pacientes (70.5 por cento) eram autônomos antes da cirurgia e cinco (29.5 por cento), tinham emprego formal. Na avaliação do terceiro ano após cirurgia, 14 (63.6 por cento) dos 22 indivíduos conseguiram um emprego formal. Nosso estudo verificou que a QV manteve ...

Comparação prospectiva entre o tratamento clinico e o tratamento cirurgico para epilepsia de lobo temporal mesial / Prospective analysis between surgical and clinical treatments for mesial temporal lobe epilepsytemporal

Objetivo: A cirurgia para pacientes com epilepsia de lobo temporal mesial refratária oferece um controle de crises para aproximadamente 70 por cento dos pacientes. Neste estudo comparamos a eficácia entre o tratamento clínico e cirúrgico e investigamos a relação entre as alterações estruturais (atrofia de substância branca, SB e cinzenta, SC) nas imagens de ressonância magnética (RM) pré-operatórias e o resultado cirúrgico; bem como evidências estruturais de neuroplasticidade nas imagens de RM pós-operatórias. Métodos: Realizamos uma curva de sobrevivência de Kaplan-Meier para comparar a eficácia entre os dois tipos de tratamento, para o grupo clínico (85 pacientes, 30 mulheres) e grupo cirúrgico (46 pacientes, 16 mulheres). Avaliamos as imagens de RM através da técnica de Morfometria Baseada em Voxel com o software SPM2 (Statistical Parametric Mapping)/MATLAB 7.0, comparando pacientes com indivíduos normais através de um Teste-T. Para essa análise dividimos os pacientes operados em grupos de acordo com o controle de crises obtido. Para investigar as alterações plásticas pós-operatórias realizamos um teste-T pareado entre as imagens pré e pós-operatórias. Resultados: A análise de sobrevivência confirmou a superioridade do tratamento cirúrgico (84 por cento de pacientes controlados) em longo razo em comparação ao tratamento medicamentoso (7 por cento de pacientes controlados), p< 0,001. Os pacientes com melhor resultado cirúrgico apresentavam um padrão restrito de atrofia de SC em comparação aos pacientes com crises após a cirurgia. Apenas os pacientes controlados tiveram evidências de recuperação de SB e SC após a cirurgia. Conclusão: A cirurgia oferece um melhor controle de crises que o tratamento medicamentoso e a chance de recuperar áreas com atrofia de SB e SC.

Objective: Surgery for refractory mesial temporal lobe epilepsy (MTLE) generally offers good seizure control for approximately 70 per cent of patients. In this study we compared the efficacy between surgical and clinical treatments and investigated the relationship between pre-operative structural abnormalities (white matter and grey matter atrophy) and surgical outcome. We also investigated the structural evidences of brain plasticity on post-operative MRI scans. Methods: We performed Kaplan-Meier survival analysis to compare the efficacy between surgical and medical groups. Clinical group included 85 patients (30 women) and the surgical group included 46 patients (16 women). We applied Voxel Based Morphometry technique on SPM2 (Statistical Parametric Mapping)/MATLAB 7.0 and compared patients with normal individuals with T-Test. For this analysis we separated patients according to post-operative surgical control. In order to investigate plastic changes after surgery we performed paired T-Test between pre and postoperative MR scans. Results: Survival analysis confirmed the superiority of surgical treatment for long-term seizure control (seizure control in 84 per cent of patients) compared to medical treatment (seizure control in 7 per cent of patients), p<0.001. Patients with better seizure control presented a restricted pattern of Grey matter atrophy, compared to patients with poorer seizure control which presented a widespread pattern of Grey matter atrophy. Our analysis showed that only patients with good seizure control presented structural evidences of white matter and grey matter recovery after surgery. Conclusion: Surgical treatment offers better chances of seizure control for refractory MTLE as well as the opportunity of relative white matter and grey matter recovery.

