Brain, Vol. 123, No. 12, 2445-2466,
December 2000
© 2000 Oxford University Press
Failed surgery for epilepsy
A study of persistence and recurrence of seizures following temporal resection
1 Departments of Clinical Neurophysiology and 2 Neurosurgery, Kings College Hospital, London, UK
Correspondence to:
Robert D. C. Elwes, Department of Clinical Neurophysiology, Kings College Hospital, Mapother House, de Crespigny Park, London SE5 9RS, UK
From a series of 282 consecutive temporal resections for medically intractable epilepsy associated with mesial temporal sclerosis (MTS), dysembryoplastic neuroepithelial tumour (DNT) or non-specific pathology (NSP), 51 patients had persistent or recurrent seizures occurring at least monthly. Of these patients, 44 underwent detailed assessment of their postoperative seizures, which included clinical evaluation, interictal and ictal EEG and high-resolution MRI. Of the 20 patients with MTS in the original pathology, 14 (70%) had postoperative seizures arising in the hemisphere of the resection, the majority (12 patients) in the temporal region. Although MRI demonstrated residual hippocampus in five of these 12 patients, only one patient was considered to have seizures arising there, whilst the remainder had electroclinical evidence of seizure onset in the neocortex. In contrast, five of the MTS relapses (25%) had seizure onset exclusively in the contralateral temporal region. Among the 14 patients with non-specific pathology, relapse was also predominantly from the ipsilateral hemisphere (64%), but more relapsed from extratemporal sites compared with the MTS cases, including two with NSP who had occipital structural abnormalities. Although 70% of the 10 patients with DNT had postoperative partial seizures arising in the ipsilateral hemisphere, many (60%) had evidence of a more diffuse disorder with additional generalized seizures, cognitive and behavioural disturbance and multifocal and generalized EEG abnormalities. Nine patients (20%) had immediate postoperative seizure-free periods of at least 1 year, and seven of these had MTS in the operative specimen. Of these seven patients, four had ipsilateral temporal seizures and three had contralateral temporal seizures. Overall, few missed lesions were discovered on postoperative MRI and reoperations were performed or considered possible in a minority of cases. Despite well-defined preoperative electroclinical syndromes of temporal lobe epilepsy, many patients relapsed unexpectedly, either immediately or remotely from the time of surgery. Maturing epileptogenicity in a surgical scar was not, however, considered to be a significant primary mechanism in patients who relapsed after a seizure-free interval.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R E Hogan, R P Carne, C J Kilpatrick, M J Cook, A Patel, L King, and T J O'Brien Hippocampal deformation mapping in MRI negative PET positive temporal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, June 1, 2008; 79(6): 636 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. S. Hoffer, S. L. Allen, and M. Mathews Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection Am J Psychiatry, June 1, 2007; 164(6): 877 - 882. [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Vinton, R. Carne, R. J. Hicks, P. M. Desmond, C. Kilpatrick, A. H. Kaye, and T. J. O'Brien The extent of resection of FDG-PET hypometabolism relates to outcome of temporal lobectomy Brain, February 1, 2007; 130(2): 548 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Guye, J. Regis, M. Tamura, F. Wendling, A. M. Gonigal, P. Chauvel, and F. Bartolomei The role of corticothalamic coupling in human temporal lobe epilepsy Brain, July 1, 2006; 129(7): 1917 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Janszky, I. Janszky, R. Schulz, M. Hoppe, F. Behne, H. W. Pannek, and A. Ebner Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome Brain, February 1, 2005; 128(2): 395 - 404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Siegel, G. D. Cascino, F. B. Meyer, R. L. McClelland, E. L. So, W. R. Marsh, B. W. Scheithauer, and F. W. Sharbrough Resective reoperation for failed epilepsy surgery: Seizure outcome in 64 patients Neurology, December 28, 2004; 63(12): 2298 - 2302. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Nolan, R. Sakuta, N. Chuang, H. Otsubo, J. T. Rutka, O. C. Snead III, C. E. Hawkins, and S. K. Weiss Dysembryoplastic neuroepithelial tumors in childhood: Long-term outcome and prognostic features Neurology, June 22, 2004; 62(12): 2270 - 2276. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Chassoux, F. Semah, V. Bouilleret, E. Landre, B. Devaux, B. Turak, F. Nataf, and F.-X. Roux Metabolic changes and electro-clinical patterns in mesio-temporal lobe epilepsy: a correlative study Brain, January 1, 2004; 127(1): 164 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Christodoulou, M. Koutroumanidis, M.J. Hennessy, R.D.C. Elwes, C.E. Polkey, and B.K. Toone Postictal psychosis after temporal lobectomy Neurology, November 12, 2002; 59(9): 1432 - 1435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S F Berkovic Surgical treatment of temporal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, November 1, 2002; 73(5): 470 - 470. [Full Text]
|
|