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Efficacy of temporal lobe surgery for epilepsy in patients with negative MRI for mesial temporal lobe sclerosis |
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| Authors: | Fernando L. Vale Euclides EffioNicolas Arredondo Ali BozorgKondi Wong Carlos MartinezKatheryne Downes William O. TatumSelim R. Benbadis |
| Affiliation: | a Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, Florida 33606, USA b Department of Neurosurgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico c Department of Neurology, University of South Florida, Tampa, Florida, USA d Department of Pathology, University of South Florida, Tampa, Florida, USA e Department of Radiology, University of South Florida, Tampa, Florida, USA f Department of Biostatistics, University of South Florida, Tampa, Florida, USA g Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA |
| Abstract: | Epilepsy surgery is a successful treatment for refractory temporal lobe epilepsy (TLE). Reports suggest fewer seizure-free outcomes for patients with TLE and who have a negative brain MRI (nMRI) for mesial temporal sclerosis. Data were collected prospectively from patients with nMRI who underwent temporal lobe surgery for TLE characterized by unilateral ictal temporal lobe seizure onset based on a scalp video electroencephalogram or invasive subdural electrode recordings. A total of 86 patients were followed for at least 24 months after surgery. Outcome was evaluated using the Engel classification. Seizure control was obtained by 55% (47/86) of patients (Class [CL]-I), 27% (23/86) showed significant improvement (CL-II) and 19% (16/86) were deemed surgical failures. Shorter duration of epilepsy, later onset of seizures, and ictal theta rhythm (5-7 Hz) were the most significant predictors of postoperative seizure control. Although hypometabolism on positron emission tomography scan and significant memory disparity (>2.5/8) were not significant prognosticators independently, cumulatively they were predictors for favorable outcome. |
| Keywords: | Focal epilepsy Nonlesional focal epilepsy Normal brain MRI Temporal lobe epilepsy Temporal lobe surgery |
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