Postoperative Electroclinical Features in Epilepsy Patients With Seizures After Anteromesial Temporal Resection

BACKGROUND: Anteromesial temporal resection (AMTR) is well established as effective in patients with intractable mesial temporal epilepsy. However, little electroclinical information is available relevant to poor surgical outcome after AMTR. We examined the postoperative electroclinical features based on postoperative MRI and video-EEG monitoring (VEM) in patients with poor surgical outcome. METHODS: We reviewed clinical features and postoperative VEM results in 20 patients with failure in AMTR. According to the postoperative electroclinical features, we classified them into mesial temporal (MT), bitemporal (BT), extramesial temporal (XMT), combined (C), and unclassified groups. The postoperative VEM results were compared among the groups. Surgical outcome was assessed in five patients who underwent reoperation. RESULTS: Patients comprised 6 MT, 2 BT, 6 XMT, 1 C, and 6 unclassified. Aura and automatism were more frequent in MT (50.0%, 83.3%) than in XMT (16.7%, 33.3%). Theta to delta rhythm, during the ictal onset and build-up period, was more frequent in MT (83.3%, 66.7%) than in XMT (33.3%, 33.3%). The ictal onset and build-up pattern of ictal EEG were most frequently localized to the frontotemporal region in MT (66.7%, 100.0%), while there was no predominantly localized region in XMT. The surgical outcome after reoperation was better in MT group than in XMT and C groups. CONCLUSIONS: Postoperative MRI and VEM are useful to assess the postoperative electroclinical features in failed AMTR. Reoperation of the residual mesiotemporal structures after confirming epileptogenic foci may have good surgical outcome.

Epilepsia do lobo temporal mesial associada à esclerose hipocampal / Mesial temporal lobe epilepsy with hippocampal sclerosis

INTRODUÇÃO: A importância clínica da epilepsia do lobo temporal mesial (ELTM) decorre de sua alta prevalência e elevada proporção de pacientes com crises epilépticas refratárias ao tratamento medicamentos; sendo a esclerose mesial a etiologia encontrada em 50-70 por cento dos pacientes com ELTM refratária ao tratamento clínico. OBJETIVO: Revisão, atualização e discussão dos aspectos clínicos, de histologia e fisiopatogenia da ELTM associada à esclerose hipocampal. RESULTADOS: Apesar da relação entre esclerose hippocampal e ELTM já estar bem estabelecida na literatura, o mecanismo exato pelo qual a esclerose hipocampal participa da gênese das crises epilépticas ainda não foi completamente desvendado. CONCLUSÕES: Estudos retrospectivos de centros de cirurgia de epilepsia enfatizam a associação entre esclerose hipocampal e história de injúria precipitante inicial, tais como crises epilépticas, ocorrendo em fase precoce do desenvolvimento cerebral. Apenas recentemente fatores genéticos foram implicados na gênese da esclerose hipocampal.

Predicting Factors of Long-term Surgical Outcome for Mesial Temporal Lobe Epilepsy with Unilateral Hippocampal Atrophy on MRI / 대한간질학회지

PURPOSE: To identify the clinical and electroencephalographic factors which are independently predictive of a postoperative seizure-free outcome for 4 years. We compared the outcomes of the first 2 years with the subsequent 2 years one after anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal atrophy (HA) on MRI. METHODS: We studied 51 consecutive operated patients who had above 4 years of follow-up and had MTLE with definite unilateral HA on MRI. The surgical outcome was classified as either seizure-free or not seizure-free in the first postoperative 2 years and the subsequent 2 years. Several clinical variables were included. The scalp EEG parameters included the lateralization of interictal epileptiform discharges, ictal onset location, ictal onset frequency, ictal EEG lateralization, and ictal scalp EEG propagation (bitemporal asynchrony or switch of lateralization). Variable factors were subjected to univariate analysis. RESULTS: Overall, 36 patients (71%) became seizure-free during the postoperative 4 years. On univariate analysis, only one factor was significantly associated with poor outcome (p<0.05): ictal scalp EEG propagation pattern such as bitemporal asynchrony or switch of lateralization. The seizure-free outcome was seen in 88.9% of patients without bitemporal asynchroncy, or switch of lateralization while only 54.5% of patients with those patterns (p=0.007) during the postoperative third and fourth year. However, those propagation patterns did not show the prognostic value during the first 2 years (p=0.449). Other variable factors were found not to be predictive of prognosis on early or late recurrence. CONCLUSIONS: Bitemporal asynchrony or a switch of lateralization in the ictal scalp EEG might be a highly predictive factor for an undesirable surgical outcome, late recurrence of seizure during a follow-up period after ATL, and probably an index of bitemporal epileptogenicity in MTLE.

