Temporal lobe epilepsy

Analysis of patients with dual pathology

Research output: Contribution to journalArticle

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Abstract

Objectives - To determine the frequency and types of dual pathology in patients with temporal lobe epilepsy (TLE) and to analyze the clinical manifestations and surgical outcome. Material and methods - A total of 240 patients with TLE underwent temporal resections following a comprehensive pre-surgical evaluation. Thirty-seven (15.4%) of these had hippocampal sclerosis (HS) or temporal lobe gliosis in association with another lesion (dual pathology). Results - Eighteen of 37 patients with dual pathology had heterotopia of the temporal lobe, nine had cortical dysplasia, four had cavernous angiomas or arteriovenous malformations, one had a dysembryoplastic neuroepithelial tumor, one had a contusion and four patients had cerebral infarctions in childhood. 68.5% had abnormal head magnetic resonance imagings, 91.3% had abnormal positron emission tomography scans, and 96% had abnormal ictal SPECT. The intracarotid amobarbital procedure (IAP) showed impaired memory of the epileptogenic side in 72% of the patients. Twenty patients had left and 17 had right-sided en bloc temporal resections, including the lesion and mesial temporal structures. Twenty-six (70.2%) became seizure-free, eight (21.6%) had rare seizures, two (5.4%) had worthwhile seizure reduction and one (2.7%) had no improvement (range of follow-up 1-16 years, mean = 7.4 years). Conclusions - 15.4% had dual pathology. The dual pathology was almost exclusively seen in patients whose lesions were congenital, or occurred early in life, suggesting that the hippocampus is more vulnerable and more readily develops HS in early childhood. Resections, including the lateral and mesial temporal structures led to a favorable outcome with no mortality and little morbidity.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalActa Neurologica Scandinavica
Volume109
Issue number2
DOIs
StatePublished - Feb 2004

Fingerprint

Temporal Lobe Epilepsy
Pathology
Seizures
Sclerosis
Temporal Lobe
Neuroepithelial Neoplasms
Amobarbital
Malformations of Cortical Development
Cavernous Hemangioma
Gliosis
Contusions
Arteriovenous Malformations
Cerebral Infarction
Single-Photon Emission-Computed Tomography
Positron-Emission Tomography
Hippocampus
Stroke
Head
Magnetic Resonance Imaging
Morbidity

Keywords

  • Dual pathology
  • Outcome
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Temporal lobe epilepsy : Analysis of patients with dual pathology. / Salanova, Vicenta; Markand, Omkar; Worth, R.

In: Acta Neurologica Scandinavica, Vol. 109, No. 2, 02.2004, p. 126-131.

Research output: Contribution to journalArticle

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abstract = "Objectives - To determine the frequency and types of dual pathology in patients with temporal lobe epilepsy (TLE) and to analyze the clinical manifestations and surgical outcome. Material and methods - A total of 240 patients with TLE underwent temporal resections following a comprehensive pre-surgical evaluation. Thirty-seven (15.4{\%}) of these had hippocampal sclerosis (HS) or temporal lobe gliosis in association with another lesion (dual pathology). Results - Eighteen of 37 patients with dual pathology had heterotopia of the temporal lobe, nine had cortical dysplasia, four had cavernous angiomas or arteriovenous malformations, one had a dysembryoplastic neuroepithelial tumor, one had a contusion and four patients had cerebral infarctions in childhood. 68.5{\%} had abnormal head magnetic resonance imagings, 91.3{\%} had abnormal positron emission tomography scans, and 96{\%} had abnormal ictal SPECT. The intracarotid amobarbital procedure (IAP) showed impaired memory of the epileptogenic side in 72{\%} of the patients. Twenty patients had left and 17 had right-sided en bloc temporal resections, including the lesion and mesial temporal structures. Twenty-six (70.2{\%}) became seizure-free, eight (21.6{\%}) had rare seizures, two (5.4{\%}) had worthwhile seizure reduction and one (2.7{\%}) had no improvement (range of follow-up 1-16 years, mean = 7.4 years). Conclusions - 15.4{\%} had dual pathology. The dual pathology was almost exclusively seen in patients whose lesions were congenital, or occurred early in life, suggesting that the hippocampus is more vulnerable and more readily develops HS in early childhood. Resections, including the lateral and mesial temporal structures led to a favorable outcome with no mortality and little morbidity.",
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