Abstract
INTRODUCTION: with adecuate antiepilectic therapies; there are 40% patients with persisten crisis and 20% of them have any response to antiepilectic drugs. This patients have a refractary epilepsia almost produced by mesial sclerosis of temporal lobe. Surgery mough be a good alternative in these cases.
OBJECTIVE: to describe the experience of Instituto Neurológico de Antioquia epilepsy surgery group in the evaluation of patients with intractable temporal lobe epilepsy, using Wada’s test and surgical treatment.
MATERIALS AND METHODS: a descriptive, prospective, longitudinal study was carried out from october 2001 to june 2005 in patients suffering from temporal lobe epilepsy which was refractory to medical treatment. These patients were studied by clinical neurological evaluation, magnetic resonance, videoEEG, neuropsychological, psychiatric evaluation, and Wada’s test in order to evaluate cognitive functions, specially language and memory and also to quantify their functional reserve, to predict their cognoscitive risk, to be able to determine which patients were candidates to surgical treatment. For the post-surgical follow-up, Engel’s classification was used.
RESULTS: 85 patients suffering from intractable epilepsy were evaluated. 66 patients were operated on; from them 42 patients were suffering from mesial temporal lobe epilepsy. In the evaluation with the Wada’s test, it was demonstrated that in patients suffering from MTLE, the language was dominant in the side collateral to the lesion in 45% of the patients, and for the memory in all patients. The functional reserve for the memory was higher than 50% in most of the patients. The frequency of the crisis in the post-surgical period was reduced in the patients who were operated on for temporal lobe epilepsy 91.8% of patients were under Engel I classification.
CONCLUSIONS: a proper selection of the candidates for surgery by a defined protocol guarantees a good post surgical prognosis in relation to the control to the crisis. Wada’s test is fundamental in the prediction of the cognoscitive risk.
References
Luders H, Comair Y. Epilepsy surgery. Second edition. New York: Raven Press; 1991:95-101, 497-504 y 719-727.
Sagar H, Oxburry J. Hippocampal neuron loss in temporal lobe epilepsy. Ann Neurol 1987;29:175-182.
Burgerman RS, Sperling MR, French JA, Saykin AJ, O’Connor MJ. Comparison of mesial versus neocortical onset temporal lobe seizures: neurodiagnostic findings and surgical outcome. Epilepsia 1995; 36: 662-670.
Harvey AS, Grattan-Smith JD, Desmond PM, Chow CW, Berkovic SF. Febrile seizures and hippocampal sclerosis: frequent and related findings in intractable temporal lobe epilepsy of childhood. Pediatric Neurol 1995;12:201-206.
French JA, Williamson PD, Thadani VM, Darcey TM, Mattson RH, Spencer SS, et al. Characteristics of medial temporal lobe epilepsy: I. Results of history and physical examination. Ann Neurol 1993; 34: 774-780.
Foldvary N, Lee N, Thwaites G, Mascha E, Hammel J, Kim H, Friedman AH, et al. Clinical and electrographic manifestations of lesional temporal lobe epilepsy. Neurology 1997; 49: 757-763.
O’Brien TJ, Kilpatrick C, Murrie V, Vogrin S, Morris K, Cook MJ. Temporal lobe epilepsy caused by mesial temporal sclerosis and temporal neocortical lesions: a clinical and electroencephalographic study of 46 pathologhically proven cases. Brain 1996; 119: 2133-2141.
Wieser HEJ, Williamson PD, Babb TL, et al. Surgically remediable temporal lobe syndromes. In: Engel J Jr, ed. Surgical treatment of the epilepsies, 2nd ed. New York: Raven Press; 1993:49-63.
Glaser G. Natural history of temporal lobe-limbic epilepsy. In: Engel J Jr, ed. Surgical treatment of the epilepsies. New York: Raven Press; 1987:13-30.
Maestú F, Martin P, Gil-Nagel A, Franch O, Sola RG. Evaluación en la Cirugía de Epilepsia. Rev Neurol 2000;30: 477-482.
Montañés P. Evaluación Neuropsicológica y Prueba de Wada en Candidatos a “Cirugía de Epilepsia”. Neurociencias en Colombia. 1998; 6:41-49.
Orozco-Giménez C, Verdejo-García A, Sánchez- Álvarez JC, Altuzarra-Corral A, Pérez-García M. Neuropsicología Clínica en la Cirugía de Epilepsia del lóbulo Temporal. Rev Neurol 2002 Dic;35:1116-1135.
Westerveld M, Loring DW. Test del amital intracarotídeo para evaluar la cirugía de epilepsia. Rev Neurol 2002;34:865-870.
Spencer DC, Morrell MJ, Risinger MW. The Role of Intracarotid Amobarbital. Procedure in Evaluation of Patients for Epilepsy surgery. Epilepsia 2000;41:320-325.
Williamson PD, French JA, Thadani VM, Kim JH, Novelly RA, Spencer SS, et al. Characteristics of medial temporal lobe epilepsy: II. Interictal and ictalictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology. Ann Neurol 1993;34:781-787.
Araujo D, Najm I, Ruggieri P, et al. Lack of hippocampal asymmetry in mesial temporal lobe epilepsy: correlation with surgical outcome. Epilepsia 1997;38[suppl]:79.
Jack CR Jr, Rydberg CH, Krecke KN, Trenerry MR, Parisi JE, Rydberg JN, et al. Mesial temporal sclerosis: diagnosis with fluid-attenuated inversion-recovery versus spin-echo MR imaging. Radiology 1996;199:367-373.
Ng TC, Comair YG, Xue M, So N, Majors A, Kolem H, et al. Temporal lobe epilepsy: presurgical localization with proton chemical shift imaging. Radiology 1994;193:465-472.
Kaufman A. Psicometría Razonada con el WISC-R. México: Editorial Manual Moderno; 1982, 303 p.
Engel J Jr, Van Ness P, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. In: Engel J Jr, ed. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press, 1993:609-621.
Berkovic SF, McIntosh AM, Kalnins RM, Jackson GD, Fabinyi GC, Brazenor GA, et al. Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology 1995;45:1358-1363.
Hugg J, Kuzniecky R, Gilliam F, et al. Normalization of contralateral metabolic function following temporal lobectomy demonstrated by 1H magnetic resonance spectroscopy imaging. Ann Neurol 1996;49:236-239.
Najm IM, Wang Y, Hong SC, Luders HO, Ng TC, Comair YG. Temporal changes in proton MRS metabolites after kainic acid-induced seizure in rat brain. Epilepsia 1997;38:87-94.
Comair Y, Ng T, Xue M, et al. Posictal lactate detection for the localization of seizure foci: a proton chemical shift imaging study of temporal lobe epilepsy. Epilepsia 1998;39.
Aoki Ch, Siekevitz P. Plasticity in Brain Development. Sci Am 1988 Dec; 34-42.
Sass KJ, Spencer DD, Kim JH, Westerveld M, Novelly RA, Lencz T. Verbal memory impairment correlates with hippocampal pyramidal cell density. Neurology 1990;40:1694-1697.
Miller L, Munoz D, Finmore M. Hippocampal sclerosis and human memory. Arch Neurol 1993;50:391-394.
Regis J, Bartolomei F, Rey M, Genton P, Dravet C, Semah F, et al. Gamma knife surgery for mesial temporal lobe epilepsy. Epilepsia 1999;40:1551-1556.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.