Effect of Seizure on Hippocampus in Mesial Temporal Lobe Epilepsy and Neocortical Epilepsy: MR Spectroscopy Study / 대한간질학회지

PURPOSE: This study was performed to evaluate the effect of seizures on the bilateral hippocampus in mesial temporal lobe epilepsy (mTLE) and neocortical epilepsy by single voxel proton magnetic spectroscopy. METHODS: Forty-one patients with mTLE having unilateral hippocampal sclerosis and 43 patients with a neocortical epilepsy who underwent subsequent epilepsy surgery were recruited. Ninety-five percent confidence intervals of N-acetyl aspartate/choline (NAA/Cho) and NAA/creatine (NAA/Cr) ratios in 20 healthy control subjects were used as threshold values to determine abnormal NAA/Cho and NAA/Cr. The relationship between the results of MRS and the duration of epilepsy, the frequency of seizure, the effect of secondary generalized tonic clonic seizures (2GTCS), and the postsurgical outcome was evaluated. RESULTS: NAA/Cho and NAA/Cr were significantly lower in the ipsilateral hippocampus of mTLE and neocortical epilepsy. NAA/Cho was abnormally low in the ipsilateral hippocampus in 43.9% (18/41) and bilateral hippocampus in 26.8% of mTLE patients. Ipsilateral or bilateral abnormal NAA/Cr was detected in 46.3% (19/41) of mTLE. NAA/Cho was abnormally lower in the ipsilateral hippocampus in 27.9% and bilateral hippocampus in 41.9% of neocortical epilepsy patients. Ipsilateral or bilateral abnormal NAA/Cr was detected in 32.6% of the patients with neocortical epilepsy. Using AIs for patients with bilaterally abnormal ratios of NAA/Cho and NAA/Cr combined with unilateral abnormal ratio, the seizure focus was correctly lateralized in 65.9% of the patients with mTLE and 48.8% of neocortical epilepsy patients. Bilateral NAA/Cho abnormality was significantly related with a poor surgical outcome in mTLE. No significant relationship was found between the results of NAA/Cho or NAA/Cr and the surgical outcome in neocortical epilepsy. The mean contralateral NAA/Cr ratio of the hippocampus in mTLE was significantly lower in patients with a history of the secondary generalized tonic clonic seizure (2GTCS) than in those without it. CONCLUSIONS: Our results demonstrate functional abnormality of the hippocampus in neocortical epilepsy and the relation between 2GTCS and NAA/Cr of the contralateral hippocampus in mTLE. This proves the presence of the seizure effect on the hippocampus in neocortical epilepsy as well as in mTLE.

Interhemispheric Reorganization of Memory Function Assessed by Wada Test in Patients with Mesial Temporal Lobe Epilepsy

