Surgical treatment of temporal lobe epilepsy
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TLDR
According to cost analysis, epilepsy surgery is considered to be cost effective, however, in the long run, indirect cost benefits (employment, independent living) add even more to the cost effectiveness of this method.Abstract:
Introduction. The surgical treatment of epilepsy is a therapeutic procedure aimed at removal of the brain tissue responsible for seizures. Neurological examinations are performed to delineate the epileptic zone, which is then removed, without causing a functional deficit. In order to fulfill these goals, it is essential to localize accurately and lateralize the epileptogenic zone and the surrounding eloquent cortex. Material and Methods. Ninety-four adult patients were included in the study of the Epilepsy Center, National Institute of Psychiatry and Neurology, Budapest. All patients underwent a standard anterior temporal lobectomy between 1989 and 2001, whereas their preoperative evaluation consisted of detailed history of epilepsy, interictal EEC (awake and asleep), video EEG monitoring of seizures, magnetic resonance imaging, all according to the epilepsy protocol and neuropsychological investigations. The mean follow up was 6.1 years (range: 2-17 years). Seizure outcome was assessed annually, using Engel's classification. Seventy-two percents of patients were seizure-free 1 year after surgery. Results The percentage of seizure-free patients two, five and ten years after the surgery was 67%, 59%, and 61%, respectively. Discussion and Conclusion According to cost analysis, epilepsy surgery is considered to be cost effective. However, in the long run, indirect cost benefits (employment, independent living) add even more to the cost effectiveness of this method. Although the economic aspect is of great importance, especially in countries with limited financial resources, it is often neglected both by neurologists and health authorities. .read more
Citations
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Hippocampal sclerosis--origins and imaging.
Kristina Malmgren,Maria Thom +1 more
TL;DR: HS on preoperative MRI strongly predicts good seizure outcome following temporal lobe resection (TLR), and if adequate MRI shows no structural correlate in patients with MTLE, functional imaging studies are valuable, especially if they are in agreement with ictal electroencephalography (EEG) findings.
Journal ArticleDOI
Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort
Athanasios Grivas,Johannes Schramm,Thomas Kral,Marec von Lehe,Christoph Helmstaedter,Christian E. Elger,Hans Clusmann +6 more
TL;DR: Surgical treatment of refractory temporal lobe epilepsy (TLE) is promising for selected patients, but only little experience has been acquired in operating on older patients, especially with limited resections.
Journal ArticleDOI
Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy
Roman Liscak,Hana Malikova,Miroslav Kalina,Zdenek Vojtech,Tomas Prochazka,Petr Marusic,Vilibald Vladyka +6 more
TL;DR: Stereotactic amygdalohippocampectomy is a minimally invasive procedure with low morbidity and good results that can be the method of choice in selected patients with MTLE.
Journal ArticleDOI
Influence of age and location of ictal onset on postoperative outcome in patients with localization-related epilepsy
Sanjay E. Patra,Kost Elisevich,Kenneth Podell,Lonni Schultz,Shailaja Gaddam,Brien J. Smith,Marianna Spanaki-Varelas +6 more
TL;DR: It is demonstrated that epilepsy surgery in the older population has similar seizure-free outcomes and complications when compared with younger patients for both mesial temporal and extratemporal origins.
Journal ArticleDOI
Dysmorphic neurons in patients with temporal lobe epilepsy
Alexandre Valotta da Silva,Jean-Christophe Houzel,Elza Márcia Targas Yacubian,Henrique Carrete,Américo Ceiki Sakamoto,Américo Ceiki Sakamoto,Margareth Rose Priel,Heloise Helena Martins,Ivanilson Oliveira,Eliana Garzon,João Norberto Stávale,Ricardo Silva Centeno,Hélio Rubens Machado,Esper Abrão Cavalheiro +13 more
TL;DR: It is interesting to note that a higher proportion of patients with dysmorphic neurons continued to present auras after surgery, when compared with patients without those cells.
References
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Journal ArticleDOI
A randomized, controlled trial of surgery for temporal-lobe epilepsy.
TL;DR: In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy, and Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects.
Journal ArticleDOI
Seizure outcome after temporal lobectomy: current research practice and findings.
TL;DR: The literature regarding seizure outcome and prognostic factors for outcome after temporal lobectomy is often contradictory, which is problematic, as these data are the basis on which surgical decisions and counseling are founded.
Journal ArticleDOI
The Prognosis for Control of Seizures with Medications in Patients with MRI Evidence for Mesial Temporal Sclerosis
TL;DR: The overall clinical prognosis of patients with MTS is studied and the factors related to the degree of medical responsiveness are analyzed, which shows its presence in magnetic resonance imaging scans is strongly correlated with a successful surgical outcome.
Journal ArticleDOI
Is Ictal Recording Mandatory in Temporal Lobe Epilepsy? Not When the Interictal Electroencephalogram and Hippocampal Atrophy Coincide
TL;DR: A strong concordance between EEG and MRIVol lateralization in patients with TLE is found and previous studies in addition to the present series support that a concordant outpatient EEG evaluation in patientswith TLE and unilateral hippocampal atrophy would obviate the need for inpatient EEG monitoring.
Journal ArticleDOI
Ictal Scalp EEG in Unilateral Mesial Temporal Lobe Epilepsy
Ekaterina Pataraia,Stefanie Lurger,Wolfgang Serles,Gerald Lindinger,S Aull,Fritz Leutmezer,Johanna Bacher,A. Olbrich,Thomas Czech,Klaus Novak,Lüder Deecke,Christoph Baumgartner +11 more
TL;DR: In this article, the authors determined the predictive significance of unilateral hippocampal atrophy and interictal spikes on localization of ictal scalp EEG changes and assess whether ictAL EEG provides information that might change treatment or influence prognosis in patients with such characteristics of epilepsy.