BACKGROUND: We investigate an interhemispheric reorganization of memory functions using Wada test in patients with unilateral mesial temporal lobe epilepsy (MTLE). METHODS: We included 70 patients with unilateral MTLE and 37 with neocortical epilepsy (NE). The Wada memory stimuli were composed of 10 items. Scores for each injection were calculated with 1 and 0.5 points assigned for each correct free recall and recognition, respectively. A cut-off asymmetry score for lateralization of memory deficit was defined as 2 points. We statistically analyzed the proportion of memory asymmetry and the average memory score according to the type of epilepsy and the lateralization of seizure focus. RESULTS: The lateralizations of memory deficit determined by Wada memory asymmetry were evenly distributed in the left MTLE (n=34): left in 12 (36%), right in 11 (32%), and undetermined in 11 (32%). However, most (92%) of the right MTLE (n=36) were correctly lateralized to the side of seizure focus. More than 90% of patients with NE were lateralized to right hemisphere regardless of the seizure laterality. The average total (left plus right) memory score were not significantly different between each group. However, right memory score in left MTLE or left memory score in right MTLE were significantly higher than those in NE. The earlier age at seizure onset and the longer duration of epilepsy were observed in patients with left MTLE who had ipsilateral memory deficit comparing to those who had contralateral memory deficit. CONCLUSIONS: A pure interhemispheric reorganization of memory functions could occur in some patients with MTLE. It may be influenced by age at the onset of a seizure and the duration of epilepsy.

Interhemispheric Reorganization of Memory Function Assessed by Wada Test in Patients with Mesial Temporal Lobe Epilepsy

BACKGROUND: We investigate an interhemispheric reorganization of memory functions using Wada test in patients with unilateral mesial temporal lobe epilepsy (MTLE). METHODS: We included 70 patients with unilateral MTLE and 37 with neocortical epilepsy (NE). The Wada memory stimuli were composed of 10 items. Scores for each injection were calculated with 1 and 0.5 points assigned for each correct free recall and recognition, respectively. A cut-off asymmetry score for lateralization of memory deficit was defined as 2 points. We statistically analyzed the proportion of memory asymmetry and the average memory score according to the type of epilepsy and the lateralization of seizure focus. RESULTS: The lateralizations of memory deficit determined by Wada memory asymmetry were evenly distributed in the left MTLE (n=34): left in 12 (36%), right in 11 (32%), and undetermined in 11 (32%). However, most (92%) of the right MTLE (n=36) were correctly lateralized to the side of seizure focus. More than 90% of patients with NE were lateralized to right hemisphere regardless of the seizure laterality. The average total (left plus right) memory score were not significantly different between each group. However, right memory score in left MTLE or left memory score in right MTLE were significantly higher than those in NE. The earlier age at seizure onset and the longer duration of epilepsy were observed in patients with left MTLE who had ipsilateral memory deficit comparing to those who had contralateral memory deficit. CONCLUSIONS: A pure interhemispheric reorganization of memory functions could occur in some patients with MTLE. It may be influenced by age at the onset of a seizure and the duration of epilepsy.

Prognostic Factors in Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy: Multivariate Analysis

BACKGROUND: In order to identify the prognostic factors of anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (TLE), we performed multivariate analyses in patients with mesial TLE. METHODS: One hundred eighty six patients with mesial TLE (112 men and 74 women; mean age 28.9+/-8.7 years) were included. The primary outcome variable was a the patient's status in the third postoperative year: seizure free (except aura), or not. Clinical, electroencephalographic, radiological, intracarotid amobarbital test, and pathologic data were considered. Clinical data included age at surgery, age at nonfebrile seizure onset, duration of epilepsy, sex, seizure frequency, secondary generalization, history of febrile seizure, and existence of aura. RESULTS: One hundred fifty eight patients (84.9%) had remission of seizure. Univariate analysis found age at surgery (p=0.006) and MRI abnormality including hippocampal sclerosis ipsilateral to surgery (p=0.01) to be significant. Multivariate analyses using logistic regressions, the younger age at surgery (p=0.002) and MRI lateralization (p=0.02) were found to be the significant predictors for good surgical outcome. CONCLUSIONS: Age at surgery and hippocampal findings on MRI are independent prognostic factors for ATL in mesial TLE. These findings suggest that mesial TLE is a progressive disorder and surgical outcome is better when early ATL is performed, at least in medically intractable cases.

Regional Cerebral Blood Flow Patterns in Unilateral Mesial Temporal Lobe Epilepsy: Statistical Parametric Mapping of Ictal and Interictal SPECT / 대한간질학회지

PURPOSE: To investigate the regional cerebral blood flow of patients with mesial temporal lobe epilepsy (mTLE), we performed the statistical parametric mapping (SPM) analysis in patients with mTLE. METHODS: Nineteen normal subjects and 38 with mTLE (22 left, 16 right) underwent brain SPECT. For SPM analysis, all SPECT images were spatially normalized and then smoothed. The left and right mTLE groups were statistically compared with normal subjects, and the paired t-test was performed between ictal and interictal SPECTs. The positive and negative contrasts displayed the regions of hypo- or hyper-perfusion, respectively. The significance level was set to false discovery rate corrected p<0.05. RESULTS: In the interictal state, the ipsilateral hippocampus, both thalami, pericentral gyri, left insula, and both medial frontal lobes showed hypoperfusion, whereas both posterior lateral temporal areas showed hyperperfusion. In the ictal state, the rCBF of ipsilateral temporal lobe to the epileptic focus and both prefrontal white matters increased, while both medial frontal lobes showed hypoperfusion. In the right mTLE, the left hippocampus and insula showed hypoperfusion during the interictal state. In the paired t-test, ipsilateral temporal lobe, hippocampus, thalamus, putamen, insula, and both precentral gyri showed hyperperfusion. CONCLUSIONS: Surprisingly, the hypoperfusion and hyperperfusion patterns of patients with mTLE were similar both in the interictal and ictal states. These findings indicate that the occurrence and propagation of epileptic discharges happen not only in the ictal state but also during the interictal period. The hypoperfusion patterns suggest that the cortico-thalamo-hippocampal-insula circuit was impaired during the interictal state while temporal and prefrontal regions showed hypofunction during the ictal period.

Effect of Combination of Ictal Scalp EEG and Seizure Semiology on Seizure Lateralization in Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: To compare the reliability of lateralization between seizure semiology and ictal scalp EEG findings in mesial temporal lobe epilepsy (MTLE) patients, and to examine the advantage of the combined use of these two methods. METHODS: We independently reviewed the ictal scalp EEG recordings and clinical seizure semiology of 243 seizures recorded in 58 consecutive MTLE patients. All patients were seizure-free for at least 1 year postoperatively. Each seizure was lateralized on the basis of ictal semiology and ictal scalp EEG patterns according to strictly defined criteria, respectively. Individual patients were also lateralized based on these data. RESULTS: Seizure semiology analysis lateralized 64.6 % of seizures and 82.8 % of patients. Ictal scalp EEG analysis lateralized 74.5% of seizures and 74.1% of patients. Combination of the information from the two methods allowed for lateralization in a greater portion of both seizures (79.8%) and patients (89.7%). CONCLUSION: This study suggests that combination of ictal scalp EEG findings and seizure semiology improves the lateralization of individual seizures and patients. Therefore, it is worth lateralizing with standardized combined ictal EEG and semiology analysis for noninvasive presurgical evaluation in TLE patients.

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy: Lesion Laterality-Sex Interaction

BACKGROUND: Memory changes and its predictors after anterior temporal lobectomy (ATL) were investigated. A standardized regression-based (SRB) outcome methodology was used, accounting for the effects of practice and preoperative memory functions. METHODS: Consecutive 45 ATL patients (male 22) with mesial temporal sclerosis (dominant 21) who became seizure-free for at least 1 year postoperatively were included in the study. Wechsler Memory Scale-Revised(WMS-R) was performed pre- and postoperatively. Memory changes were estimated using SRB norms and then were correlated with age of onset, seizure duration, chronological age, seizure risk factors, and preoperative memory function. RESULTS: 1) The majority of cases (76~84%) showed no significant memory changes. Significant declines in verbal memory were noted for 8 (18%) out of 45 ATL patients whereas significant declines in visual memory were found in only 2 (4%). There were no differences in memory changes according to lesion laterality. 2) Later age at onset, shorter duration of epilepsy, absence of history of infection or febrile convulsion were significantly related to verbal memory decrease after ATL. 3) Using SRB methodology, adequacy of preoperative memory performance was correlated with decrease in visual memory but not in verbal memory, even if absolute change scores between pre-and postoperative values were associated with preoperative performances in both verbal and visual memory. CONCLUSIONS: Although group variability of memory outcome after ATL using WMS-R was not found to be significant, considerable individual variability of memory outcome after ATL was found along with significant predictors of postoperative verbal memory decrease. (J Korean Neurol Assoc 19(3):219~225, 2001)

Prognosis of Temporal Lobectomy for Temporal Lobe Epilepsy Patients with Mental Retardation

BACKGROUND: For decades, patients with epilepsy and mental retardation (MR) have been considered as a relative contraindication for focal resective epilepsy surgery. However, considerable debate exists concerning whether the presence of MR is a contraindication for epilepsy surgery or not. We examined the postsurgical seizure outcome of temporal lobe epilepsy (TLE) according to preoperative intelligence scores and the relationship between preoperative intelligence and postsurgical seizure outcomes of TLE. METHODS: We investigated 131 patients with TLE divided into two groups according to standard IQ ranges and seizure outcomes were compared by Engel's classification. RESULTS: The percentage of seizure free patients after surgery was 66.4% in all patients and the percentage in patients with and without MR were 60.7% and 68%, respectively. The age at seizure onset was significantly different between the MR group and non the MR group. However, other factors which have been thought to affect the intelligence of patients with TLE were not significantly different between the two groups. The best postoperative seizure outcome was shown in the borderline group, where the frequency of hippocampal sclerosis and age at seizure onset were significantly higher compared to the other groups. CONCLUSIONS: Although preoperative MR has been regarded as a predictor for a poor prognosis of surgical outcome, our results suggest that MR alone is not a contraindication for epilepsy surgery. Therefore, epilepsy patients with MR who meet other inclusion criteria for epilepsy surgery should not be rejected for epilepsy surgery.

Difference and Correlation between Seizure Numbers during the First Year and the Second Year of Antiepileptic Drug Treatnent in Temporal Lobe Epilepsy with Mesial Temporal Sclerosis / 대한간질학회지

PURPOSE: Determination of medical intractability is primarily essential for planning a surgical treatment of epolepsy. Questions regarding intractability include the optimum duration of adequate antiepileptic drug (AED) treatment and the tolerable seizure frequency. Unfortunately, thereis no established guideline for determination of medical intractability in terms of the duration or the tolerability of AED resistance. In temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), a Well-Known surgically remediable epileptic syndrome, the inverstigation of relationship between short-term and long-term AED response may help us finding a way to solve the above questions. METHODS: From 2 epilepsy centers, 86 patients with TLE demonstrating MTS on MRI were evaluated. All of them were on AED treatment for at least 2 years. We investigated seizure free rate for 1st 1 year, for next 1 year and that for two years. We compared seizure number of 1st 1 year with that of 2nd 1 year and analyzed corrdlation coefficiency between seizure numbers of the two periods. Paired-t-test and Pearson correlation test were performed for statistical analysis. RESULTS: Two year terminal remission rate was 3.5%. Remission rate for the 1st 1 year was 4.7% Whereas in the 2nd 1 year it rose to 16.3%. Mean seizure number of 1st one year was 34.9 and that of next one year was 27.0. Mean paired differences between seizure numbers of the two periods was 7.95(95% dcnfidence interval:1.82-14.09) Which was statistically significant(p=0.012). Pearson correlation coefficiendy was 0.815 between seizure numbers fo the two periods. CONCLUSION: In TLE with MTS, seizure free outcome was very poor. However, seizurw-free rate rose and seizure number declined as AED treatment duration was prolonged for 2 years. Weizure munber of 1st year may predict that of 2nd year. To establish an appropriate index time for considering medical intractability, further studies on longer-term outcone by AED treatment duration was porlonged for 2 years. Seizure munber of 1st year further studies on longer-term outcome by AED treatment should be recommended in addition to studies on adequate tolerability of AED resistance.